Daily Health Policy Report

Tuesday, May 6, 2014

Last updated: Tue, May 6

KHN Original Reporting & Guest Opinion

Health Reform

Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Health Law Requires Medicare To Cover Dementia Evaluation

Kaiser Health News consumer columnist Michelle Andrews writes: “For the millions of seniors who worry that losing their keys may mean they’re losing their minds, the health law now requires Medicare to cover a screening for cognitive impairment during an annual wellness visit. But in a recent review of the scientific research, an influential group said there wasn’t enough evidence to recommend dementia screening for asymptomatic people over age 65. What’s a worried senior to think?” (Andrews, 5/6). Read the column.

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Capsules: More Insurance Equals Fewer Deaths In Massachusetts; Colorado Redraws Map To Cut Sky-High Ski Town Rates; Hospitals’ Purchase Of Doctors Leads To Higher Prices, Spending, Study Finds; Study: Illegal Immigration Doesn’t Cause Overuse Of Health Care

Now on Kaiser Health News’ blog, WBUR’s Martha Bebinger reports on how coverage rates have impacted Massachusetts’ death rate: “Fewer people died in Massachusetts after the state required people to have health insurance, according to researchers from the Harvard School of Public Health. In each of the first four years of the state law, 320 fewer Massachusetts men and women died than would have been expected. That’s one life extended for every 830 newly insured residents” (Bebinger, 5/6). 

In addition, Eric Whitney reports on Colorado’s attempt to redraw the insurance rate map: “Relief is in sight – and it won’t involve a lawsuit – for the four counties in Colorado that have the highest Obamacare health insurance premiums in the country. Local officials in the ski resort region in the mountains west of Denver had threatened to sue over the high rates. But on Friday Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw those boundaries, making the resort counties part of a much larger 22-county pool” (Whitney, 5/5). 

Phil Galewitz writes about a new study showing that hospitals purchase of doctors’ practices leads to higher prices: “The study, published Monday in the journal Health Affairs, was based on an analysis of 2.1 million hospital claims from workers of self-insured employers between 2001 and 2007. The analysis by Stanford University researchers found prices were most likely to increase when hospitals bought physician practices, as opposed to hospitals forming looser contractual relationships with physicians” (Galewitz, 5/5). 

Also on Capsules, Marissa Evans reports on the relationship between illegal immigration and the overuse of care: “Even before the Affordable Care Act was close to passing, it was clear that immigrants illegally living in the country would not be part of many of the law’s benefits. They are not allowed to buy health insurance from the online marketplaces, at least in part because opponents argued that these immigrants overburden emergency rooms and hospitals. But a study released Monday finds that they’re less likely to use health services than U.S. citizens and other immigrants here legally” (Evans, 5/5). Check out what else is on the blog.

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Political Cartoon: 'This Just In?'

Kaiser Health News provides a fresh take on health policy developments with "This Just In?" by Gary Varvel. 

Here's today's health policy haiku: 


Eight million signups...
Are fewer now uninsured
Gallup poll says yes.

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Uninsured Rate Drops To Lowest Since 2008

The percentage of American adults without health insurance dropped to 13.4 percent in April -- the lowest level since polling organization Gallup began tracking the rate in 2008. Gallup attributed the decline to "the surge in late health insurance signups to meet the official March 31 deadline" under the health law.

The Wall Street Journal’s Washington Wire: Poll Shows Portion Of Uninsured Drops To 13.4% In April
The percentage of American adults without health insurance dropped to 13.4% in April, polling organization Gallup reported Monday, signaling that the federal health law improved coverage rates during the initial enrollment period. Gallup said 15% of Americans were uninsured in March, and attributed the decline to “the surge in late health insurance sign-ups to meet the official March 31 deadline” (Radnofsky, 5/5).

The Washington Post’s Wonkblog: The Uninsured Rate Keeps Falling And Falling, Survey Says
The nation’s uninsured rate after Obamacare's first enrollment has dropped to the lowest point in at least six years, according to a new Gallup poll. The 13.4 percent uninsured rate among adults – the lowest since Gallup starting tracking the number in January 2008 – is down from 17.1 percent near the end of 2013 and 15.6 percent at the end of this year’s first quarter. The uninsured rate fell 2.2 percent between April and the first quarter of 2014, suggesting that Obamacare's late enrollment surge was driven by people who previously lacked coverage (Millman, 5/5).

