Daily Health Policy Report

Friday, May 9, 2014

Last updated: Fri, May 9

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Information Technology

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Bipartisan Praise For Nominee To Lead HHS In Senate Hearing

Despite the warm reception from members of the Senate HELP panel, Republican senators had tough questions for Sylvia Mathews Burwell about implementation of the health law. Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call's Melissa Attias discuss what's next for the nomination (5/8). Read the transcript or listen to the audio.

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A Reader Asks: Where Can I Find Insurance Options Between Open Enrollments?

Kaiser Health News consumer columnist Michelle Andrews answers a reader’s question about what happens when, because of special circumstances, one must shop for health coverage through the online insurance marketplaces even though it’s not open enrollment season (Andrews, 5/9). Read her response.

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Cops In Conn. Train In Mental Health 101 Class

WNPR’s Jeff Cohen, working in partnership with Kaiser Health News and NPR, reports: “How do you tell the difference between someone who needs to be taken to jail and someone who needs to be taken to the hospital? That’s a big concern in Connecticut, where the intersection of law enforcement and mental health has been a huge issue since the Sandy Hook Elementary School shootings in Newtown in 2012” (Cohen, 5/8). Read the story.

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Capsules: During Confirmation Hearing, Burwell Pledges Support For CHIP; IRS Urged To Broaden Preventive Coverage In High-Deductible Plans

Now on Kaiser Health News’ blog, Mary Agnes Carey writes about Sylvia Mathews Burwell's comments about CHIP: “Advocates of the Children’s Health Insurance Program cheered Thursday when President Obama’s choice to head the Department of Health and Human Services said she supports continued funding for the program, which covers about 8 million low-income children whose families’ income exceeds Medicaid’s eligibility guidelines” (Carey, 5/9).

Also on Capsules, Julie Appleby reports on efforts to broaden preventive coverage in high-deductible plans: "High deductible health plans paired with tax-free savings accounts — increasingly common in job-based insurance and long a staple for those who buy their own coverage – pose financial difficulties for people with chronic health problems. That’s because they have to pay the annual deductible, which could be $1,250 or more, before most of their medications and other treatments are covered" (Appleby, 5/9). Check out what else is on the blog.

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Political Cartoon: 'Out Of Step?'

Kaiser Health News provides a fresh take on health policy developments with "Out Of Step?" By Clay Bennett. 

Here's today's health policy haiku: 

MIXED EMOTIONS

A Senate lovefest
For Sylvia M. Burwell
But not for health law
-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

Obama's Pick To Head HHS Draws Bipartisan Praise In Confirmation Hearing

Sylvia Mathews Burwell, who has been nominated by the White House to become the next Health and Human Services secretary, also faced tough questions about the health law's implementation and the trouble-plagued healthcare.gov.

The New York Times: Pick To Replace Sebelius Draws Senators’ Praise At Confirmation Hearing
Sylvia Mathews Burwell, President Obama’s nominee to replace Kathleen Sebelius as secretary of health and human services, charmed senators at a surprisingly cordial confirmation hearing on Thursday. And she even picked up a couple of Republican endorsements (Pear, 5/8).

The Hill: McCain Makes Cameo Appearance To Praise Obama’s HHS Nominee
Sen. John McCain made a cameo appearance at a hearing on Thursday to heap praise on President Obama’s nominee for secretary of Health and Human Services (HHS). The Arizona Republican showed up at the confirmation hearing for Sylvia Matthews Burwell even though he isn’t a member of the Senate panel that is vetting her nomination (Al-Faruque, 5/8).

Los Angeles Times: Obama’s Pick To Head Health And Human Services Draws GOP Support
“Regardless of my objections to Obamacare, the Department of Health and Human Services needs competent leadership,” Sen. John McCain (R-Ariz.) told the Senate health committee in introducing Sylvia Mathews Burwell. “I believe Ms. Burwell has the qualifications” (Levey, 5/8).

The Washington Post: Fixing Healthcare.gov Would Be Top Priority, HHS Nominee Sylvia Mathews Burwell Says
But the wide-ranging hearing also touched on some of the more contentious aspects of the law that she would be mired in: the technical problems that continue to plague the federal health insurance Web site, the unfinished job of expanding Medicaid and the president’s broken promise that people who liked their old plans could keep them (Somashekhar, 5/8).

The Associated Press: HHS Nominee Faces GOP Questions On Health Law
Burwell defended the Affordable Care Act, asserting that it has improved the economy, held down the growth of health costs, reduced premiums and expanded coverage. … Republican senators disagreed. The top committee Republican, Sen. Lamar Alexander of Tennessee, warned her that Republicans hope to retake the Senate in November and scale back the law in numerous ways (Werner, 5/8).

