Daily Health Policy Report

Thursday, May 8, 2014

Last updated: Thu, May 8

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Quality

Health Care Marketplace

Coverage & Access

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

California's Small Business Health Insurance Exchange Off To Slow Start

Kaiser Health News staff writer Anna Gorman, working in collaboration with the Voice of San Diego, reports: “California’s insurance marketplace for small businesses has attracted just a fraction of eligible companies, with most being deterred by technology glitches, paperwork delays and customer service problems” (Gorman, 5/8). Read the story.

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Hospitals Boost Patient Safety, But More Work Is Needed

Kaiser Health News staff writer Jordan Rau reports: “Two major safety shortcomings in America’s hospitals—the frequency with which patients get hurt during their stays and the large number who are readmitted—have decreased as government penalties and other programs targeting them kick in” (Rau, 5/7). Read the story.

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Capsules: PhRMA: High Cost-Sharing Could Harm Patient Drug Access; Report: Federal Exchange A Comparative Bargain; Arizona Offers ‘Sneak Peak’ At Costs Of Shifting Kids Off CHIP

Now on Kaiser Health News’ blog, Mary Agnes Carey writes about the drug industry’s concerns about the health law’s cost-sharing requirements: “Enrollees in some of the health law’s most popular plans will face high cost-sharing requirements that the pharmaceutical industry says could keep patients from getting the drugs they need” (Carey, 5/7). 

Julie Rovner writes about a new report on the federal exchange: “As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C. The report, released Wednesday, was compiled using data from federal enrollment figures and federal exchange funding for both the federal and state exchanges” (Rovner, 5/8).

Also on the blog, Phil Galewitz takes a look at CHIP and Arizona: “Families of Arizona children who were forced to switch from the Children’s Health Insurance Program (CHIP) to private plans sold in the federal marketplace are likely paying more and getting fewer benefits, according to a study by Georgetown University researchers released Thursday. Millions of families who are ineligible for Medicaid could soon face the same choice if Congress chooses not to extend funding for the state-federal CHIP program when it expires in October 2015. Arizona was the first and only state to end its children’s insurance program — because its state legislature acted before the 2010 Affordable Care Act banned states from reducing children’s health coverage” (Galewitz, 5/7). Check out what else is on the blog.

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Political Cartoon: 'Post-Op Complications?'

Kaiser Health News provides a fresh take on health policy developments with 'Post-Op Complications?' by Chris Wildt. 

Here's today's health policy haiku: 

INSURERS AND THE ENERGY AND COMMERCE COMMITTEE

Please come testify...
said GOP lawmakers,
But don't say good stuff.
-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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Capitol Hill Watch

Confirmation Hearings Begin For Obama's Pick To Head HHS

Today the first of two scheduled hearings will take place for Sylvia Mathews Burwell. Though she is expected to be confirmed as the Secretary of the Department of Health and Human Services, she is also expected to face some tough questions about the health law.   

The New York Times: Confirmation Hearings Loom For Health Services Nominee
Sylvia Mathews Burwell, President Obama’s nominee for secretary of health and human services, will undergo the first of two Senate confirmation hearings on Thursday, with lawmakers from both parties hoping she can improve relations between the administration and Congress on health care. Ms. Burwell, 48, a native of Hinton, W.Va., is to be introduced by the state’s senior senator, Jay Rockefeller, a Democrat. Democrats said they hoped she would also be introduced by Senator John McCain, Republican of Arizona, who has described her as “an excellent choice” to be health secretary (Pear, 5/8).

The Associated Press: Obama HHS Nominee Gets First Turn Before Senators
Sylvia Mathews Burwell was to testify Thursday before the Senate Health, Education, Labor and Pensions Committee, the first of two Senate committees that will hold hearings on her nomination. Burwell is Obama’s choice to replace Health and Human Services Secretary Kathleen Sebelius, who resigned last month after presiding over the passage of the health law and the disastrous rollout of the federal enrollment website. Sebelius left just as the law had begun to recover with stronger-than-expected sign-up numbers (5/8).

Politico: Questions Sylvia Mathews Burwell Will Face On Obamacare
The White House’s new pick to run Obamacare will kick off her confirmation battle Thursday with the first of two grillings from Senate Republicans. Sylvia Mathews Burwell has a very strong chance of getting confirmed with strong support of Senate Democrats and even some Republicans who have indicated that they could vote for her, barring a significant gaffe or a skeleton discovered in her close (Haberkorn, 5/7).

CBS News: Kathleen Sebelius' Replacement To Face Tough Obamacare Questions
Before the Senate confirms Sylvia Mathews Burwell to take the helm of the Health and Human Services (HHS) Department, lawmakers are sure to have tough questions for her. On Thursday, when she appears before the Senate Health, Education, Labor and Pensions (HELP) Committee, Burwell will find out whether those questions will focus on the partisan controversies surrounding Obamacare or more substantive policy matters. She's likely to get a taste of both (Condon, 5/8).