NBC News: US Uninsured Rate Falls to Lowest Point Since 2008
The rate of people going without health insurance has fallen to 13.4 percent, according to the latest Gallup poll. It’s the lowest rate since 2008. The report credits the 2010 Affordable Care Act. The Obama administration says more than 8 million Americans have signed up for health insurance for 2014 on the new online exchanges, which offer a batch of new private insurance plans, heavily subsidized for most people. “The uninsured rate peaked at 18 percent in the third quarter of 2013, but has consistently declined since then,” Gallup said in a statement (Fox, 5/5).

CBS News: Uninsured Rate At Its Lowest Point In Years, Poll Shows
Since the new Obamacare marketplaces opened for business in January, the percentage of adults without health insurance has fallen 3.7 percent, according to a new Gallup survey. If accurate, that amounts to more than 8.9 million adults gaining health coverage this year. The latest data comes from interviews with more than 14,700 Americans conducted between April 1-30, as part of the Gallup-Healthways Well-Being Index. The survey has a one-point margin of error (Condon, 5/5).

Reuters:  Poll: Fewer In U.S. Lack Health Insurance But Issues Remain
The percentage of adults in the United States who lack health insurance has fallen to its lowest rate since 2008, down to about 13 percent in April from a peak of 18 percent last year, according to a Gallup poll released on Monday. The decline coincided with the October 2013 launch of the health insurance exchanges that allowed people to buy coverage on their own under the Affordable Care Act and accelerated as the deadline to buy coverage neared, the nonpartisan research organization said (Heavey, 5/5).

The Hill: Uninsured Rate Drops To Lowest Since 2008
The uninsured rate in the United States has dropped to the lowest level recorded by Gallup since January 2008, coinciding with the launch of ObamaCare. A Gallup poll released Monday found the number of U.S. adults without health insurance dropped to 13.4 percent in April, down from 15 percent in March. After the uninsured rate peaked at 18 percent in the third quarter of 2013, the rate has dropped more than 4 percentage points (Shabad, 5/5).

The Fiscal Times: Uninsured Rate Lowest Ever Recorded By Gallup
The president’s health care law continues to slice the uninsured rate—which is now at its lowest level ever recorded by Gallup, the polling firm said Monday. The percentage of adults without health insurance dropped to 13.4 percent from 14.7 percent in mid-March, and 16 percent in January, thanks to the combination of Obamacare’s new insurance exchanges, Medicaid expansion, and the falling unemployment rate. The uninsured rate peaked at 18 percent last year then steadily climbed down each month after more people began to enroll in insurance policies sold on the exchanges (Ehley, 5/5).

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Massachusetts Starts Over With Insurance Exchange

The state also will prepare, as a back-up plan in case the new system is not ready in time for this fall's open enrollment period, to join the federal insurance marketplace.

The New York Times: Massachusetts Starts Over On Health Website After Troubles
Massachusetts will stop trying to fix its deeply flawed health insurance website and instead buy new software to help its residents enroll in coverage, officials there said Monday. But the state will also prepare to join the federal insurance marketplace by the next enrollment period, which starts in November, in case the new system is not working in time (Goodnough, 5/5).

Politico: Massachusetts Ditches RomneyCare Health Exchange
RomneyCare’s pioneering health insurance exchange is headed for the scrap heap. Bay State officials are taking steps this week to junk central parts of their dysfunctional health insurance exchange — the model for President Barack Obama’s health care law — and merge with the federal enrollment site HealthCare.gov (Cheney, 5/6).

CBS News: More Bad News For State-Run Obamacare Marketplaces
Less than two weeks after Oregon announced it is giving up on its failed Obamacare marketplace and switching to the federally-run marketplace, Massachusetts officials are saying they may follow suit. The state is scrapping its own Obamacare website because it would be too costly to fix, the Boston Globe reports, and will instead use "off-the-shelf" software called hCentive to enroll people in the new marketplace. Should that back-up plan fail, the state will join the federally-run marketplace facilitated by HealthCare.gov (Condon, 5/5).

