Daily Health Policy Report

Thursday, May 9, 2013

Last updated: Thu, May 9

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Lags In Project To Expand Hospice Care

Kaiser Health News staff writer Jordan Rau, working in collaboration with Politico, reports: "Despite a three-year-old order from Congress, Medicare has yet to begin an experiment to expand hospice services to allow beneficiaries to continue potentially lifesaving treatments to see if it would save money while improving the patients' quality of life. The demonstration project would eliminate one major reason that people are reluctant to take up Medicare's hospice benefit: they have to first agree to forgo curative treatments such as chemotherapy" (Rau, 5/9). Read the story.

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Health Perks Geared To Top Workers Could Trigger Penalties Under Health Law

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "Many executives have long enjoyed perks like free health care and better health benefits for themselves and their families. But under a little noticed anti-discrimination provision in the federal health law, such advantages could soon trigger fines of up to $500,000" (Appleby, 5/9). Read the story.

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California Weighs Expanded Role For Nurse Practitioners

Capitol Public Radio's Pauline Bartolone, working in partnership with Kaiser Health News and NPR, reports: "As state governments get ready for the Affordable Care Act coverage expansion, some are taking a close look at their networks of health care professionals to make sure they will be able to meet increased demands as more people gain health insurance. California is one of 15 states expected to consider legislation this year that would give advanced practice nurses more independence and authority" (Bartolone, 5/9). Read the story.

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Capsules: Study: Per Capita Rx Spending Fell For First Time In 2012; Colo. Launches Ad Campaign For New Online Marketplace; Audio: Getting To The Bottom Of Hospital Pricing

Now on Kaiser Health News' blog, Alvin Tran reports on a study tracking per capita prescription drug spending: "Americans' per capita spending on prescription drugs fell last year for the first time on record, according to a report released Thursday by the IMS Institute For Healthcare Informatics firm headquartered in Danbury, Conn., which tracks pharmaceutical sales and other health care data" (Tran, 5/9).

Also on the blog, Phil Galewitz writes about the new ad campaign in Colorado: "With less than five months until Colorado’s new online health insurance marketplace opens for business this fall, officials are concerned that few state residents have heard of it. This week, it became the first state to launch a public awareness campaign with television, print, radio and billboard ads that will cost $2 million and run two months. The TV ad shows a woman at her kitchen table scrolling through health plan information on the Connect for Health Colorado website. The voice over says the website lets people shop and buy a health plan online" (Galewitz, 5/8).

In addition, Capsules links to NPR's "Talk of the Nation" conversation which included KHN's Jordan Rau, who discussed the data released Wednesday by the Centers for Medicare & Medicaid Services on variations in hospital pricing and whether higher prices are correlated with better quality. Check out what else is on the blog.

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Political Cartoon: '(No) Fun House?'

Kaiser Health News provides a fresh take on health policy developments with "(No) Fun House?" by Matt Wuerker.

Meanwhile, here is today's health policy haiku:


Health spending slow down!
Cyclical or structural?
Affordable care!?
-Team Haiku, Altarum 

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

For Obama, Health Law Is Central To Legacy

Bloomberg reports that shortly after President Barack Obama's re-election, he told senior staff members that the health law would be one of his second term's highest priorities. In related news, health care will be a focus for Obama this week, and it was a hot topic at a recent dinner between the president and House Democrats.

Bloomberg: Obama Sees Health Care As Legacy Too Worthy To Resist
Just weeks after his re-election, President Barack Obama summoned about 20 senior administration officials to the White House’s Roosevelt Room for an hour-long meeting on the implementation of his health-care law. Obama began by reminding his staff that the Affordable Care Act would be one of his major legacies and its execution among the highest priorities of his second term, according to a Democrat familiar with the gathering (Dorning & Wayne, 5/9).

USA Today: Obama To Promote Jobs, Health Care Plan
President Obama will spend the rest of the week on two issues that largely define his years in office: jobs and health care. Obama will board Air Force One on Thursday for a flight to Austin, where he will kick off a series of "Middle Class Jobs and Opportunity Tours" designed to push his budget plans and criticize congressional Republicans for inaction on the economy (Jackson, 5/8).