Marketplace: What Would You Ask About Obamacare?
President Barack Obama's pick to lead the Department of Health and Human Services appears before the U.S. Senate on Thursday. Sylvia Burwell's nomination will be considered by the Senate Committee on Health, Education, Labor and Pensions. There will be plenty of political questions about the future of Obamacare. But what questions would healthcare executives and policy wonks want to ask? We got in touch with a few to find out (Gorenstein, 5/8).

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Insurers: Payment Rates Above 80% For Plans Purchased On Health Exchanges

Officials from the major insurance companies were not following themes of gloom and doom and instead told the Energy and Commerce Committee that the overhaul has not triggered a government takeover of their industry, and that their stock prices are doing well.   

The New York Times: Called by Republicans, Health Insurers Deliver Unexpected Testimony
House Republicans summoned a half-dozen health insurance executives to a hearing Wednesday envisioned as another forum for criticism of the Affordable Care Act. But insurers refused to go along with the plan, and surprised Republican critics of the law by undercutting some of their arguments against it. Insurers, appearing before a panel of the Energy and Commerce Committee, testified that the law had not led to a government takeover of their industry, as some Republicans had predicted. Indeed, several insurers said their stock prices had increased in the last few years (Pear, 5/7).

The Associated Press: Health Insurers: Payment Rates Above 80 Percent
Aetna reported payment rates in “the low- to mid-80 percent range;” Wellpoint said the rate was as high as 90 percent for those whose premium had come due; the Blue Cross and Blue Shield Association said 80 to 85 percent; and the Health Care Service Corporation, which sells Blue Cross Blue Shield plans in five states, pegged the rate at 83 percent or above. The figures were in line with what individual insurers have said on earnings calls with analysts and elsewhere in recent weeks. Democrats seized on the figures disclosed at a House hearing as the latest sign that the health care law has defied its critics and is working (5/7).

The Wall Street Journal: Insurers: High Proportion Of Health Plan Enrollees Paid Premiums
Insurance company executives on Wednesday told Congress that high proportions of people signing up for coverage under the Affordable Care Act paid their first month's premium, fueling the partisan fight over the impact of the health law. Officials from Aetna Inc., WellPoint Inc. and Health Care Service Corp. said that in March and April they had seen around 80 percent to 90 percent of enrollees who faced payment deadlines respond to invoices by the insurers' deadlines. They expect more people who had signed up for coverage toward the end of the enrollment period to pay in the coming weeks (Radnofsky, 5/7).

USA Today: Insurers: Most New Enrollees Have Paid Health Premiums
Insurers also have duplicate enrollments caused by the disastrous launch of the federal healthcare.gov exchange website. Many people were advised to start from scratch, but their original applications were still in the system, Pratt said. The insurers said back-end payment issues are still causing problems (Kennedy, 5/7).

The Fiscal Times: Insurers: 80 To 90 Percent Have Paid Premiums
Executives from some of the largest insurance companies in the country just poured cold water on Republicans’ claims that a significant portion of Obamacare enrollees had not paid their premiums. In congressional testimony on Wednesday, executives from Aetna, Blue Cross Blue Shield, Cigna and WellPoint estimated about 80 to 90 percent of people who had signed up for plans on the state or federal exchanges had paid their first month’s premiums. For months, Republicans have attacked the Obama administration for not releasing figures on how many people had paid their first month’s premiums. Though the administration still has not cited official figures, they have previously cited insurers’ estimates that about 80 percent had paid (Ehley, 5/7).

Politico Pro: Health Plans Say Payment Rates High
Insurance executives testifying on Capitol Hill for the first time since Obamacare enrollment ended confirmed that the vast majority of enrollees have started paying their premiums -- but wouldn’t say how much the cost of coverage will rise next year. Top officials for Wellpoint, Blue Cross Blue Shield and Aetna told the House Energy and Commerce oversight subcommittee that 80 percent to 90 percent of enrollees in the new marketplaces have paid at least their first month’s premium, as insurers had already suggested. But they had little to say when Republicans tried to pry more information from them (Cunningham, 5/7).

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Health Reform

Federal Exchange Spent $647 Per Enrollee -- A Relative Bargain

Meanwhile, Oregon names an official to oversee its shift to the federal exchange, while other stories examine the slow start of California's small business exchange and the higher costs faced by some Arizona families forced to switch their children from the Children's Health Insurance Program to private insurance when that state ended the program.

Kaiser Health News: Capsules: Report: Federal Exchange A Comparative Bargain
As rocky as its rollout was, it cost the federal exchange, healthcare.gov, an average of $647 of federal tax dollars to sign up each enrollee, according to a new report. It cost an average of $1,503 – well over twice as much – to sign up each person in the 15 exchanges run by individual states and Washington, D.C. The report, released Wednesday, was compiled using data from federal enrollment figures and federal exchange funding for both the federal and state exchanges (Rovner, 5/8).