Fox News: Massachusetts Overhauls Its ObamaCare Site With New Software
Massachusetts announced a “dual-track” plan Monday to fix its problem-plagued ObamaCare website, buying new software for the state-run site while preparing to move enrollment to the federal site. State officials will buy an off-the-shelf application used on the state-run Colorado and Kentucky sites, instead of trying to fix months of problems. They also are preparing to send customers temporarily to the federal site, HealthCare.gov, if their site is not ready when ObamaCare enrollment resumes in the fall (5/5).

The Boston Globe: Mass. Scrapping Flawed Health Insurance Website
Massachusetts plans to scrap the state’s dysfunctional online health insurance website, after deciding it would be too expensive and time-consuming to fix, and replace it with a system used by several other states to enroll residents in plans. Simultaneously, the state is preparing to temporarily join the federal HealthCare.gov insurance marketplace in case the replacement system is not ready by the fall. The strategy announced Monday will still cost an estimated $100 million, and it creates many uncertainties, especially for insurance companies and consumers. Some customers might eventually need to change insurance plans (Kowalczyk and Levenson, 5/5).

The Associated Press:  State Announces Strategy To Overhaul Health Site
Massachusetts officials unveiled a strategy on Monday for overhauling the hobbled health insurance website that has dramatically slowed the state's transition from a first-in-the-nation universal health care program to the requirements of the federal Affordable Care Act. The state planned a "dual-track" approach that calls for purchasing software powering health exchanges in other states while at the same time laying the groundwork for a temporary switchover to the federal government's health care exchange, should that become necessary (Salsberg, 5/5).

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Colorado Exchange Officials Debate Financial Plan

Connect for Health Colorado officials are scrambling to come up with a financial plan that does not raise fees. Meanwhile, a top executive with the company that Maryland hired to build its dysfunctional exchange is fired, and a new chairman takes over the Washington state board that oversees that state's exchange. 

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 Baltimore Sun:  Health Exchange Contractor’s Top Executive Terminated
A top executive with the company Maryland hired to build its health exchange website — and later dumped — has been terminated on the heels of heavy financial losses. Paul von Ebers, president and CEO at Noridian Mutual Insurance Co., was let go after a unanimous board vote Monday. Noridian Healthcare Solutions is an affiliate of the North Dakota company and was responsible for more than $50 million of the company's $80 million in losses last year, said Andrea Dinneen, a company spokeswoman (Cohn, 5/5).

The Associated Press:  North Dakota Blue Cross Fires Top Exec For Md. Exchange Losses
The company that does business as Blue Cross Blue Shield of North Dakota fired president and chief executive officer Paul von Ebers on Monday, days after the state's dominant insurer reported nearly $80 million in financial losses in 2013. The bulk of the company's financial woes stem from a subsidiary — Noridian Healthcare Solutions — that lost $51 million developing a health exchange in Maryland, as part of President Barack Obama's new federal health care law, Blues spokeswoman Andrea Dinneen said (5/5).

The Seattle Times:  Ron Sims To Lead Board Overseeing State’s Health Insurance Exchange
Ron Sims is taking the helm of Washington’s Health Benefit Exchange Board, which oversees the state’s health insurance exchange. Sims was appointed chair of the board by Gov. Jay Inslee, according to an announcement made today by the exchange. The exchange, called the Washington Healthplanfinder, was created under the Affordable Care Act and is the marketplace where Washington residents can enroll in Medicaid and purchase insurance coverage, including insurance plans subsidized by the government (Stiffler, 5/5).

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Va. Democrats Want GOP Counterparts To Offer Medicaid Expansion Alternatives

The state's Democratic legislators called on GOP lawmakers to present an alternative proposal -- one that was promised, they say, months ago to close the so-called coverage gap. Meanwhile, a Kansas study quantifies the impact that not expanding Medicaid might have on the health of state residents.