The Wall Street Journal’s Washington Wire: Health Care, Economy Discussed At Latest Obama Dinner
According to a White House official familiar with the dinner, the president and House members discussed the economy and deficit reduction, as well as Mr. Obama’s efforts on overhauling immigration law, gun control and school improvement. Mr. Obama also talked about continuing efforts to support the investigation of the Boston marathon bombing. Rep. Chris Van Hollen (D., Md.), ranking Democrat on the House Budget Committee who also attended the dinner, said the group also talked about implementation of the president’s health-care law. That process is being viewed by some Democrats as fraught with potential political peril if there are glitches as a major new system of insurance exchanges is set up. But Mr. Van Hollen said the discussion with the president was "very upbeat" (Hook, 5/8).

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Will The Health Law Ease Job Lock?

The Wall Street Journal writes how the health law's coverage expansions could provide entrepreneurs with a new source for health coverage.

The Wall Street Journal: Will Health Care Law Beget Entrepreneurs?
Thousands of would-be entrepreneurs are itching to start their own businesses, but many are shackled to their current employer by health care benefits they don't think they could otherwise afford. Economists call this phenomenon "job lock," or "entrepreneurship lock." But the pressure some Americans feel to cling to a corporate job chiefly for the health insurance could, conceivably, ease in coming years. Under provisions of the health care law, new business owners will be able to get coverage through public marketplaces, or "exchanges," beginning in October, for policies that will take effect starting in January (Maltby and Loten, 5/8).

Also, KHN offers two stories that examine particular health law provisions and changes they could trigger-

Kaiser Health News: Health Perks Geared To Top Workers Could Trigger Penalties Under Health Law
Many executives have long enjoyed perks like free health care and better health benefits for themselves and their families. But under a little noticed anti-discrimination provision in the federal health law, such advantages could soon trigger fines of up to $500,000 (Appleby, 5/9).

Kaiser Health News: California Weighs Expanded Role For Nurse Practitioners
As state governments get ready for the Affordable Care Act's coverage expansion, some are taking a close look at their networks of health care professionals to make sure they will be able to meet increased demands as more people gain health insurance. California is one of 15 states expected to consider legislation this year that would give advanced practice nurses more independence and authority (Bartolone, 5/9).

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Medicaid Expansion Unlikely In Ohio, Texas; California Moves Forward

As the clock continues to wind down on state legislative sessions, the optional expansion of eligibility for the program looks unlikely in those states. But, in California, health care advocates offer a compromise approach on how to move ahead.

The Associated Press: Protestors Demand Medicaid Expansion As Hopes Fade
Dozens of protesters marched through the Texas Capitol on Wednesday, demanding expansion of the Medicaid program, but Democrats said political pressure from the governor was preventing the Legislature from considering the measure. Chanting, "We need health care, we can't wait," members of the Texas Organizing Project marched around the Capitol's rotunda holding photos of key lawmakers with the word "FAILED" stamped on them (Tomlinson, 5/9).

The Texas Tribune: As Clock Ticks, Chance For Medicaid Expansion Dwindles
With the prospect of Medicaid expansion on life support, protesters gathered at the Capitol on Wednesday to urge state leadership to expand coverage to poor adults, and state Democrats announced that they’re still searching for a legislative vehicle to expand coverage (Aaronson and Batheja, 5/8).

CQ HealthBeat: Republican Legislator Resistance To Medicaid Slows Expansion
Action in the Ohio legislature — or rather, a lack of it — is raising questions about whether Ohio will be the next state that does not implement a Medicaid expansion even though its Republican governor supports it. That was the case in Florida, where Gov. Rick Scott first opposed the idea of broadening eligibility for the program (Adams, 5/9).

California Healthline: Compromise Proposed For Medi-Cal Expansion
A new plan is expected to be unveiled today offering a compromise approach to the state's optional Medi-Cal expansion. Health Access California, a not-for-profit health advocacy organization came up with the plan as a bridge between the state's rough outline in the budget for two choices -- a state-administered or county-administered approach. More than one million Californians will be newly eligible for Medi-Cal under the optional expansion to those people making up to 138 percent of federal poverty level. The federal government will pay 100 percent of expansion costs for the first three years, and 90 percent thereafter (Gorn, 5/8).

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California's Health Exchange Board Given Unusual Degree Of Secrecy Over Contracts

The Associated Press reports that a California state law created a state agency to oversee implementation of the health law and gave it authority to keep what it spent on contractors a secret.