The Oregonian: Top Oregon Health Agency Manager, Tina Edlund, Will Head Health Insurance Exchange Transition
Acting Oregon Health Authority Director Tina Edlund has been tapped to head Cover Oregon's transition to using the federal health insurance exchange. Edlund had taken over the helm at OHA, the state's Medicaid agency, when then-director Bruce Goldberg moved over as interim head of Cover Oregon. Now she finds herself with the task of fixing the problem Goldberg and others couldn't: giving Oregonians access to a website allowing same-day self-enrollment (Budnick, 5/7).

Kaiser Health News: California's Small Business Health Insurance Exchange Off To Slow Start
California’s insurance marketplace for small businesses has attracted just a fraction of eligible companies, with most being deterred by technology glitches, paperwork delays and customer service problems (Gorman, 5/8).

Kaiser Health News: Capsules: Arizona Offers ‘Sneak Peak’ At Costs Of Shifting Kids Off CHIP
Families of Arizona children who were forced to switch from the Children’s Health Insurance Program (CHIP) to private plans sold in the federal marketplace are likely paying more and getting fewer benefits, according to a study released Thursday. Millions of families who are ineligible for Medicaid could soon face the same choice if Congress chooses not to extend funding for the state-federal CHIP program when it expires in October 2015. Arizona was the first and only state to end its children’s insurance program — because its state legislature acted before the 2010 Affordable Care Act banned states from reducing children’s health coverage (Galewitz, 5/7).

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'Face Of Campaign' Initially Unable To Get Coverage

It took a reporter's intervention to obtain coverage for a Chicago resident who had touted the law's benefits at a news conference last year but who had been mired in computer and other problems. Other reports look at how free preventive services may reduce health disparities and whether insurers can charge higher premiums to those who smoke e-cigarettes.

The Associated Press: 'Face Of The Campaign' Mired In Health Law Snags
Celeste Castillo, a Guatemalan immigrant, was invited to a news conference with Illinois Gov. Pat Quinn and Health and Human Services Secretary Kathleen Sebelius early last year to help promote enrollment in the country’s new health insurance marketplaces. Fourteen months later, the 57-year-old nanny was still uninsured until The Associated Press contacted the Quinn administration last week. She had first become tangled in computer problems, then was denied by the state’s expanded Medicaid program -- underscoring how complicated the process has been for many Americans, even one held up as an example of who the law was designed to help (5/7).

Stateline: A Chance To Prevent Illness
The 13 million Americans who are newly enrolled in health insurance are now eligible for preventive health services, such as screenings and vaccinations, intended to forestall serious and costly illnesses. The cost: free. The Affordable Care Act requires cost-free prevention services for most health plans, including private insurance plans, meaning no co-payments, deductibles or co-insurance payments. Many health policy experts believe this step alone will greatly reduce health disparities for minorities, the poor and the poorly educated (Ollove, 5/8).

ABC News: Health Insurance Surcharge Has Vapers Fuming
Under the Affordable Care Act, insurance companies can charge smokers and other tobacco users up to 50 percent more than non-smokers for a health insurance policy. But where do e-smokers fit in? E-cigarettes are battery-operated nicotine inhalers that consist of a rechargeable lithium battery, a cartridge called a cartomizer and an LED that lights up during each puff. Although they contain no tobacco, the U.S. Food and Drug Administration plans on regulating them like cigarettes and cigars. This, it turns out, is complicating things for insurance companies (Neporent, 5/8).

Fox News: NFIB: Health Insurance Tax To Cost Up To 286K Jobs
An Obamacare-related tax will slash between 152,000 and 286,000 jobs by 2023, according to new research from the National Federation of Independent Business. The Health Insurance Tax is a 2 percent to 3 percent tax on employer-sponsored health policies purchased on the fully insured market. According to the NFIB, 88 percent of small businesses purchase their policies on this market, while most large corporations and labor unions do not (Karol, 5/7).

The Associated Press: Illinois Allows Further Extension Of Health Plans
Illinois Gov. Pat Quinn's administration is allowing an additional year's extension for existing health insurance plans that fall short of coverage requirements in the nation's health care law. The Illinois Department of Insurance announced the change last week, following a similar announcement March 5 from President Barack Obama's administration (5/7).

Meanwhile, a top IRS official says the agency is drawing funds from other programs to enforce the health law --

CQ Healthbeat:  IRS Chief Says Health Law Duties Sap Funds From Other Priorities
The Internal Revenue Service is drawing funds from other agency programs in order to enforce health law requirements because Congress hasn’t accommodated the agency’s budget requests, Commissioner John Koskinen said Wednesday. Taxpayer services and enforcement are taking a hit as a direct result of the shortfall, Koskinen said. He also told a congressional panel that the agency is making a top priority of intercepting fraudulent tax returns and cracking down on individuals who steal personal information, including physicians’ Social Security numbers, to file them (Reichard, 5/7).