The Richmond Times-Dispatch: Senate Democrats Urge GOP To Offer Health Proposal
Virginia Senate Democrats on Monday called on House Republicans to produce the alternative health care proposal they promised months ago to close the coverage gap. "In a January Op-Ed, you argued that it would be a mistake to expand Medicaid -- but you also said that 'Virginia should look at alternative ways to help those in the Obamacare coverage gap,'" writes Sen. A. Donald McEachin, D-Henrico, the Democratic Caucus chairman, in a letter to House Speaker William J. Howell, R-Stafford. "It is now May. Four months have passed, and I feel compelled to ask: What are the alternatives you’ve offered?" (Nolan, 5/6).

Kansas Health Institute News Service: Expanding Medicaid Would Prevent Cancer Deaths In Kansas
The decision by state officials not to expand Medicaid eligibility could deny thousands of uninsured Kansans access to life-saving cancer treatments, according to a recent report by researchers at the University of Kansas Medical Center. “There are some people who will die of cancer because we’re not able to screen them or provide them with the prevention services they need,” said Dr. Edward Ellerbeck, director of the Cancer Control and Population Health Program at the medical center. The report, issued in March, estimates that without Medicaid expansion about 40,000 uninsured Kansans may not get necessary screenings for colorectal, breast and cervical cancers or get the medical help they need to quit smoking (McLean, 4/5).

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Who Will Pay The Tab For Uncompensated Care Under The Health Law?

News outlets take a look at Health Affairs studies that examine issues related to uncompensated care in the health law's changing environment as well as whether illegal immigration leads to health care overuse.

The Washington Post’s Wonkblog: Health Care’s $85 Billion Challenge -- Uncompensated Care In The Obamacare Age
A Monday morning survey showed a steady decrease in the uninsured rate since Obamacare's insurance marketplaces opened, but tens of millions will remain uninsured. And a separate study Monday showed just how much it could cost to care for them. Health-care providers faced $74.9 billion to $84.9 billion in care costs for the uninsured and people who struggled to pay their medical bills, according to new estimates published in the journal Health Affairs. Using the lower of the two estimates, Urban Institute researchers calculated that hospitals provided $44.6 billion of the uncompensated care, publicly supported community providers delivered $19.8 billion, and office-based physicians provided about $10.8 billion (Millman, 5/5).

In other news about cost and utilization --

Kaiser Health News: Capsules: Study: Illegal Immigration Doesn’t Cause Overuse Of Health Care
Even before the Affordable Care Act was close to passing, it was clear that immigrants illegally living in the country would not be part of many of the law’s benefits. They are not allowed to buy health insurance from the online marketplaces, at least in part because opponents argued that these immigrants overburden emergency rooms and hospitals. But a study released Monday finds that they’re less likely to use health services than U.S. citizens and other immigrants here legally (Evans, 5/5).

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More Court Hearings For Health Law Legal Challenges

This week, the Pacific Legal Foundation will make oral arguments in the U.S. Court of Appeals for the District of Columbia. Its challenge claims the health law imposes new taxes unconstitutionally. Meanwhile, a Connecticut couple has filed a lawsuit against the state's online insurance marketplace over "moral principles" because they can't buy a health plan on the exchange that excludes abortion coverage.

The Associated Press:  Group Challenges Health Law As Unconstitutional
The Sacramento-based Pacific Legal Foundation this week will take another step in its challenge to President Barack Obama's health care law, claiming it imposes new taxes unconstitutionally. The foundation, which advocates for limited government, is scheduled to make oral arguments Thursday in the U.S. Court of Appeals for the District of Columbia. A district court ruled last year against the foundation, which filed the case on behalf of Iraq war veteran and Washington state small business owner Matt Sissel (Lin, 5/5).