The Wall Street Journal: Sylvia Burwell, HHS Nominee, Answers Senators' Questions
Ms. Burwell was asked about her plans to continue the Obama administration's policies in implementing the health law, including whether she would further extend canceled policies or back other substantive changes to provisions in the law, such as the requirement that employers offer coverage to all workers clocking 30 hours a week or more, or pay a penalty. The nominee gave careful, noncommittal answers (Radnofsky and Hughes, 5/8).

Politico: Burwell Gets Some GOP Boost For HHS Post
Health and Human Services nominee Sylvia Mathews Burwell began her confirmation hearings Thursday with a defense of Obamacare — and with strong endorsement from a prominent Republican critic of the health law: John McCain. Burwell made no promises to change the Affordable Care Act as she testified in front of the Senate Health, Education, Labor and Pensions Committee. Democrats widely praised her while Republicans blasted the health law that Burwell will have to operate and focused on state-specific health care issues (Haberkorn, 5/9).

Kaiser Health News: Health On The Hill: Bipartisan Praise For Nominee To Lead HHS In Senate Hearing
Despite the warm reception from members of the Senate HELP panel, Republican senators had tough questions for Sylvia Mathews Burwell about implementation of the health law. Kaiser Health News staff writer Mary Agnes Carey and CQ Roll Call's Melissa Attias discuss what's next for the nomination (5/8).

Kaiser Health News: Capsules: During Confirmation Hearing, Burwell Pledges Support For CHIP
Advocates of the Children’s Health Insurance Program cheered Thursday when President Obama’s choice to head the Department of Health and Human Services said she supports continued funding for the program, which covers about 8 million low-income children whose families’ income exceeds Medicaid’s eligibility guidelines (Carey, 5/9).

PBS NewsHour: Republicans Praise Reputation Of Obama’s HHS Secretary Choice, Take Aim At Affordable Care Act 
Democrats also touted benefits of the law, and Connecticut’s Chris Murphy zeroed in on Republican governors who’ve balked at embracing key provisions, such as expanding Medicaid (Sreenivasan, 5/8).

NBC News: Hearing On New HHS Secretary Starts With Attack On Obamacare
Burwell said she hoped to win more states over to the idea of expanding Medicaid. "Both the results and the willingness for conversation are the two ways that will make progress on that front," she said (Fox, 5/9).

 

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VA Secretary Shinseki Subpoenaed In VA Wait List Probe

The subpoena asks for all email and other correspondence to look into the alleged secret wait list that sought to make wait times at a Phoenix VA hospital seem shorter than they really were.

The New York Times: V.A. Officials Subpoenaed For Inquiry Into Wait List
A House committee voted Thursday to subpoena the head of the Department of Veterans Affairs, Eric Shinseki, and other top department officials, stepping up scrutiny of the agency amid allegations that secret waiting lists were used to cover up long delays for doctors’ appointments. The subpoena from the Committee on Veterans’ Affairs covers all emails and other correspondence related to the “destruction or disappearance of an alternate or interim wait list” at the department’s Phoenix medical center. It asked for all emails from April 9 to May 8 sent to or from Mr. Shinseki; Dr. Robert A. Petzel, the department’s under secretary for health; Will A. Gunn, the department’s general counsel; and five other senior officials (Oppel, 5/8).

The Wall Street Journal: House Committee Subpoenas Emails From Veterans Affairs Officials
The House Committee on Veterans Affairs voted Thursday to subpoena Veterans Affairs Secretary Eric Shinseki and other top officials in the department to turn over materials related to the panel's investigation of practices at a VA hospital in Phoenix. The panel voted unanimously to subpoena email and correspondence written over the past month by eight VA officials, including Mr. Shinseki and the VA's general counsel, that may relate to an alleged secret wait list intended to make official patient wait times at the Phoenix VA Health Care System seem shorter than they actually were (Kesling, 5/8).

Modern Healthcare:  House VA Panel Subpoenas Arizona Official In Vet Deaths
The House Veterans' Affairs Committee voted unanimously Thursday to subpoena VA Secretary Eric Shinseki and other senior VA officials to supply documents from the department as allegations continue to swirl over the VA's Phoenix health system and the department's response and possible cover-up of problems there. The subpoena will cover e-mails and other written correspondence exchanged since the morning of April 9 in which Shinseki and department leaders allegedly discussed the destruction of an alternate wait list for patients at its Phoenix facility (Landen, 5/8).