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N.C. Senate GOP Nominee Calls For Obamacare Repeal

In Massachusetts, former CMS chief Dr. Don Berwick's campaign for governor calls for single-payer care, and Democratic candidates in Maryland's race for governor clash over the insurance exchange.

Los Angeles Times: Thom Tillis’ North Carolina Win Is A Victory For A Redefined GOP
Tillis, though, is hardly a bipartisan pragmatist in the old-school GOP style. He is a conservative leader who, according to his campaign, wants to "shrink" government, believes "the traditional family is the bedrock of America's culture" and calls Obamacare a "cancer" that needs to be repealed. Under his watch, the North Carolina statehouse has enacted strict voting laws and refused to expand Medicaid under Obama's Affordable Care Act (Mascaro, 5/7).

The Washington Post’s Wonkblog: Obama’s Former Medicare Chief On Why He Wants To Bring Single-Payer To Massachusetts 
Don Berwick -- who, as administrator of the Centers for Medicare and Medicaid Services, oversaw large chunks of the early implementation of the Affordable Care Act -- is trying to shake up the health policy world again. He ran CMS from July 2010 to December 2011, and left because Senate Republicans blocked his confirmation to lead the agency permanently. Now, more than two years later, he is a long-shot Democratic candidate for governor of Massachusetts and the heart of his platform is a single-payer health plan (Millman, 5/7).

The Associated Press: Gansler, Brown Clash Over Health Care 
Lt. Gov. Anthony Brown and Attorney General Doug Gansler clashed over Maryland's rocky health care exchange rollout in a Democratic primary debate Wednesday night in the state's governor's race. Del. Heather Mizeur stayed out of the fray, standing in the middle of the two men and focusing on her own plans. Gansler kicked off the debate by criticizing Brown, who led the state's health care reform rollout that was plagued with problems (Witte, 5/7).

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Quality

HHS Finds Hospitals Getting Safer

The administration credited the improvements at least partially to the Affordable Care Act.

The Associated Press: Gov’t Report: Hospitals Improving Patient Safety
The government says hospitals are becoming safer for patients due to a quality improvement partnership between industry and federal agencies. A report out Wednesday from Health and Human Services finds that adverse events such as medication mistakes, falls and infections went down by 9 percent from 2010 to 2012, the latest year that such statistics were available (5/7).

The Washington Post’s Wonkblog: Hospitals Are Cutting Down Their Deadly Mistakes, HHS Says
That translates to 15,000 fewer deaths in hospitals, a $4.1 billion savings in avoidable costs and a total of 560,000 "patient harms" avoided in 2011 and 2012, HHS says. For reference, a Journal of Patient Safety study last year estimated anywhere between 210,000 and 400,000 hospital deaths tied to preventable harm each year (Millman, 5/7).

Kaiser Health News: Hospitals Boost Patient Safety, But More Work Is Needed
The Obama administration credited the new quality initiatives created by the federal health law. But some of the improvements in patient safety preceded that law. Even with the improvements, one out of eight patients is injured during their time in the hospital (Rau, 5/7).

The Hill: HHS Reports O-Care Cut Into Hospital Deaths
The report also found while 30-day Medicare hospital readmission held at a steady 19 percent between 2007 and 2011 that number dropped to 17.5 percent by 2013. According to HHS that meant 150,000 fewer hospital readmissions among Medicare beneficiaries between January 2012 and December 2013 (Al-Faruque, 5/7).

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Health Care Marketplace

Medicare Advantage Enrollment Grows Despite Health Law Cuts

Also, more insight into Humana's smaller earnings in the first quarter.

CQ Healthbeat: Despite Health Law Cuts, Medicare Advantage Enrollment Stays Strong
Don’t look now, but the private sector is quietly strengthening its grip on the Medicare program, at least if enrollment in the Medicare Advantage plans is a good proxy. It’s happening despite the payment cuts to private Medicare plans under the health law (Reichard, 5/7).

The Wall Street Journal: Humana Earnings Shrink On Higher Costs
Humana Inc. said first-quarter profit shrank 22 percent, after a legal settlement helped boost year-earlier results. Still, revenue and earnings came in above analysts' forecasts, as Humana reported growing membership in Medicare Advantage plans, which are the private industry's version of the federal program for the elderly and disabled (Mathews and Rubin, 5/7).

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Drugmakers Realign To Reduce Costs

Meanwhile, their trade group warns that the patient cost-sharing requirements in some health law plans could restrict prescription drug access.

NPR: Drug Industry Moves To Cut Costs, Banks On Future Big Sellers
Bayer has announced it is buying Merck's consumer drugs business, and Pfizer is trying to take over AstraZeneca. Why is this reorganization happening now, and what does it mean for drug development? (Hensley, 5/8).