The CT Mirror: Couple Sues Over Abortion Coverage In Access Health CT Plans
Thanks to subsidies under the Affordable Care Act, Barth and Abbie Bracy of Dayville can buy a comprehensive health insurance policy through Access Health CT for only $2.63 a month. But they are suing the exchange, and federal officials, over what they say are moral principles. Barth Bracy is executive director of Rhode Island State Right to Life and a deacon at his Catholic church. He and his wife strongly oppose abortion. With the help of a conservative, pro-life group, the couple is suing Access Health CT, outgoing Secretary of Health and Human Services Kathleen Sebelius and other federal officials because they say Connecticut’s health exchange does not offer any policies that exclude abortion coverage (Radelat, 5/5).

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Health Law Plays Central Role In Key Senate Races

News outlets examine how the overhaul is being used in campaign ads in North Carolina, where a primary election is being held today, as well as in Iowa. Meanwhile, in Tennessee, the political spin has raised some eyebrows.

Los Angeles Times: It’s Tea Party Vs. GOP Establishment In North Carolina Primary
[Sen. Kay] Hagan's camp took the unusual step of recently running a radio ad apparently intended to help Brannon, whom experts say would be easier for her to beat in the general election. The ad tears into [Thom] Tillis' support for certain aspects of Obamacare, portraying him as soft on a signature GOP issue. Hagan, who supported Obamacare, defended the ad, accusing Tillis of waffling on the health care law. Tillis has promised to repeal Obamacare (Mascaro, 5/5).

The Washington Post: Vulnerable Democratic Sen. Hagan Runs Anti-Obamacare Attack Ads Against GOP Contender
The fliers landed in the mailboxes of Republican voters here last week with a warning likely to unnerve many conservatives. Thom Tillis, the Republican front-runner for a U.S. Senate seat, once called President Obama’s health-care law “a great idea,” the mailer said. The assertion echoed recent radio ads that also seem to question Tillis’s adherence to the orthodoxy of a party that has made its opposition to the Affordable Care Act a centerpiece of its midterm-election strategy. But the warnings didn’t come from any of the seven opponents Tillis will face in Tuesday’s GOP primary, where he has been regularly attacked as not conservative enough. Instead, they were paid for by Sen. Kay Hagan, a Democrat who will face the eventual GOP nominee in November (Helderman, 5/5).

Modern Healthcare:  N.C. Primary Preview:  Eight Republicans, One Anti-Obama Message
When Republican voters head to the North Carolina polls Tuesday, they will have eight candidates to choose from in the contest to take on Democratic Sen. Kay Hagan. But when it comes to their positions on health care, the GOP challengers offer little diversity: They all favor repealing Obamacare (Demko, 5/5).

The Washington Post’s Post Politics: GOP Senate Hopeful Ernst Fires Gun In Ad Vowing To ‘Unload’ On Obamacare
Republican U.S. Senate candidate Joni Ernst of Iowa has released a new TV ad vowing to "unload" on Obamacare, in which she takes target practice at a shooting range with a handgun. The narrator of the ad says Ernst, a state senator and lieutenant colonel in the Iowa Army National Guard, "carries more than just lipstick in her purse." The commercial portrays her riding a motorcycle to a shooting range where she takes target practice (Sullivan, 5/5).

The Associated Press: Health Care Law-Holocaust Comparison Criticized
A state Senator’s blog post likening the insurance requirement under President Barack Obama’s health care law to the forced deportation of Jews during the Holocaust drew swift condemnation Monday from leaders of both parties in Tennessee. Republican Sen. Stacey Campfield of Knoxville wrote the comment in a post titled “Thought of the Day” (5/5).

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Coverage & Access

Massachusetts' Deaths Fall After Coverage Expansion

Fewer people died in Massachusetts after the state required virtually all residents to have health insurance, according to researchers at the Harvard School of Public Health. The study found the steepest decline in counties with the highest proportions of poor and previously uninsured people.

Los Angeles Times: Massachusetts Study Suggests Health Insurance Saves Lives
Giving more people health insurance could save tens of thousands of lives nationwide, according to a new analysis of data from Massachusetts, whose reforms became the model for President Obama's health law (Levey, 5/5).