CNN: House Panel Subpoenas VA Secretary Shinseki For Phoenix Hospital Documents
A House committee voted Thursday to subpoena Veterans Affairs Secretary Eric Shinseki for emails and documents tied to an alleged secret "waiting list" for sick veterans at a Phoenix VA hospital. The vote on the House Veterans Affairs Committee comes as Shinseki begins to face calls -- from Congress and beyond -- for his resignation. In an interview with CBS News, Shinseki brushed aside those calls, while acknowledging that the Phoenix controversy "makes me angry” (5/8).

PBS NewsHour: Under Scrutiny In The Past, VA Clinic Delay Allegations Strike A Chord
Veterans Affairs Secretary Eric Shinseki is pushing back against calls for him to resign after allegations that dozens of patients have died because of delayed treatment at an agency hospital. Shinseki has ordered a nationwide review of access to care at all VA clinics. Jeffrey Brown learns more from Phillip Carter from Center for a New American Security and Brian Skoloff of the Associated Press (Brown, 5/8).

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Senate To Vote On Exempting Veterans From Employer Mandate

Meanwhile, USA Today looks at Congress' failure to pass legislation that would address the fragmentation of mental health services following the 2012 shootings in Newtown, Conn., and Sen. Lindsey Graham plans to push a bill that would ban abortion after 20 weeks of pregnancy.

The Hill:  Reid Sets Up Vote On O-Care Tweak 
Senate Majority Leader Harry Reid (D-Nev.) set up a procedural vote on a House bill that would allow companies not to treat veterans as full-time employees under the Obamacare employer mandate. On Thursday, Reid filed cloture on the motion to proceed to H.R. 3474, the Hire More Heroes Act of 2014, meaning the first procedural vote on that measure could take place next Tuesday or Wednesday (Cox, 5/8).

USA Today: Congressmen Introduce Competing Mental Health Bills
In the weeks after the shootings in Newtown, Conn., many mental health advocates hoped that the tragedy would lead Congress to address problems in the country's fragmented mental health system. Nearly a year and a half later -- and in spite of several additional shootings -- Congress has yet to pass major mental health reforms (Szabo, 5/8).

Politico: Graham Plans Push On Abortion Bill 
Senate Republicans, led by Lindsey Graham, are planning to ramp up their advocacy for an abortion bill around the high-profile anniversary of a former abortion provider’s murder conviction. The South Carolina Republican is organizing a group of his colleagues to speak in support of a bill that would federally ban abortions after more than 20 weeks of pregnancy, legislation that has the support of 41 Senate Republicans and has already passed the House. Graham is centering this legislative push on the May 13 anniversary of Kermit Gosnell’s conviction for killing infants that were born alive (Everett, 5/8).

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Health Reform

Mass. Plan For New Health Insurance Exchange Has Estimated Price Tag Of $121 Million

After millions of dollars have already been spent on attempts to fix Massachusetts' online marketplace, known as the Health Connector, insurers and some exchange board members say the cost is too high. Meanwhile, news outlets also report on developments from Connecticut, Maryland, California, Oregon and Illinois.   

The New York Times: Massachusetts Pushes Fix For State Health Exchange
The board of the broken Massachusetts health insurance exchange voted on Thursday to support a state plan to buy new software to help people enroll in coverage, while also preparing to join the federal marketplace if the system is not ready by fall. But insurers complained about the plan, and several members of the exchange board expressed concerns about the cost — an estimated $121 million, on top of tens of millions already spent on the broken exchange, known as the Health Connector (Goodnough, 5/8).

The Boston Globe: New Mass. Health Website Estimated To Cost $121M
The estimated price tag for ensuring that Massachusetts has a functioning health insurance website is $121 million, and, even then, consumers are unlikely to get a one-stop shopping experience this fall as they search for health plans, state officials said Thursday. Sarah Iselin, the insurance executive whom Governor Deval Patrick tapped to oversee repairs to the state’s broken Health Connector website, said Massachusetts intends to ask the federal government to pay for the fix. The state has already received $174 million in federal funds to build a site that is compliant with the federal health care law, but about a third of that money has been spent, and Iselin said the Patrick administration is sorting out how much of the remaining $117 million has been committed to pay contractors for work already done (Lazar, 5/8).