Kaiser Health News: Capsules: Castellani: Health Law’s Cost-Sharing Could Limit Patient Access To Prescription Drugs
Enrollees in some of the health law’s most popular plans will face high cost-sharing requirements that the pharmaceutical industry says could keep patients from getting the drugs they need (Carey, 5/7). 

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Coverage & Access

American Legion Calls On VA Secretary To Resign Over Health System

Accusations that records were kept secret or falsified and over preventable deaths and mismanagement are part of a larger problems within the Veterans Affairs health system, some say.

The New York Times: American Legion, Citing Problems, Calls For Veterans Secretary To Resign
Mr. Dellinger’s alarm grew when reports soon emerged that the department’s medical center in Phoenix, and possibly other veterans hospitals, was using off-the-books lists to conceal long appointment waiting times. Finally, when the department’s under secretary for health insisted in recent congressional testimony that nothing had been found wrong in Phoenix, Mr. Dellinger had had enough. This week the Legion, one of the nation’s oldest and most influential veterans organizations, called for Mr. Shinseki and two other senior department officials to resign, the first time the group has sought to oust a public official since 1978 (Oppel Jr., 5/7).

Modern Healthcare: Pattern Of Problems With Veterans Affairs Healthcare System 
As accusations of mismanagement, falsified records and preventable patient deaths rock the Veterans Affairs health care system, some who are familiar with the VA say the failures are consistent with a pattern of well-documented problems. For more than a decade, the department's inspector general and the Government Accountability Office have pressed the health administration to address breaches of the requirement to schedule timely appointments and problems with its recordkeeping on wait times (Landen, 5/7).

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State Watch

State Highlights: Missouri Medicaid Benefits; Telepsychiatry In Rural States; Conn. For-Profit Hospital Bill

A selection of health policy stories from Missouri, North Carolina, Connecticut, Georgia, Minnesota, Michigan and Alaska.

The Associated Press:  Missouri Budget Would Restore Medicaid Benefits 
Missouri lawmakers are poised to give final approval to a state budget that could restore Medicaid benefits that were cut a decade ago. The proposed 2015 budget would provide funding for adult dental care and physical rehabilitation items, such as specially fitted wheelchairs. Those benefits were halted by the Republican-led Legislature in 2005 as part of a larger package of Medicaid cuts (5/8).

The St. Louis Post-Dispatch:  Poor Missourians Could Get Dental Coverage Under Changes OK'd By Lawmakers
Some Medicaid-eligible adults would have access to dental insurance for the first time since 2005 under a bill agreed on by Missouri lawmakers Tuesday. The chairmen of the House and Senate budget committees announced the measure among other funding decisions Tuesday during a conference committee to reconcile differences in the two chambers’ fiscal year 2015 budgets. The budget must be completed by Friday, the constitutional deadline for passing the state’s spending plan. Medicaid provides free or low-cost health insurance for more than 800,000 low-income Missourians. About 60 percent are children and the rest are custodial parents, pregnant women, the elderly and people with disabilities. In 2005, then-Gov. Matt Blunt and the Legislature eliminated an assortment of services, including dental care for most adults. Since then, Medicaid has provided dental benefits only for children and adults who are pregnant, blind or in nursing homes (Stuckey, 5/8).

NPR: Telepsychiatry Brings Emergency Mental Health Care To Rural Areas
North Carolina is facing a very big mental health care challenge -- 28 counties across the state do not have a single psychiatrist. That's despite the fact that in recent years, emergency rooms in the state have seen more patients with mental health, developmental disability or substance abuse problems. So the state is trying telepsychiatry. When a patient comes into an emergency room, they can be connected via a two-way video connection with a psychiatrist. A recent study by the nonpartisan North Carolina Center for Public Policy Research found that the method is having some success in providing more timely treatment (5/7).

The CT Mirror: The Basics: The Last-Minute For-Profit Hospital Bill
It came down to the final hours, but legislators tackled one of the most complex, controversial issues of the session by passing a measure that makes it easier for nonprofit hospitals to convert to for-profits and adds state oversight to hospital sales and transactions involving physician practices. The bill, the subject of intense lobbying by hospitals and unions representing health care workers, now heads to Gov. Dannel P. Malloy, whose administration was among several groups involved in crafting the measure. If signed by the governor, the bill could clear the way for hospitals in Bristol, Manchester, Vernon and Waterbury to be acquired by Tenet Healthcare, a national for-profit company (Becker, 5/8).

The CT Mirror: Health IT Agency Getting Axed
The quasi-public agency set up to promote the use and sharing of electronic medical records is being eliminated as part of budget implementation legislation that’s expected to pass the General Assembly Wednesday. The Health Information Technology Exchange of Connecticut was created in 2010 to promote the use of electronic medical records. Officials had also hoped it would help create a network that health care providers could use to share patients’ medical records electronically (Becker, 5/7).