The Associated Press/The Washington Post: AP Exclusive: Lawmakers Granted Calif. Health Exchange Unusual Secrecy In Contracting Records
A California law that created an agency to oversee national health care reforms granted it sweeping authority to conceal spending on the contractors that will perform most of its functions, creating a barrier from public disclosure that stands out nationwide. The degree of secrecy afforded Covered California appears unique among states attempting to establish their own health insurance exchanges under President Barack Obama's signature health law (5/9).

Also, developments regarding Colorado's health exchange -

Kaiser Health News: Capsules: Colo. Launches Ad Campaign For New Online Marketplace
With less than five months until Colorado’s new online health insurance marketplace opens for business this fall, officials are concerned that few state residents have heard of it. This week, it became the first state to launch a public awareness campaign with television, print, radio and billboard ads that will cost $2 million and run two months. The TV ad shows a woman at her kitchen table scrolling through health plan information on the Connect for Health Colorado website. The voice over says the website lets people shop and buy a health plan online (Galewitz, 5/8).

Health Policy Solutions (a Colo. news service): Governor Adds Deputy To Health Exchange Board
Colorado's governor has added his deputy chief of staff to the state’s health exchange board and says he wants the project to come in on time and on budget. Kevin Patterson, Gov. John Hickenlooper's deputy chief of staff and chief administrative officer, joined the board following news that Colorado needed a mediator to help settle differences between the state's Medicaid managers and those building the state’s new health exchange (Kerwin McCrimmon, 5/8).

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Capitol Hill Watch

Cantor Schedules (Yet Another) Health Law Repeal Vote

The vote, which is likely to take place next week, will be the first one in 2013. There have been more than 30 votes to repeal all or parts of the health overhaul since its passage in 2010.

The Washington Post: House To Vote Again On Repealing 'Obamacare' Next Week
Cantor's decision to schedule the vote comes as he’s devoted most of the House calendar in recent months to a series of bills that fit within his "making life work" agenda that emphasizes kitchen-table issues over slashing federal spending. Among such bills is the "Working Families Flexibility Act," which would give private employers the option of offering workers additional time off in lieu of overtime pay and is set for a vote Wednesday (O'Keefe and Kane, 5/8).

The Wall Street Journal's Washington Wire: House Plans Another Vote To Repeal Obama Health Law
Republicans remain implacably opposed to the health-care law, more than three years after it was signed into law by Mr. Obama. Many of the law's key provisions come into effect from 2014, including the creation of health-care exchanges to help individuals who don't receive health insurance through work to group together to purchase more affordable insurance (Boles, 5/8).

Politico: Eric Cantor Sets Repeal Vote On Health Care Law For Next Week
It will be the first vote against all or part of the law this year. The House had voted more than 30 times on repealing all or parts of the law since it passed in March 2010, but many members — especially first-year lawmakers — were pushing leadership to get a vote on the record in 2013 (Haberkorn, 5/8).

The Hill: ObamaCare Repeal Vote Next Week In House
In a nod to the right, House Republican leaders will once again seek to repeal President Obama’s healthcare law next week. The decision, announced Wednesday by House Majority Leader Eric Cantor (R-Va.), represents a shift by top Republicans in the lower chamber (Baker, 5/8).

In other news from Capitol Hill -

The Hill: Senate Fails To Approve Resolution Condemning Illegal Medical Practices
Sen. Mike Lee (R-Utah) tried to pass a Senate resolution that would have condemned illegal abortion practices. Lee asked unanimous consent to pass his resolution on Wednesday in reaction to the case of Kermit Gosnell, a Philadelphia abortion doctor who is on trial for performing illegal and unsafe abortions (Cox, 5/8).

CQ HealthBeat: Health Panel Backs Drug Measures
A House panel advanced measures Wednesday to renew animal drug user fees and to overhaul the prescription drug supply chain. The Energy and Commerce Subcommittee on Health first approved, by voice vote, a bill that would reauthorize user fees that fund the Food and Drug Administration’s approval processes for brand-name and generic drugs for animals. Both current authorizations expire Oct. 1 (Marcos, 5/9).

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Health Care Marketplace

New Data Help Explain Hospital Pricing, But Experts Caution That Medicare And Insurers Get Much Lower Rates

Although the government releases a list of what hospitals across the country charge for common procedures in an effort to make health costs more transparent, few patients or their insurers pay that.