Los Angeles Times: Regulating State’s Health Premiums Could Hurt Exchange, Report Says
Obamacare in California could suffer setbacks, delays and legal challenges if voters this year approve a statewide ballot initiative to regulate insurance rates, a new industry-backed report warns. Those predictions drew immediate fire from Insurance Commissioner Dave Jones. He said the concerns are nonsense and passage of the ballot measure is essential for consumers to reap the full benefits of the Affordable Care Act (Terhune, 5/8).

The Wall Street Journal’s CIO Journal: Connecticut’s ‘Exchange In A Box’ Stymied By Government IT Culture
Maryland Health Exchange staffers will meet next week with Connecticut’s Access Health CT team to learn how the state exchange’s technology works, as well as best practices, says Joshua Sharfstein, the chairman of the board of Maryland’s defunct health benefit exchange. Maryland last month decided to scrap its existing exchange and pay consulting firm Deloitte LLP roughly $50 million to rebuild its broken website using Connecticut’s software. Connecticut’s state health exchange has begun commercializing its expertise, but is still looking for a full-fledged buyer for its “exchange in a box” – a package of hosting and consulting services it is offering states struggling with their own exchange (Boulton, 5/8).

The Washington Post: Fact Check: Did Only Four People Sign Up For Health Insurance Through Maryland’s Web Site? 
The Web site that Maryland built so that residents in need of health insurance could shop for low-priced plans made possible by the Affordable Care Act has not been working well. In fact, it’s so buggy and structurally flawed that officials have decided to scrap nearly all of it and rebuild before the next enrollment period starts in November. This made it difficult for thousands of people to get insurance, and Maryland only signed up a fraction of the number of people officials had originally hoped would enroll in private plans.
But is it really possible that only four people signed up directly through the Web site? (Johnson, 5/8).

The Oregonian: Cover Oregon: Hires Deloitte For $2.98 Million To Plot Federal Exchange Transition
The money keeps on flowing at Cover Oregon. But the latest $2.98 million contract, approved Thursday by the Cover Oregon board of directors, represents the state's first concrete step toward a downsized future with the federal health insurance exchange. Cover Oregon hired Deloitte Consulting to develop a roadmap for Oregon's move away from its own disastrous exchange to the federal alternative. Deloitte will develop a plan to move the 77,500 Oregonians who signed up for commercial health insurance through the exchange to move to the federal system (Manning, 5/8).

The Associated Press: Nonprofit Health Insurance Company In Illinois To Stick Around For 2015
A new nonprofit offering health insurance in Illinois will continue to sell plans next year despite capturing only a small portion of customers on the marketplace that's the cornerstone of the national overhaul. Land of Lincoln Health sold policies to more than 3,600 Illinois individuals, families and small businesses in its first year, the nonprofit insurance co-op's CEO Dan Yunker said in an email this week (Johnson, 5/8).

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Federal Judges Hear 'Origination Clause' Challenge To Health Law

The case, brought by the Pacific Legal Foundation in Sacramento, Calif., argues the law's insurance mandate is unconstitutional because the Constitution's origination clause requires all revenue-raising measures to originate in the House of Representatives and this legislation began in the Senate.

McClatchy: Judges Seem Skeptical Over Latest Challenge To Health Care Law
The seemingly endless legal war over health care found an esoteric new front Thursday, as appellate judges considered where certain bills should originate. Amid references to various 18th-century Founding Fathers, some of them obscure, skeptical-sounding judges weighed claims that the Affordable Care Act’s so-called individual mandate is invalid because it violates an under-appreciated part of the Constitution called the Origination Clause. The clause says that all bills “for raising revenue” must originate in the House of Representatives. The case pressed Thursday by the Pacific Legal Foundation, based in Sacramento, Calif., is that the health care legislation was a revenue-raising measure that effectively started in the Senate (Doyle, 5/8).

CQ Healthbeat:  Appeals Court Hears ‘Origination Clause’ Challenge to Health Law
Members of a powerful federal appeals court appeared impassive during oral arguments Thursday in a case that aims to throw out the 2010 health care overhaul on the grounds that it unconstitutionally violated the procedures Congress must follow in making laws. But if the members of the three-judge panel of the U.S. Court of Appeals for the District of Columbia weren’t signaling how it would rule in Sissel v HHS, the odds seem slim that they’ll side with the Iowa small business owner who’s the named plaintiff in the case that pivots around the Origination Clause of the Constitution (Reichard, 5/9).