Georgia Health News: Georgia A Focus Of Maternal Death Project 
Twenty-two Georgia hospitals have joined a project to reduce maternal death rates in the United States, a nursing group announced Wednesday. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) has launched an initiative to improve the treatment of pregnancy-related complications, and is focusing on birthing hospitals in Georgia and New Jersey. Georgia ranks 50th among states in maternal deaths. That’s a prime reason why the state was one of the two selected for the project (Miller, 5/7).

MinnPost: Meeting The Health Needs Of Traumatized Refugees
About 10 years ago, Dr. Jim Letts began to notice an influx of Karen refugees in his primary-care practice at HealthEast Roselawn Clinic in St. Paul. All had been exiled by Myanmar’s long-running and ongoing civil war. ... The staff moved quickly to accommodate the newcomers, partnering with the Karen Organization of Minnesota to locate bilingual and culturally competent staff members (there now are five on staff) who could help identify the most pressing needs, including mental-health care. ... But accurately screening for post-traumatic stress disorder and depression, common issues in this population, was another matter entirely (Williams, 5/7).

St. Louis Post-Dispatch: Rural Nurses:  ‘We’re Like A Mini ER Up Here’
A patient walks into Hannibal Clinic's Monroe City location complaining of chest pains. When initial assessment shows the patient is having a heart attack, staff call 911 and quickly work to stabilize the man until the ambulance arrives. "There's a lot of days I say we're like a mini ER up here," said Mindy Hufford, a licensed practical nurse in the Monroe City, Mo., office. "We do what we were taught in nursing school. It all goes back to our training” (Husar, 5/6).

The Detroit Free Press:  Ascension Health And Trinity Health Create New Statewide Network
Two large Catholic hospital systems in Michigan have joined to form a new health care network across the state, encompassing 27 hospitals, hundreds of clinic sites and more than 5,000 doctors. Ascension Health and Livonia-based CHE Trinity Health announced Wednesday the creation of their Together Health Network, which has set for itself the goal of reducing medical costs while improving patient care. The Affordable Care Act contains various incentives for hospitals to reduce costs in such ways. Hospitals and doctors can sometimes get bonuses representing a portion of the money they save (Reindl, 5/7).

Modern Healthcare: Alaska Telehealth Bill Would Allow Phone, Online Prescribing Visits 
Alaska may soon allow physicians to write prescriptions for many medications without an initial face-to-face encounter between the prescriber and the patient. A bill to allow the remote prescribing process passed on the final day of the state legislative session April 25 and is awaiting the signature of Alaska Republican Gov. Sean Parnell. The measure's aim is to enable patients “to obtain over-the-phone or online consultations where physicians can diagnose and, if necessary, provide a prescription,” according to a release by its sponsor, State Rep. Lynn Gattis, a first-term Republican from Wasilla (Conn, 5/7).

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Weekend Reading

Longer Looks: Understanding Downsides Of Saturated Fat, Sugar; Will Innovation Save U.S. Health Care System?

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

New York: The Day I Started Lying to Ruth
The streetlights in Buenos Aires are considerably dimmer than they are in New York, one of the many things I learned during my family’s six-month stay in Argentina. The front windshield of the rental car, aged and covered in the city’s grime, further obscured what little light came through. When we stopped at the first red light after leaving the hospital, I broke two of my most important marital promises. I started acting like my wife’s doctor, and I lied to her. I had just taken the PET scan, the diagnostic X-ray test, out of its manila envelope ​(Dr. Peter B. Bach, 5/6). ​ ​

The Health Care Blog: Dad, You Have To Inhale
Our lives are enhanced and modified by the most unexpected of teachers, our children. The mentoring of our progeny keeps those of graying years at least partially youthful. Still, I was astonished to hear this week, the words, “Dad, you need to starting doing drugs.” The “dad” being addressed is 93 years old and has advancing cancer. He is tired, nauseas, anxious and sleeps poorly. Though he likely has a number of months to live, he has become withdrawn. Despite my usual medical brew, his incapacitating symptoms are without palliation. Dad is miserable. Enter his daughter with the solution. The “drug” she is talking about is the treatment de jour, marijuana (Salwitz, 5/6).

Politico Magazine: Why Both Sides Are Losing The Health Care Debate
In a word, the solution to America’s health care woes is innovation — the cost-cutting innovation we’ve seen in almost every other industry. Genomics, 3-D printing, nanobots, wearable sensors, social media, telecommunications, ... The ACA will impede innovation by, among other things, homogenizing the delivery of care and funneling resources toward well-entrenched providers. ... To seize the offensive, ACA opponents will have to define a new vision, based on innovation. To do so, they will have to cross swords with hospitals, physician groups, academicians, attorneys, medical schools, state governments, federal agencies and more (Robert F. Graboyes, 5/6).

The Wall Street Journal: The Questionable Link Between Saturated Fat And Heart Disease
"Saturated fat does not cause heart disease"—or so concluded a big study published in March in the journal Annals of Internal Medicine. How could this be? ... The new study's conclusion shouldn't surprise anyone familiar with modern nutritional science, however. The fact is, there has never been solid evidence for the idea that these fats cause disease. We only believe this to be the case because nutrition policy has been derailed over the past half-century by a mixture of personal ambition, bad science, politics and bias (Nina Teicholz, 5/2).