The Wall Street Journal: Data Shine Light On Hospital Bills
The release of government data showing wide variation in hospital pricing removes a layer of secrecy but probably won't make medical charges more uniform, experts said Wednesday. … Hospitals are required to set an official value of treatment for a given procedure, but private insurance carriers, Medicare and Medicaid—covering low-income people—all negotiate their own reimbursement rates with providers. Some uninsured people could be billed for the list price, although the amount they end up paying is also often subject to negotiation (Radnofsky and Barry, 5/8).

Los Angeles Times: Hospital Prices Diverge Wildly, U.S. Data Show
New Medicare data reveal wildly varying charges among the nation's hospitals for 100 of the most common in-patient treatments and procedures, calling into question medical billing practices just as U.S. officials try to rein in rising costs. The escalating price of medical care may complicate the rollout of the new federal healthcare law, which is designed to make health insurance affordable for millions of uninsured Americans next year. And federal officials said they hope the data will encourage more price competition and make consumers better healthcare shoppers (Terhune and Poston, 5/8).

Politico: Big Price Swings Among Hospitals Driving Costs
Although the data are only available in a dense Excel spreadsheet, administration officials say they're hopeful to crunch the numbers in a way that's more accessible to consumers. It also comes on the heels of a Time magazine story by Steve Brill, which highlighted hospitals' use of "chargemaster" lists of procedure prices. "This release helps to highlight the opaque pricing/payment system used in health care, and along with the recent Time magazine story, should increase the public awareness of this fact," said Don Taylor, a public policy professor at Duke University. In response to the HHS release, Brill hailed the "fire hose of data — which prints out at 17,511 pages" as a "tipsheet for reporters in every American city and town, who can now ask hospitals to explain their pricing" (Cheney, 5/9).

The Associated Press: High Hospital Bills Go Public, But Will It Help
For the first time, the government is publicly revealing how much hospitals charge, and the differences are astounding: Some bill tens of thousands of dollars more than others for the same treatment, even within the same city.  Why does a joint replacement cost 40 times as much at one hospital as at another across the country? It's a mystery, federal health officials say (Cass and Neergaard, 5/9).

Marketplace: Let's Go Shopping For Surgery: New Government Data Shines Light On Health Care Cost Variations (Audio)
Let's say you needed a pacemaker and you went to Uniontown hospital in Uniontown, Pennsylvania, the charge might be $20,000. If you went to Phoenixville Hospital near Philadelphia, the charge might have been $211,000. Hospitals list radically different charges "because they can," says Gerard Anderson, director of the Johns Hopkins Center for Hospital Finance and Management. "Nobody's been looking at their charges over the last 30 years." In the past, hospitals have kept their charges hidden, according to Peter Ubel , professor of Business Administration and Medicine, at Duke University. "If I'm negotiating prices with insurers, I don't want people to know about it" (Ben-Achour, 5/8).

The Fiscal Times: Why Your Hospital Bill Is Total Negotiable
Yesterday, for the first time, the government revealed how much hospitals charge for 100 of the most common medical procedures. The data revealed a seemingly random pricing scheme with the cost of the same procedure varying by tens of thousands of dollars from hospital to hospital. But it also painted a misleading picture of how the health care system works. Hospitals charge prices they know Medicare will not pay. They use these high prices as a starting point for negotiation and in the end, Medicare and private insurance pay just a fraction of the original charge. Consumers rarely foot the bill (Francis, 5/9).

Kaiser Health News: Capsules: Audio: Getting To The Bottom Of Hospital Pricing
The Centers for Medicare & Medicaid Services released data Wednesday on variations in hospital pricing and how much Medicare has actually paid to individual hospitals for various procedures. Jordan Rau joined NPR's "Talk of the Nation" Wednesday afternoon to discuss what the data tell us about the the cost of health care and whether higher prices are correlated with better quality (5/9).

Meanwhile, AP profiles two friends facing big medical bills and their efforts to help each other.