Kaiser Health News: Capsules: More Insurance Equals Fewer Deaths In Massachusetts
Fewer people died in Massachusetts after the state required people to have health insurance, according to researchers from the Harvard School of Public Health. In each of the first four years of the state law, 320 fewer Massachusetts men and women died than would have been expected. That’s one life extended for every 830 newly insured residents (Bebinger, 5/6).

The New York Times: Mortality Drop Seen To Follow ’06 Health Law
The study tallied deaths in Massachusetts from 2001 to 2010 and found that the mortality rate — the number of deaths per 100,000 people — fell by about 3 percent in the four years after the law went into effect. The decline was steepest in counties with the highest proportions of poor and previously uninsured people. In contrast, the mortality rate in a control group of counties similar to Massachusetts in other states was largely unchanged (Tavernise, 5/5).

The Boston Globe: Study Calls Wide Mass. Coverage A Lifesaver
The groundbreaking Massachusetts health insurance law may have prevented about 320 deaths a year, according to a Harvard study of the legislation that was used as a model for President Obama’s national health program. The researchers from the Harvard School of Public Health, in a study published Monday, estimated that the law, which expanded coverage to most residents, has saved about one life for every 830 people who enrolled in health insurance. “This is a strong and credible finding,” said Austin Frakt, a health economist at Boston University School of Medicine who wrote an editorial that accompanied the study. “I think there’s enough evidence at this point to conclude that health insurance does improve health and mortality” (Kotz, 5/5).

Reuters:  Deaths Fell After Mass. Healthcare Overhaul
When Massachusetts blazed the trail of healthcare reform in 2006 by expanding coverage for the poor and requiring all residents to have health insurance, it may have done more than serve as a model for nationwide reform: it also seemed to save lives, according to a study released on Monday. The findings, reported in the Annals of Internal Medicine, are the first to provide a detailed analysis of the effects of systematically expanding healthcare coverage. Increasing access to Medicaid, the government-run insurance program for the poor, and mandating that everyone have health insurance were the two centerpieces of Massachusetts' healthcare reform (Seaman, 5/5).

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Health Care Marketplace

Insurer WellCare Doubles Profit Amid Higher Membership

In the meantime, Tenet Healthcare loses less after it acquires Vanguard Health Systems, Pfizer looks again to woo AstraZeneca into a purchase and Bayer AG moves to buy Merck's consumer business.

The Wall Street Journal: WellCare Earnings Surge On Revenue, Membership Growth
WellCare Health Plans Inc. said first-quarter profit more than doubled as the health insurer posted stronger revenue and increased membership rolls. The company raised its adjusted earnings forecast for the year, now expecting $4.40 to $4.75 a share, from its prior view of $3.75 to $4.05 a share. The increased guidance came mainly from factoring in the company's better-than-expected first quarter results, as well as an improved outlook for the Medicaid Health Plans segment (Rubin, 5/6).

The Wall Street Journal: Tenet Healthcare Loss Narrows, Buoyed By Admissions Trend
Tenet Healthcare Corp. said its first-quarter loss narrowed on stronger revenue that was boosted by its Vanguard Health Systems acquisition. "Aided by our extensive preparations to serve the newly insured patient populations under the Affordable Care Act, we achieved a broadly-based improvement in our admissions trend in the first quarter," said Trevor Fetter, president and chief executive officer. "The strengthening volume trend was particularly pronounced in the states that expanded their Medicaid programs" (Stynes, 5/5).

The New York Times: Profits Off, Pfizer Again Aims To Lure AstraZeneca
As the drug maker Pfizer announced a 15 percent drop in first-quarter earnings on Monday, its chief executive renewed his call for its British rival AstraZeneca to accept Pfizer’s offer to buy it. Pfizer has aggressively pursued AstraZeneca since January — raising its offer to more than $106 billion as recently as Friday — but so far AstraZeneca has rejected its advances, saying the bids are too low. On Monday during a conference call with analysts, Ian Read, Pfizer’s chief executive, described Pfizer as in a “position of strength” (Thomas, 5/5).