Maclean's Magazine: Death By Sugar
Between 1985 and 2011, the obesity rate among Canadian adults more than tripled; by 2019, overweight and obese adults will outnumber those of normal weight in half of our provinces, predicts a new report in Canadian Medical Association Journal Open. Childhood obesity, too, has risen significantly in the past few decades. Obesity is now seen in babies as young as six months old, and it’s become a global crisis. We all know we’re supposed to eat less and exercise more, but that mantra doesn’t seem to be working. What if the accepted wisdom on obesity—that to lose weight, we simply need to burn off more calories than we consume—is dead wrong? (Kate Lunau, 5/6).

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Editorials and Opinions

Viewpoints: Insurance And Death Rates; Massachusetts 'Exit Plan'; Obamacare Premiums

The New York Times: What Health Insurance Might Do
Alert (or at least health-care-obsessed) readers have no doubt been following the coverage of a new study on mortality in Massachusetts in the years following Romneycare’s coverage expansion, the gist of which — the authors found a striking, Massachusetts-specific decline in death rates for the non-elderly — tends to confirm liberal assumptions about the benefits of health insurance, and undercut the conservative and libertarian argument that insurance doesn’t have the impact on health and mortality that most people expect. The study’s findings are an almost-diametrical reversal of the results from Oregon’s Medicaid experiment, which were much discussed around this time last year (here’s my contribution), and which seemed to strengthen the conservative critique of Obamacare’s pursuit of comprehensive coverage. So now it’s liberalism’s turn to claim vindication, and to press Obamacare’s critics to give ground in the debate (Ross Douthat, 5/7). 

The Boston Globe: Exit Plan For Health Site Mess Deserves Scrutiny Of Its Own
Having decided that fixing the current website is a lost cause, officials at the troubled Massachusetts Health Connector today will recommend buying a software product from a different vendor, hCentive. But the Connector also wants to prepare to join Healthcare.gov, the federal website, in case hCentive’s “off-the-shelf” website product can’t be adapted in time to let Massachusetts residents secure health plans for 2015, for which enrollment starts on Nov. 15. That course has left the state’s health insurance plans deeply concerned, and understandably so: Having invested heavily to prepare for the dysfunctional website, they’ll now have to prepare to work with two different websites (5/8).

The Wall Street Journal: Disconnected In Massachusetts 
The FBI is reportedly investigating criminal fraud by the architects of Oregon's ObamaCare program, but maybe the G-men should take a look on the East Coast too. Like Oregon two weeks ago, Massachusetts announced on Monday that it is dumping its dysfunctional insurance exchange and defaulting to the federal version—though in fairness to Governor Deval Patrick, his crimes are merely against competent government (5/7).

Los Angeles Times: The Insurers Speak: Yes, People Are Paying Their Obamacare Premiums
Things continue to get tough for the Obamacare dead-enders, those increasingly lonely opponents whose only comeback against the flow of good news about the Affordable Care Act is to conjure up absurd arguments against it (I mean you, Cato's Michael Cannon) or, if all else fails, make stuff up (Michael Hiltzik, 5/7). 

The New England Journal Of Medicine: Here To Stay — Beyond The Rough Launch Of The ACA 
Come 2017, outright repeal will remain unlikely for three reasons. First, all major parts of the ACA except the individual mandate are popular — including the insurance-market reforms, the subsidies to make insurance affordable, closure of the drug-benefit “doughnut hole,” and the incentives for most employers to provide affordable insurance as a fringe benefit. Second, lawmakers who support repeal will not want to snatch insurance coverage from an estimated 37 million people who will be insured thanks to the ACA in 2017. Third, repeal would cut into the sales and profits of health care providers and suppliers of all stripes. Although repeal of the ACA is therefore unlikely, amendments are certain (Henry J. Aaron, 5/7).

The New England Journal Of Medicine: Health Care Reform After The ACA 
The ACA creates new subsidies for insurance purchased on the exchanges and expands Medicaid eligibility, increasing the pressure from entitlements on state and federal budgets. Subsidies shift the burden but do not reduce the cost. ... If Republicans gain a Senate majority in the fall, they ... can be expected to advance targeted proposals to eliminate the ACA's most unpopular and unworkable aspects and substitute market-based alternatives. Such proposals will embrace the possibility of a more decentralized, less regulatory, and more consumer-driven model of health care. I believe that will be the direction of the next phase of health care reform in 2017, no matter who is elected President (Joseph R. Antos, 5/7).