Meanwhile, lawyers for several prominent Catholic organizations opened another battle about the law's contraceptive mandate -

Los Angeles Times: New Legal Battle Opens Over Obamacare And Contraceptives
Even as the Supreme Court weighs one challenge to the Obama administration's rule that female employees be offered health plans that include a full range of contraceptives, lawyers for several prominent Catholic groups are seeking to set up a potential Round 2 in the fight. In arguments Thursday before a U.S. appeals court, lawyers for the Catholic Archdiocese of Washington clashed with administration attorneys over whether Catholic schools, colleges and charities should have a complete religious exemption from the so-called contraceptive mandate that forms part of President Obama's healthcare law (Savage, 5/8).

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Hagan Defends Medicaid Expansion, Criticizes GOP Rival In Burwell Hearing

During a nomination hearing Thursday for Sylvia Mathews Burwell, Sen. Kay Hagan -- a North Carolina Democrat in a tough re-election battle -- criticized North Carolina Republicans for declining to expand the Medicaid program under the health law. Her GOP opponent, Thom Tillis, is the state House speaker.

The Washington Post: How North Carolina Republicans Are Helping Kay Hagan
Will Republicans take the Senate? The answer will hinge in part on the race between Sen. Kay Hagan and State House Speaker Thom Tillis in North Carolina. Many analysts see this election as a referendum on President Obama and the Affordable Care Act. There is likely some truth in that. According to an April 25-28 Elon University Poll I helped conduct, Hagan is supported by 61 percent of voters who think the ACA will improve healthcare in North Carolina. Among those who think the ACA will make things worse, only 14 percent support her. However, the North Carolina race will also allow voters to evaluate not only national politics but state politics, especially the recent policy shift in Raleigh. For the first time in a century, the state has a Republican governor and legislature. The GOP quickly moved to pass many controversial measures -- including restrictions on abortion facilities, requirements of voter photo identification, elimination of teacher tenure and implementation of a less progressive tax code. Tillis presided over the NC House of Representative when these measures passed (Husser, 5/8).

The Wall Street Journal’s Washington Wire: Hagen Uses Burwell Hearing To Criticize N.C. GOP On Health Law
Sen. Kay Hagan (D., N.C.), in a tough re-election race, used her time Thursday at Sylvia Mathews Burwell‘s hearing to be Health and Human Services secretary to criticize North Carolina Republicans for declining to expand the Medicaid program under the Affordable Care Act. Ms. Hagan, like some other vulnerable Democrats, has pushed the administration to make changes to the health-care law to make it more palatable to her constituents. But she has also taken a tack used by other vulnerable Democrats by criticizing Republican efforts to obstruct the law (Radnofsky, 5/8).

McClatchy: Hagan Defends Medicaid Expansion And Goes After Tillis
Sen. Kay Hagan, D-N.C., on Thursday defended the expansion of Medicaid under the Affordable Care Act, saying it would provide health coverage for 500,000 people in the state who need it. In an interview Thursday, Hagan said her support for the expansion underscored a big difference between her and Thom Tillis, the Republican state House speaker who hopes to unseat her in November. “That’s just one example of Thom Tillis not understanding North Carolina and not understanding North Carolina values,” Hagan said (Schoof, 5/8).

The health law is also the focus of a debate in Iowa --

The Des Moines Register:  GOP Senate Candidates Will Focus On Obamacare In Debate
Five Republican candidates for U.S. Senate plan to debate about the Affordable Care Act later this month, but the Democratic candidate won't join them. The May 22 debate is being organized by the Iowa Association of Health Underwriters, which represents insurance agents and brokers. The group said Thursday that Republican candidates Sam Clovis, Joni Ernst, Mark Jacobs, Scott Schaben and Matt Whitaker had all committed to participating (Leys, 5/8).

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Health Information Technology

Virtual Doctors Visits Await Regulation, Grow In Popularity

And recommendations on digital privacy protections for electronic health records could come as early as June.

The Wall Street Journal: Where Does It Hurt? Log On. The Doctor Is In
Can downloading an app, and describing your symptoms to a doctor you'll never meet, take the place of an office visit? Can sending a "selfie" of your sore throat help diagnose strep? Those are some of the issues state and federal regulators—and the medical profession itself—are wrestling with as telemedicine spreads rapidly (Beck, 5/8).

The Wall Street Journal: Virtual Doctor Visits: What's Treated And What's the Cost?
A growing number of Web-based companies offer virtual medical visits, where users can go online and consult with a doctor or other health-care provider, any time of the day or night, from wherever they are (Beck, 5/8).