The Associated Press: 2 Florida Teens Who Are Best Friends Help Each Other Pay For Expenses During Cancer Treatment
Ashley was diagnosed with T-cell lymphoma in September. She needed a bone marrow transplant and would be in isolation for months. Tony knew how that would affect Ashley’s family financially. … Starting with a garage sale and car wash, he gathered donations. Then he opened an account with www.giveforward.com, a site dedicated to raising money for people with medical bills. Within months, Tony raised about $25,000 for Ashley. Ashley's mom, Pat Myers, who had quit her job as a website programmer so she could care for her daughter, was overwhelmed. Myers recalled thinking: "I hope we never have to repay the favor." But two weeks after Ashley's diagnosis, Tony discovered his cancer returned. He would need costly treatment in Bethesda, Md., at the National Institutes of Health. Ashley, from her hospital bed, told her mother that she wanted to start an online fundraiser for her friend (5/9).

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Expiring Patents Drive Drug Spending's First Time Fall

Patient spending on prescription drugs fell in 2012 -- for the first time ever, a new study reports -- due in part to expiring patents on brand-name drugs.

Kaiser Health News: Capsules: Study: Per Capita Rx Spending Fell For First Time In 2012
Now on Kaiser Health News' blog, Alvin Tran reports on a study tracking per capita prescription drug spending: "Americans' per capita spending on prescription drugs fell last year for the first time on record, according to a report released Thursday by the IMS Institute For Healthcare Informatics firm headquartered in Danbury, Conn., which tracks pharmaceutical sales and other health care data" (Tran, 5/9).

Reuters: U.S. Spending On Medicines Fell For First Time In 2012
Patent expirations on big-name drugs such as Lipitor and Plavix has resulted in modestly less spending on medicines in the United States for the first time in at least 55 years, according to a report released on Thursday. Overall U.S. spending on medicines totaled $325.8 billion in 2012, down 1 percent from 2011, according to the report from the IMS Institute of Healthcare Informatics. Adjusting for population, per capita spending fell 3.5 percent to $898 (Beasley, 5/9).

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State Watch

State Roundup: Miss. Gov. Says Medicaid Can Go On Without Reauthorization

A selection of health policy news from Mississippi, Kansas, California, Georgia, Minnesota, Wisconsin, Massachusetts and Colorado.

The Associated Press: Miss. Governor Says He Could Run Medicaid Program
Mississippi Gov. Phil Bryant says he thinks he can run Medicaid even if lawmakers don't reauthorize the program or set its budget by the time the state's new fiscal year starts July 1. The Northeast Mississippi Daily Journal reported Bryant's remarks and said he spoke about Medicaid after taking part in a tourism event at the state Capitol (5/9).

Kansas Health Institute: More Than 1,000 Rally At Statehouse For DD Carve-Out
A Statehouse rally today that coincided with the start of the Legislature's wrap-up session drew about 1,100 people from across the state to protest Gov. Sam Brownback's plan to include long-term supports for the developmentally disabled in KanCare. ... [Protestors] at the rally did not believe that the insurance companies hired by the state to manage its Medicaid program had the experience to handle long-term services for the developmentally disabled (Shields, 5/8).

Los Angeles Times: California Ranks 11th In Hospitals With A Grades For Safety
Ronald Reagan UCLA Medical Center improved slightly from an F to a D in a national hospital safety report released Wednesday, while Cedars-Sinai Medical Center stayed at a C grade. Leapfrog Group, a nonprofit health care quality organization, based the scores on an analysis of infections, injuries, medication errors and other problems that cause patient harm or death. The organization publicizes the scores in an effort to inform patients and reduce safety problems, said Leah Binder, its president and chief executive (Gorman, 5/8).

The Associated Press: SF Eateries Pay $845K To Settle Health Care Claims
San Francisco's city attorney says his office has recovered nearly $845,000 from 19 restaurants that allegedly charged customers for the cost of complying with the city's universal health care law but did not use most of the money for that purpose. City Attorney Dennis Herrera said Wednesday that the money had come from eateries that took advantage of a one-time amnesty program his office announced in January (5/8).

Georgia Health News: A Prescription To A Fun Place Could Be A Lifesaver
Overweight patients are being encouraged to take a walk, if not a hike. A unique collaboration between the Georgia Association of Physician Assistants (GAPA) and Georgia State Parks seeks to promote physical fitness in a fresh-air way. For a day trip to one of Georgia’s state parks, there’s normally a $5 parking fee. But nowadays, physician assistants in the state can hand out "Rx For Fitness" prescriptions that allow that charge to be waived (Kanne, 5/8). 