The Washington Post: Medicaid: Will McAuliffe Play The Cuccinelli Care?
As Bill Clinton once famously said: “It depends upon what the meaning of the word is.” Ain’t that the truth. Last year, GOP gubernatorial candidate Ken Cuccinelli strongly opposed Democratic rival Terry McAuliffe’s promise to expand Medicaid. That was a partisan difference. But earlier in 2013, Mr. Cuccinelli had occasion to address a question sitting at the heart of the Medicaid expansion debate in a nonpartisan way: Who has the legal right to expand the program? (Norman Leahy and Paul Goldman, 5/7). 

news@JAMA: Good Prospects For Reform In Long-term Care
The rollout of the Affordable Care Act (ACA) continues to dominate the noisy politics and media attention devoted to health care. But there is one important area of health system reform where there’s a remarkable and growing degree of nonpartisan and constructive debate quietly focused on solving problems—that concerns long-term care (LTC), including long-term supports and services (LTSS). True, a new LTC program was deemed unworkable and stripped from the ACA after being signed into law. And last year’s Commission on Long-Term Care failed to reach agreement, spawning both official and alternative reports (Butler, 5/7).

The New England Journal Of Medicine: Vivek Murthy For Surgeon General
By obstructing the President's nomination of Vivek Murthy as surgeon general, the NRA is taking its single-issue political blackmail to a new level. With the record of past surgeons general as their guide, senators should do what is right for the health of our country by confronting the NRA and voting their own conscience. Dr. Murthy is an accomplished physician, policymaker, leader, and entrepreneur. He deserves the President's continued backing and should be confirmed (Dr. Gregory D. Curfman, Stephen Morrissey, Debra Malina and Dr. Jeffrey M. Drazen, 5/8).

The New England Journal Of Medicine: Insourcing Health Care Innovation 
Many health care professionals find it irritating when management gurus recommend solving health care's problems with approaches they would “copy and paste” from unrelated industries — a former chief executive of a manufacturing company claims that the same simple lessons that enabled him to transform his own industry can improve value in health care, or a business-school professor offers an eight-point leadership plan that she's translated into health care as easily as if she'd translated it into French. Many people who work in health care value outside perspectives and are open to new approaches — and yet bristle at facile recommendations emerging from these translations. ... The challenge of health care innovation lies in combining contextual understanding with fresh perspectives (Dr. David A. Asch, Christian Terwiesch, Kevin B. Mahoney and Roy Rosin, 5/8).

The New York Times’ Opinionator: In Delivery Rooms, Reducing Births Of Convenience 
San Francisco General is largely a hospital for the poor. It’s the city’s safety net hospital, known for providing free care for all who can’t afford it, and for its display — while you wait and wait — of the parade of humanity in all its glory. It might be surprising, then, that according to data compiled by the state it is probably the safest place in California to have a baby (Tina Rosenberg, 5/7).

The Washington Post: Pfizer’s Offer To Buy AstraZeneca Shows That U.S. Needs Corporate Tax Reform 
The hot read among policy wonks these days is “Capital in the Twenty-First Century,” by French economist Thomas Piketty. He warns of a long-term trend toward ever-concentrated wealth and urges a global wealth tax to prevent it. While that might be a bad idea even if it were politically feasible, there is merit to the broader notion that industrialized countries could better coordinate taxing wealth, corporate and otherwise, that flits around the world in search of the lowest rates. Case in point: U.S. drug maker Pfizer’s $106 billion offer for Britain’s AstraZeneca, which could enable Pfizer to flag itself as a British company and pay taxes at Britain’s 20 percent rate rather than this country’s 35 percent (5/7).

The Washington Post: D.C.’s Bad Mental-Health Report Card 
For the third year in a row, an assessment of children’s mental health in the District of Columbia has found the city lacking in its ability to reach and help those most in need. It’s long been apparent that this failure affects not only children with problems and their families but also the larger society that must contend with the costly consequences of that non-treatment. Officials need to wake up to the fact that, unless they pay better attention to the mental well-being of children, they have little chance of reducing the dropout rate, cutting juvenile crime or producing self-sufficient adults (5/7).

WBUR: Five Things Marathon Allure Can Teach Us About Improving Everyday Health
Health behavior change is hard; if it were easy, everyone would be doing it. But running a marathon is also hard, and lately it seems that just about everyone is doing it. The health care industry could learn a lot from the increasing popularity of the marathon about how to design programs that help people make positive health behavior changes (Bradley Stulberg, 5/7).

Los Angeles Times: Endorsement: David Jones For Insurance Commissioner 
Outraged by rapidly rising premiums for auto insurance, California voters passed Proposition 103 in 1988 to turn the insurance commissioner's job into an elected office with the power to reject proposed changes in the rates for property and casualty insurance. Since then, the commissioner has been arguably the most important consumer protection official in the state, overseeing more than 600 insurers that collect $123 billion in premiums for health, auto, home and other policies. This year, voters will choose among three candidates offering sharply contrasting views on how best to provide that protection, and it's a debate worth having. Nevertheless, the best candidate for the job is the one who has it already, Democrat Dave Jones (5/7).

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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.