Modern Healthcare:  Wait Continues For Behavioral Health IT Privacy Recommendations
Long-awaited recommendations on how to add digital privacy protections to health records, and particularly to sensitive behavioral health information, could emerge in June, a leader of a work group organized under the auspices of the Office of the National Coordinator for Health Information Technology's Health IT Policy Committee told its members Tuesday. That won't be soon enough for some who have followed the issue for years and wonder why standards can't be agreed upon using existing technology that involves applying what are known as metatags to data to ensure privacy (Conn, 5/8).

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State Watch

State Highlights: N.Y. Medicaid Change And Cash; Conn. Mental Health Cops; Conn. Mental Health School Outreach

A selection of health policy stories from New York, Connecticut and Minnesota.

The New York Times: Medicaid Shift Fuels Rush For Profitable Clients
When Hurricane Sandy flooded two adult homes in Queens, hundreds of disabled, elderly or mentally ill residents were caught in the surge. After weeks in public shelters, they were bused, over their objections, to a dilapidated four-story building called King’s Hotel, in a crime-ridden section of Brooklyn. Many had not showered in days. Crammed three cots to a room, they lacked basics like clean underwear. But in the parallel universe of New York’s redesigned Medicaid program, they represented a gold mine (Bernstein, 5/8).

Kaiser Health News: Cops In Conn. Train In Mental Health 101 Class
How do you tell the difference between someone who needs to be taken to jail and someone who needs to be taken to the hospital? That’s a big concern in Connecticut, where the intersection of law enforcement and mental health has been a huge issue since the Sandy Hook Elementary School shootings in Newtown in 2012 (Cohen, 5/8).

The Pioneer Press:  $45M State Grant Brings Mental Health Outreach To Schools
Any day of the week at Edison High School in Minneapolis, lead therapist Jennifer Ramji could encounter a student who lost a loved one, recently became homeless or is simply having a bad day. If Ramji and her staff can provide those students with convenient, in-school mental health care, they are less likely to miss class and have disciplinary problems and are more likely to graduate. On Thursday, top state health, education and human services leaders visited Edison to celebrate $45 million in new state funding to create more programs like the collaborative. The five-year grant will fund 36 mental health organizations' work in about 800 schools across 257 districts to reach about 35,000 students statewide by 2018 (Magen, 5/8).

The CT Mirror: For-Profit Hospital Deal Gets Done. Then, Doubts Behind The Scenes
Late Wednesday night, lawmakers managed to accomplish something many doubted would be possible: Crafting a compromise that could clear the way for four Connecticut hospitals to be acquired by a for-profit company, in a way that would mollify both unions critical of the transactions and hospitals wary of additional state oversight. The measure cleared the House and Senate by wide margins. Union leaders supported the deal. Hospital lobbyists looked pleased. But for some legislators key to the deal, any sense of celebration after the deal was short-lived (Becker, 5/9).

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Health Policy Research

Research Roundup: Unearthing Factors In Hospital Readmissions; Dissecting The Enrollment Surge

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

Health Affairs: Socioeconomic Status And Readmissions: Evidence From An Urban Teaching Hospital 
Using inpatient data from an urban teaching hospital, we examined how elements of individual characteristics and neighborhood socioeconomic status influenced the likelihood of readmission ... Patients living in high-poverty neighborhoods were 24 percent more likely than others to be readmitted, after demographic characteristics and clinical conditions were adjusted for. Married patients were at significantly reduced risk of readmission, which suggests that they had more social support than unmarried patients. These and previous findings that document socioeconomic disparities in readmission raise the question of whether CMS’s readmission measures and associated financial penalties should be adjusted for the effects of factors beyond hospital influence at the individual or neighborhood level, such as poverty and lack of social support (Hu, Gonsahn and Nerenz, May 2014).

University Of Pennsylvania/RWJ Foundation: Deciphering The Data: Final Enrollment Rates Show Federally Run Marketplaces Make Up Lost Ground At End Of Open enrollment
The ACA gave states a number of choices in how to implement the broad coverage changes it required. As such, health reform looks different from state to state, and the impact of the ACA may differ because of these state decisions. This Data Brief examines a number of choices related to the establishment and running of the new health insurance marketplaces, and their impact on enrollment rates to date. ... The final enrollment figures reveal that the federally facilitated marketplaces and some of the troubled state-based ones made up some ground in the last four to six weeks of the open enrollment period (Polsky, Weiner, Colameco, and Becker, May 2014).