USA Today: Germany’s Bayer AG To Buy Merck’s Consumer Biz For $14.2 Billion
In the latest deal in the pharmaceutical space, Germany-based Bayer AG is acquiring Merck’s consumer care business, which includes well-known brands like Claritin, Afrin and Coppertone, for $14.2 billion. The deal means Bayer will get a list of well-known U.S. brands that sell at pharmacies with the hope of expanding their sales to a broader global clientele (Shell, 5/6).

Meanwhile, here's more on Sovaldi -

The San Francisco Chronicle: $1,000 Hepatitis C Pill A Tough Miracle To Swallow
Three decades ago, Scott Barnes needed luck to survive the bullets and bombs of the Vietnam War. Today, his life depends on a beige, $1,000 pill. Hailed as a breakthrough treatment for hepatitis C, Sovaldi could help more than 130 million people across the globe who suffer from the disease. Barnes believes he became infected during the war, when he received a blood transfusion laced with the virus. "It's one thing to take a bullet or lose a leg," said Barnes, 59, whose disease is so advanced he's bought a grave and a plaque to go with it. "But it's another thing when you have a disease that's a killer and there's no cure." To people like Barnes, Sovaldi is a miracle drug. But patients may face a long wait for the miracle, if they get it at all (Lee, 5/5).

Earlier, related KHN coverage: Who Should Get Pricey Hepatitis C Drugs? (Appleby, 5/5); VA, California Panels Urge Costly Hepatitis C Drugs For Sickest Patients (Appleby,  4/17); and There’s a Life-Saving Hepatitis C Drug. But You May Not Be Able To Afford It. (Appleby, 3/3).   

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State Watch

State Highlights: N.D. Kids' Program Eligibility; Conn. Nursing Home Transparency; La. Hospital Privatization

A selection of health policy stories from North Dakota, Connecticut, Louisiana, Colorado, New York, Kansas and Missouri.

The Associated Press: Income Eligibility For ND Health Services Broadens
The income eligibility guidelines have changed for a state-funded specialty health care program that helps some North Dakota children. The North Dakota Department of Health on Monday announced the changes for the Children's Special Health Services Specialty Care Treatment Program. The department says that starting this month a family of four can earn up to $44,123 annually -- or $3,677 monthly for the household -- and still meet income eligibility requirements (5/5).

The CT Mirror: SEIU 1199 Wins Fight For CT Nursing Home Transparency Law
SEIU 1199 New England, a union closely allied with Gov. Dannel P. Malloy, won final passage early Tuesday of new financial reporting rules for nursing homes, a reaction to the union's long, continuing fight with HealthBridge Management, a company that has claimed financial distress to escape contract obligations. The Senate voted 24 to 11 to create a Nursing Home Financial Advisory Committee to regularly examine the financial solvency and quality of care of nursing homes. Senate Minority Leader John P. McKinney, R-Fairfield, and two other GOP senators, Kevin Witkos of Canton and John Kissel of Enfield, joined all 21 Democrats present in support (Pazniokas, 5/6).

The Associated Press: Jindal Won’t Scrap Hospital Privatization Model
Louisiana Gov. Bobby Jindal's administration won't reverse course on privatizing state-owned hospitals that care for the poor and uninsured and will continue negotiating with federal officials on ways to pay for the deals, Jindal's chief budget adviser said Monday. The CMS, rejected financing plans submitted by the Jindal administration for most of the privatization contracts late last week, and lawmakers were trying to determine the state's next steps (5/5).

Kaiser Health News: Capsules: Colorado Redraws Map To Cut Sky-High Ski Town Rates
Relief is in sight -- and it won’t involve a lawsuit -- for the four counties in Colorado that have the highest Obamacare health insurance premiums in the country. Local officials in the ski resort region in the mountains west of Denver had threatened to sue over the high rates. But on Friday Colorado Insurance Commissioner Marguerite Salazar said she wants to redraw those boundaries, making the resort counties part of a much larger 22-county pool (Whitney, 5/5).

The Associated Press: Pharmacy Owner Serves Jail Time For Medicaid Fraud
A pharmacy owner has been sentenced for his part in a scheme that drained $16 million from the state Medicaid program. Attorney General Eric Schneiderman said Monday that 41-year-old Raheel Pervez of Dix Hills will serve one to three years for his part in a scheme that billed Medicaid for unfilled prescriptions (5/6).