MPR News: Growth Continues At Mayo Clinic's Three Campuses
In his pitch to state legislators for $500 million to help Mayo Clinic with its $5 billion expansion, Mayo Clinic President and CEO Dr. John Noseworthy has repeatedly said if Minnesota does not provide a taxpayer subsidy, other states would be eager for Mayo Clinic to expand. Two of the most logical places would be Florida and Arizona, where existing Mayo Clinic campuses are growing steadily. Mayo Clinic is investing hundreds of millions of dollars at all three of its campuses to strengthen each as a major regional medical hub (Baier, 5/8).

HealthyCal: Ballot-Mandated Drug Treatment Cut, Despite Success
In 2000, California voters overwhelmingly approved Prop 36, a ballot measure that offers non-violent drug offenders treatment instead of jail. But now the Substance Abuse and Crime Prevention Act is on life support, if not altogether dead, despite data that shows it has saved taxpayers money and tamped down recidivism among its participants (Urevich, 5/9).

Milwaukee Journal Sentinel: Wisconsin Assembly Passes Measure That Changes What Doctors Must Tell Patients For Diagnoses 
The Assembly approved a bill Wednesday changing the standard for what doctors must tell patients when they diagnose them, which Republicans said was necessary in light of a state Supreme Court decision that they see as creating too many problems. Also, the Assembly passed a bill that would delay trials in cases where people are exposed to asbestos. Both measures now go to the Senate, which like the Assembly is controlled by Republicans (Marley, 5/8).

Boston Globe: Massachusetts To Require Labs To Test Marijuana For Medicinal Use
Massachusetts is the first state that will require independent labs to test the safety and quality of marijuana sold for medical use, under final rules that regulators unanimously approved Wednesday. The tests will screen for contaminants such as heavy metals, pesticides, and mold. They will also identify and measure the active chemical compounds in the marijuana (Lazar, 5/9).

Health Policy Solutions (a Colo. news service): Pedaling For Health
In an ambitious new health agenda, Gov. John Hickenlooper is pledging to cut the number of uninsured people in Colorado by 520,000, prevent 150,000 Coloradans from becoming obese and reduce Medicaid costs by $280 million. Hickenlooper this week released a report called The State of Health as part of his commitment to make Colorado the healthiest state in the nation. … The report centers on four key areas of focus: wellness and prevention, expanding health access and coverage, improving health systems and boosting value while cutting costs (Kerwin McCrimmon, 5/8).

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Weekend Reading

Longer Looks: A Wife's Alzheimer's; Doctors and Drug Companies

Every week reporter Ankita Rao selects interesting reading from around the Web.

Los Angeles Times: A Wife's Alzheimer's, A Husband's Obsession
When his wife got Alzheimer's disease, lawyer Ken Chiate invested all his hopes in an unorthodox treatment. Nothing, it seems, could make him give up on it. ... Jeannette's difficulties seemed to emerge out of nowhere. She couldn't grasp the rules of a dice game. She kept asking questions her husband had just answered. ... in 2001, at age 58, she was diagnosed with mild cognitive impairment. As months and years passed, she fell into an angry haze that was determined to be Alzheimer's disease. ... [Chiate] hated being told by doctor after doctor that there was no way to stop her disintegration. "I'm a fix-it guy," he says. "That's what I do. I fix people's problems. This was just a problem that needed fixing" (Alan Zarembo, 5/5).

The Atlantic: Getting To The Right Relationship Between Doctors And Drug Companies
The pharmaceutical industry is held in remarkably low esteem right now. It's seen as a bunch of nefarious pushers who pay off vulnerable doctors to prescribe their latest expensive, mediocre product. Physicians who work with pharma companies are considered especially suspect, routinely described as "cozy," "in bed with industry," and "on the take." … I think they have it backwards, though. Drug companies -- at least every one that I've worked for or consulted with -- would like to develop important new medicines that improve health and save lives. That's what gets every industry researcher I know up in the morning, and what keeps them going through the many highs and lows that characterize the scientific process (Dr. David A. Shaywitz, 5/8).