Kaiser Family Foundation: Medicare Advantage: Take Another Look
While health policy observers are mainly focused on the number of people enrolled in the new federal and state marketplaces, fewer are keeping a close eye on fairly big changes in the estimates and projections for enrollment in Medicare Advantage plans. The number of Medicare beneficiaries in Medicare private plans reached an all-time high this year of nearly 16 million beneficiaries ... Medicare Advantage enrollment was expected to decrease in response to the reductions in payments to plans that were included in the ACA. ... As Medicare Advantage enrollment increased, monthly premiums actually declined (from an average $44 per month in 2010 to $35 per month in 2014). ... Plans may be looking for ways to tighten their belts and maintain profits, but the changes thus far do not seem to be scaring seniors away (Neuman and Jacobson, 5/7).

JAMA: Prevalence Of Type 1 And Type 2 Diabetes Among Children And Adolescents From 2001 To 2009 
Adjusted for completeness of ascertainment, there was a 21.1% increase in type 1 diabetes over 8 years. In 2001, 588 of 1.7 million youth were diagnosed with type 2 diabetes for a prevalence of 0.34 per 1000. In 2009, 819 of 1.8 million were diagnosed with type 2 diabetes for a prevalence of 0.46 per 1000. ... Significant increases occurred between 2001 and 2009 in both sexes, all age-groups, and in white, Hispanic, and black youth, with no significant changes for Asian Pacific Islanders and American Indians. Adjusted for completeness of ascertainment, there was a 30.5% overall increase in type 2 diabetes (Dabelea et al., 5/7).

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

The Baltimore Sun: Functional Hospital Patients Fare Better
Testing hospital patients on their ability to perform everyday tasks before they are released could go a long way to keeping them from returning to the hospital, new research from Johns Hopkins University suggests. Tasks such as moving from a bed to a chair, eating, using the toilet and communicating are uniformly assessed after patients go to rehabilitation facilities from hospitals, but function isn’t always tested in a standardized way before they go. And Hopkins researchers found that low scores on a standardized test of the tasks was a good predictor of hospital readmission (Cohn, 5/5).

Kaiser Health News: Capsules: Chemo Costs In U.S. Driven Higher By Shift To Hospital Outpatient Facilities
The price of cancer drugs has doubled in the past decade, with the average brand-name cancer drug in the U.S. costing $10,000 for a month’s supply, up from $5,000 in 2003, according to a new report by IMS Institute for Healthcare Informatics, a health information, services and technology company (Rabin, 5/6).

The Boston Globe: Using Twitter As Tool To Track Side Effects From Drugs
Tracking the safety record of new drugs is a slow and complicated task for the US Food and Drug Administration. Once a drug is on the market, it often takes years before the full range of side effects becomes known, as side effects are reported to the agency mainly by doctors who prescribe the drug. Thousands of patients, however, use Twitter to share symptoms they’ve developed from their medications, and Boston Children’s Hospital researchers have found that such online postings could be a way to identify problems with drugs sooner (Kotz, 5/5). 

Reuters: Youth Diabetes Is On The Rise, Study Suggests
Both type 1 and type 2 diabetes became increasingly common among kids and teens in the U.S. between 2001 and 2009, according to a new study. Though researchers can’t say why exactly these rates continue to go up, it is important to monitor them, Dr. Dana Dabelea told Reuters Health (Doyle, 5/5).

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Editorials and Opinions

Viewpoints: House Chairman Calls For Shinseki Resignation; Hagan's Case For Obamacare

Fox News: Veterans Affairs Secretary Eric Shinseki Must Resign
Since January of 2013, I’ve served as the chairman of the House Veterans’ Oversight & Investigations Subcommittee, which is tasked with the oversight responsibility of making sure that the VA meets all of our nation’s obligations to our veterans. Unfortunately, I’ve been shocked and disappointed at the systemic failures of the VA, impacting everything from delays and cost overruns at major VA medical construction projects to glaring patient safety problems resulting in preventable deaths and even to the inability of the VA to resolve the tremendous backlog of veterans’ disability claims in a timely manner. In almost every instance when a problem has arisen, the response by Secretary Shinseki, assuming that he publicly expresses one at all, is almost always defensive (Mike Coffman, 5/9).

The Washington Post’s The Plum Line: Another Vulnerable Dem Offers Strong Case For Obamacare 
Democratic Senator Kay Hagan is one of the most vulnerable Dems in the country, and her problems are said to be largely about Obamacare, thanks to the millions of dollars Americans for Prosperity has spent on ads attacking her over the law. So it’s curious that Hagan today made an aggressive case for a major pillar of the law that’s supposedly on the verge of ending her Senatorial career: The Medicaid expansion (Greg Sargent, 5/8).