Kansas Health Institute News Service: Former Legislator Named KanCare Inspector General
A former state legislator, Phil Hermanson, has been named inspector general for Kansas’ Medicaid programs. As inspector general he will oversee audits of the state’s KanCare contractors -- Amerigroup, UnitedHealthcare and Sunflower State Health Plan, a subsidiary of Centene -- and be on the lookout for potential fraud and abuse, and promote efficiency, agency officials said. The inspector general position had been vacant since Gale’s exit in early January (Ranney, 5/5).

The St. Louis Post-Dispatch: Lucrative Biopsies Spur Fight By Pathologists 
For most people, a biopsy is a fast and simple procedure -- a sliver or patch of skin or a few drops of fluid are extracted in a doctor’s office and sent to a laboratory for examination. It’s also potentially lifesaving. Biopsies such as Pap smears and the analysis of polyps, tumors and skin anomalies are crucial in detecting certain cancers. But how much a biopsy costs and who pays for it can be complex. Biopsy markups are a hidden profit center in the health care industry, especially in states such as Missouri, where physicians are allowed to charge extra for lab services. Many states bar the practice, as do the Medicare and Medicaid programs. Unknown to most consumers, there’s a running feud over who controls the billing for biopsies -- one stretching back for several years and involving a tug-of-war between physicians, hospitals and laboratories. As consumers pay an increasing share of their medical costs, markups are drawing new attention (Doyle, 5/4).

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Editorials and Opinions

Viewpoints: Obamacare A 'Hispanic Success Story'; Another Day In Court For Health Law Challengers

Los Angeles Times: If Health Care Usage Is Surging, Where Are The Health Care Jobs
It makes obvious sense to attribute the surge to the Affordable Care Act, which kicked into full gear in the January-March period measured by the Bureau of Economic Analysis figures. Yet health care experts are pondering the figure with suspicion and perplexity. Among the questions they're asking is: If health care spending is rising so fast, why is health care job growth flat? (Michael Hiltzik, 5/5). 

USA Today: Obamacare A Hispanic Success Story: Column
Talk about seeing the glass half-empty. Last week, the Department of Health and Human Services released statistics on the racial and ethnic breakdown of Affordable Care Act sign-ups, generating a slew of negative headlines. "Obamacare's Hispanic enrollment is low," said The Washington Post. And the National Journal weighed in with "Why Hispanics didn't get Obamacare" (Raul Reyes, 5/5).

Richmond Times-Dispatch: An Origination Question For The ACA
If the president wants to witness a refutation of his assertion that the survival of the Affordable Care Act is assured, come Thursday he should stroll the 13 blocks from his office to the nation’s second-most important court, the D.C. Circuit Court of Appeals. There he can hear an argument involving yet another constitutional provision that evidently has escaped his notice. It is the Origination Clause, which says: “All bills for raising revenue shall originate in the House of Representatives; but the Senate may propose or concur with amendments as on other bills” (George F. Will, 5/6).

The Denver Post:  Caldwell: Flimsy Evidence Of A 'Gun Grab' In Mental Health Bill
You have to wonder whether the Rocky Mountain Gun Owners got bored this legislative session without any high-profile Second Amendment issues to take on. That may be an explanation for them having labeled a bill about mental health issues a "gun grab." Connecting this bill to gun ownership rights is like playing Six Degrees of Kevin Bacon -- you know, the parlor game that posits any human on the planet is no more than six acquaintances from the actor (Caldwell, 5/5).

The Washington Post: Time Is Short To Address Antibiotic Resistance
The World Health Organization came out last week with a warning that resistance to antibiotics has become a “major threat to public health.” Bacteria are evolving so rapidly that antibiotics -- those wonder drugs that revolutionized health care -- are, in many cases, losing their power and infections are becoming untreatable. In the latest report, which is far from the first warning, the WHO found the problem has touched every region of the world (5/5).

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Stephanie Stapleton

Andrew Villegas

Marissa Evans
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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.