The New York Times: The Changing Face Of Medical School Admissions
At an assembly during my first week of medical school, one of the institution's venerable deans took to the podium to announce that our class marked a turning point in the school's history: nearly half of us were female … two perspective pieces in The New England Journal of Medicine reveal that admissions policies have been quietly but radically changing in a handful of medical schools. And those changes have yielded surprisingly successful results. ... Since Boston University School of Medicine began incorporating holistic review in all phases of its admissions process five years ago, faculty members have noted that students appear to be more collegial, supportive of one another, open to new ideas and perspectives and engaged in community activities (Dr. Pauline W. Chen, 5/8).

The American Spectator: How Low Can Part-Timers' Hours Go?
Say you're an employer with an employee who works 30 hours a week. If you have 50 employees or more come next year, you'll be required either to provide her with health-care coverage, which the Affordable Care Act will by then mandate for all employees who work at least 30 hours a week, or you'll have to pay a $2,000 penalty for failing to cover her. Or, you could just cut her weekly hours to 29. That way, you won't have to pay a dime, in either insurance costs or penalties. ... President Obama has said that if he could devise a system from scratch, he'd prefer single-payer, but as events would have it, we have a trillion-dollar employer-based private health insurance industry already in place. The fact that employers in both the private- and public-sectors are now cutting their workers' hours to game that system is just further confirmation of how dysfunctional and cruel that system really is (Harold Myerson, 5/6).

American Spectator: President Obama And 'Uncaring' Pro-Lifers
In President Obama's view, pro-life politicians who wish to defund Planned Parenthood (PP) are working tirelessly to "shut women out" from health care. That's the president's argument at its core: pro-lifers want to abandon needy women. ... Pro-life people care to a tremendous degree for women, especially in a relative sense. Working often at the grassroots level, pro-lifers have created twice the number of care-oriented clinics as pro-choice advocates. ... [Some] will pound the podium, and raise the old falsehoods without factual basis, and tell the world that pro-lifers do not care for women. To this point, however, the data and the record is clear: the pro-life side has devoted itself to the needy (Owen Strachan, 5/2). 

The New Republic: Plan B: The Political Football Obama Keeps Punting
The administration's Plan B actions epitomize the unfair double standards that govern women's health: They face barriers to reproductive care that aren't imposed elsewhere in medicine. This is true in the case of abortion clinics, which must work under strict regulations unheard of at other low-risk outpatient centers. And true, to a much lesser extent, of Obamacare, which has been forced to provide a workaround for birth control coverage to avoid the ire of religious groups. And it's true of the gross disparity between the laws surrounding Plan B and those that govern any other drug in the country (Nora Caplan-Bricker, 5/3).

Health Affairs: To Cover Their Child, One Couple Navigates A Health Insurance Maze In Pennsylvania
Our son, Erik, was born in Philadelphia in April 2012. Two days after his birth, we applied for coverage for him through the Pennsylvania Children’s Health Insurance Program (CHIP), which covers children whose families do not qualify for Medicaid but cannot afford to buy health insurance. Under CHIP rules in our state, he should have been covered within four to six weeks. In fact it would be six months before he was covered. Changes coming under the Affordable Care Act are designed to make it easier for parents like us to navigate the CHIP and Medicaid programs, but it remains to be seen whether they will have the intended effect (Ari B. Friedman and Tara Mendola, May 2013).

The New York Times: A Forgotten Pioneer Of Vaccines
We live in an epidemiological bubble and are for the most part blissfully unaware of it. Diseases that were routine hazards of childhood for many Americans living today now seem like ancient history. … The name Maurice Hilleman may not ring a bell. But today 95 percent of American children receive the M.M.R. — the vaccine for measles, mumps and rubella that Dr. Hilleman invented, starting with the mumps strain he collected that night from his daughter.  It was by no means his only contribution (Richard Conniff, 5/8).

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Editorials and Opinions

Viewpoints: A Nurse Finds Getting Coordinated Care For Her Husband Challenging; Iowa Legislator Outlines Problems With Medicaid; Researcher's Quest To Save Experiments After Sandy

Los Angeles Times: After Hospital Care, The Test Begins
In 2011, my husband, Eric, a trial attorney, was felled by a brain stem stroke just before he was to board a flight at O'Hare in Chicago. He was just 53 years old with no prior health conditions or problems. From the outset, we knew his recovery and rehabilitation would be long and difficult. We didn't know that his transition to post-hospital medical care would be just as challenging. I'm the dean and a professor at the Jefferson School of Nursing at Thomas Jefferson University in Philadelphia, and I'm a registered nurse. I thought my training and access to resources would aid in managing my husband's care. Instead, our experience showed me the many flaws in the world of medical "care coordination" and "transition management" (Beth Ann Swan, 5/9).