The Washington Post: Obama’s Transformational Presidency 
His biggest legislative accomplishment, the Affordable Care Act, is a landmark because it establishes the principle that health care should be considered a right, not a privilege. Democrats such as Harry Truman — and Republicans such as Richard Nixon — sought for decades to move the nation toward universal care. The fact that Obama succeeded where others failed is, in itself, a huge achievement. Perhaps as important, however, is the fact that while Republicans still claim they want to repeal Obamacare, the debate within the party centers on how best to expand health insurance coverage. Returning to the way things were before the ACA is not an option (Eugene Robinson, 5/8).

The New York Times: Medicaid, Romneycare And Mortality
My post yesterday on the new study of post-Romneycare mortality rates in Massachusetts set up a contrast between two policy scenarios: One in which health insurance expansions have a substantial effect on health (as the Massachusetts mortality data suggests), and another in which insurance’s connection to public health is much more limited (as the data from the Oregon Medicaid experiment had indicated). But there’s also a third possibility, which Avik Roy — who knows the Romneycare story as well as anyone on the right — elaborates on here. It may be, he argues, that private insurance does improve outcomes but Medicaid mostly does not, and that the Massachusetts effect is the result of private coverage expanding in that state much faster than in the country as whole (Ross Douthat, 5/8).

Los Angeles Times: Obamacare May Prevail In Court, But Can It Survive Rising Premiums?
Although the total enrollment exceeded expectations and the percentage of uninsured Americans is dropping, Avalere's report finds one big dark cloud on the horizon. "[S]ecular increases in the cost of medical care and in utilization of services and new medical technology make it likely that exchange plans will need to increase their prices," the company predicted. ... [As] we saw last fall, the cost of individual policies gets a lot of attention from the media. And even if the next round of price hikes has little or nothing to do with the 2010 law, many people will still blame Obamacare. That could erode public support for the law, and its defenders in Congress, even further (Jon Healey, 5/8).

Fox News: Health Care’s Hidden Tax On Main Street
It was recently announced, and indeed celebrated, that over 8 million Americans signed up for coverage through ObamaCare.  As the administration completed their victory lap, the Congressional Budget Office (CBO) quickly released a promising projection that health insurance premiums would be lower than expected, seemingly backing the president’s narrative that the health care law is a glowing success for all.  And yet, a recent USA Today/Pew Research Center poll found that a majority of Americans still highly disapprove of the ACA. So, where is the disconnect? (Dan Danner, 5/9).

The Wall Street Journal: Nancy Pelosi's Partisan Play On Mental Health
Arizona Rep. Ron Barber, a former aide to Gabby Giffords, led four House Democrats on Tuesday in unveiling The Strengthening Mental Health in Our Communities Act. Mr. Barber insisted his bill is a "comprehensive approach to long-ignored mental health issues" and a completely "nonpartisan" exercise. Which he would say, since this is in reality a Nancy Pelosi special: a raw partisan exercise in killing mental-health reform, shoring up midterm election prospects and protecting Democratic constituencies—all at the expense of the most seriously ill (Kimberley A. Strassel, 5/8).

The San Francisco Chronicle: Support Laura's Law For Better Mental Illness Care
May is Mental Health Awareness Month, and dueling events planned for Tuesday on the south lawn of the state Capitol underscore the deep divide in the approach we take to treating the most vulnerable among us. On one side, we have the newly formed Right to Treatment group -- a collaboration of consumers, family members and providers -- whose goal is to ensure state and federal mental health parity rights in the public health care system. This group does not receive state or federal tax dollars.On the other is the state-sponsored Mental Health Matters! Day -- a one-day event promising serious speeches, personal stories of empowerment, food, a minor league baseball game and a $137,000 price tag - all on the taxpayers' tab. But apart from the thousands of lime-green "awareness ribbons" that ultimately will litter the lawn -- and the chance for a select group of consumers of public mental health services and the event organizers to get together for a day of fun and sun -- it's difficult to see how this group's state-sponsored extravaganza will do anything to expand treatment options for Californians with severe and persistent mental illness (Amy Yannello, 5/8).

The Star Tribune: Counterpoint: Don't Be Misled — Abortion Has Declined
As stated in “What’s being done in your name: Abortion” (May 7), the Minnesota Supreme Court in Minnesota ruled in 1995 that state Medicaid dollars may be used for abortion. That’s because every woman — no matter what her income is or where she gets her health coverage — should be able make a personal medical decision about her pregnancy based on what is best for her health and her family. Period. This is sensible policy (Sarah Stoesz, 5/8).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.