The Washington Post: A More Transparent Battle With Bird Flu
This variant, known as H7N9, has not reached U.S. shores, but it is a reminder of the unpredictable nature of influenza. It might cause a pandemic, or settle into a slow burn for years, or simply die out. At this stage, no one knows. The uncertainty ought to remind us of past lessons about infectious disease and globalization, which remain as urgent as ever (5/8).

Journal of the American Medical Association: ACA Implementation Starts To Get Real
President Obama spoke extensively about implementation of the Affordable Care Act (ACA) during his recent press conference, particularly about what it means for people. …The President's comments come amid reports that the American people remain confused about how the ACA (or “Obamacare”) will work. People will come to understand much more about the law as federal, state, and private outreach campaigns kick into high gear this summer, but now may be a good time to review how different segments of the public will (and will not) be affected by the ACA (Larry Levitt, 5/8).

Health Policy Solutions (a Colo. news service): Get Covered Or Run For Cover
I would have been more comfortable if the Obamacare debate had centered on two other issues. One is how do we bend the cost curve?  No one has been able to show  how this will get done.  I suspect we will crash through the 20 percent of GDP ceiling soon. Keep it up and eventually half the population will be caring for the other half. The only question is which half will be paying taxes. The other question that has been ignored is — tell me again — how does the exchange create a competitive marketplace? (Francis M. Miller, 5/8).

Des Moines Register: Healthy Iowa Plan Better For Low-Income Residents
I have the privilege of guiding the legislation pertaining to the Healthy Iowa Plan, the alternative to Medicaid expansion, in the Iowa House. ... The Healthy Iowa Plan is a better option than Medicaid expansion at keeping low-income Iowans healthy while sustaining a thriving economy. It incentivizes members to take an active role in their own health and health plans, using modern accountability techniques, regional structures, local primary care facilities and personal reward health incentive accounts. Medicaid needs an overhaul and we all know it (State Rep. Walt Rogers, 5/7).

Reuters: Putting A Price On Illness
Today, the federal Centers for Medicaid and Medicaid Services released a trove of seemingly basic data to the public for the first time: the prices American hospitals charge Medicare for the 100 most common inpatient procedures. ... This data might make the American healthcare market a bit more transparent, but it's still far from rational. In March, Ezra Klein noted that there's no semblance of coherence among the prices insurers themselves pay for common procedures, devices and pills; each insurer negotiates their own pricing deals for these things with healthcare providers. Sadly, the only constant is that Americans pay far more than other countries for the same basic, relatively routine medical care — with worse outcomes (Ryan McCarthy, 5/7). 

New England Journal Of Medicine: Saving Specimens After Sandy
On a Friday 6 months ago, a hurricane and two storms were on course to converge over New York. In preparation at the laboratory that day, we made contingency plans in case of a power outage. Three of us would come in as soon as it was safe to check the freezers and incubators. Our laboratories were on the 18th floor of the Veterans Affairs (VA) New York Harbor Healthcare System, part of the New York University (NYU) School of Medicine complex on the banks of the East River in Manhattan. Here, our group was working on the development of HIV vaccines and new diagnostic tests for tuberculosis. The news Sunday was that the confluence of the storms, a full moon, and an unusually high tide were going to result in a tidal storm surge on Monday evening (Susan Zoller-Pazner, 5/8). 

New England Journal Of Medicine: Improving Obesity Prevention At The Local Level – Emerging Opportunities
Thanks to a coalescence of available scientific evidence and new regulatory possibilities, there is currently substantial opportunity for local innovation in addressing the public health problem of obesity. One promising example stems from a recent federal obesity-prevention initiative: the menu-labeling provisions of the Affordable Care Act (ACA), which require chain restaurants operating 20 or more locations to provide calorie information on their menus and menu boards, along with a statement addressing daily recommended caloric intake (Sara Bleich and Lainie Rutkow, 5/9).

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Stephanie Stapleton

Andrew Villegas

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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.