Daily Health Policy Report

Tuesday, June 10, 2014

Last updated: Tue, Jun 10

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Coverage & Access

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: Budget Referees Make It Harder To Evaluate Obamacare Costs

The Congressional Budget Office will no longer evaluate the fiscal implications of some parts of the Affordable Care Act, partly because of all the changes made during implementation. Kaiser Health News' Mary Agnes Carey and The Fiscal Times' Eric Pianin discuss the developments (6/9). Watch the video or read the transcript.

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Insuring Your Health: School Nurses' Role Expands With Access To Students’ Online Health Records

Kaiser Health News’ consumer columnist Michelle Andrews writes: “Although the school nurse is a familiar figure, school-based health care is unfamiliar territory to many medical professionals, operating in a largely separate health care universe from other community-based medical services. Now, as both schools and health care systems seek to ensure that children coping with chronic conditions such as diabetes and asthma get the comprehensive, coordinated care the students need, the schools and health systems are forming partnerships to better integrate their services” (Andrews, 6/10). Read the column.

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Capsules: Study Puts A Price Tag On Autism

Now on Kaiser Health News’ blog, Jenny Gold reports: “Autism exacts a heavy toll on families across the country, but what is the financial cost of the disorder? Now we have an actual price tag: the lifetime cost of supporting a person with autism ranges from $1.4 million to $2.4 million in the United States, depending on whether the person also has an intellectual disability” (Gold, 6/10). Check out what else is on the blog.

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Political Cartoon: 'Don't Forget The Breadcrumbs?'

Kaiser Health News provides a fresh take on health policy developments with "Don't Forget The Breadcrumbs?" by Andrew Toos.

Meanwhile, here's today's haiku:

VIRGINIA'S MEDICAID EXPANSION: A SHORT SALE?

Months-long clash of wills
to expand or not expand
ends with a whimper.
-Anonymous

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

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Administration News

Audit: 57,000 Vets Have Been Waiting More Than 3 Months For Care

The examination also uncovered difficulties in scheduling appointments and a culture in which employees were pressured to change data. Acting VA Secretary Sloan Gibson detailed a $300 million plan that would increase hours for VA medical staffers and fund contracts with private clinics to provide care to some veterans who cannot get into VA medical centers.

The New York Times: Audit Shows Extensive Medical Delays For Tens Of Thousands Of Veterans
More than 57,000 patients have been waiting more than three months for medical appointments at hospitals and clinics run by the Department of Veterans Affairs, and nearly 64,000 others have been enrolled in the system for a decade but have still not been seen by doctors despite their requests, according to a nationwide audit released Monday (Oppel, 6/9).

Los Angeles Times: New Audit Of VA Finds 3-Month Waits For Medical Appointments
The audit's results came as the inspector general announced at a House hearing that his office had widened its investigation to include 69 sites across the country where employees may have falsified records to conceal long waits for care. That number is in addition to the Phoenix VA, which was the epicenter of the scandal and the focus of an inspector general's investigation into whether patients died as a result of delays in care (Simon and Zarembo, 6/9).

The Wall Street Journal: Nearly 60,000 Veterans Face Delays Receiving Health Care—VA Audit
During a nearly monthlong audit of 731 VA facilities and nearly 4,000 employees, the VA found widespread problems with appointment scheduling and pressure on employees to change data. More than 10% of scheduling staff were given instruction on how to alter patient appointment scheduling, according to the audit (Kesling, 6/9).

NPR: Audit Reveals Vast Scale Of VA Waitlist Issues
Before former Veterans Affairs Secretary Eric Shinseki stepped down, he ordered an audit of the VA system, hoping to find how many hospitals were lying about wait times. The audit found that approximately 100,000 veterans are waiting too long for care at the VA (Lawrence, 6/9).

The Washington Post: VA Audit: 57,000 Veterans Waiting More Than 90 Days For Appointment At Medical Facilities
[Acting Director Sloan] Gibson — who took over on May 30 after his predecessor, Eric K. Shinseki, resigned under pressure — outlined a series of emergency measures Monday to ensure that veterans stuck on long waiting lists will receive care as quickly as possible in the coming days and weeks. The interim VA secretary said he would spend $300 million to increase hours for VA medical staffers and contract with private clinics to see veterans who are unable to get care through VA medical centers. Gibson also promised to institute new patient satisfaction surveys and said he had eliminated the 14-day scheduling goal for VA appointments, a measure that VA officials said was unrealistic and led to widespread cheating among hospital administrators whose bonuses were tied to hitting the mark (Jaffe and Hicks, 6/9).

McClatchy: Audit: 57,000 Vets Waiting More Than 3 Months To See Doctor
The first comprehensive review of the medical care system for veterans found widespread scheduling abuses, data falsification and long waiting times at dozens of hospitals and clinics across the country. In its audit of 731 medical facilities, the Department of Veterans Affairs reported Monday that 57,436 veterans have been waiting more than 90 days for an initial medical appointment. Thirteen percent of schedulers told VA auditors that supervisors or other co-workers had instructed them to enter a different date in the appointment system than the one requested by a veteran (Rosen, 6/9).

Politico: VA Report: Months-Long Waits For 57,000-Plus Vets
Since taking over for Shinseki, Acting Secretary Sloan Gibson has taken an aggressive posture, vowing to restore confidence in the beleaguered agency and punish VA officials who retaliated against whistleblowers. Gibson said the release of the audit reflected a commitment to transparency and showed the "extent of the systemic problems we face, problems that demand immediate actions" (Wheaton, 6/9).

The Wall Street Journal: VA Halted Visits To Troubled Hospitals
Starting in 2011, when the VA instituted a new system to track performance standards, five VA hospitals notched consistently poor scores on a range of critical-care outcomes, including mortality and infection rates. By the first quarter of this year, that bottom-performing group had expanded to at least seven hospitals, records show. During most of that time, VA senior management suspended a long-standing program that had sent teams of doctors and monitors to its worst-performing hospitals to try to improve them, agency doctors said (Burton, 6/9).

Los Angeles Times: Veterans Frustrated By Long Delays In Opening Of New VA Hospitals
It was a day of shiny shovels and high hopes on that hot August morning in 2009. Politicians and dignitaries beamed at the cameras and congratulated themselves for finally breaking ground on a new medical facility dedicated to veterans, at the time projected to be the largest of its kind in the nation. … Nearly five years later, the project is still less than half finished even though work is continuing. The expected cost has risen to $1 billion, and the earliest patients will be seen is 2017 — if then. New VA hospitals in New Orleans, Las Vegas and suburban Orlando, Fla., also face delays as long as five years and construction costs that have risen a total of $1.5 billion, according to a 2013 review by the General Accounting Office (Deam, 6/9).

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The Details Of The VA Waiting Game At Specific Locations Around The Country

Media outlets scrutinize how local Veterans Affairs health facilities fared in a national audit of 731 VA hospitals and clinics.  

Des Moines Register: VA Auditors Don’t Flag Iowa Hospitals In Wait-time Scandal
Federal auditors who checked VA hospitals and clinics for signs of waiting-list manipulation are not recommending follow-up investigations at the agency's Iowa facilities, a new report shows. The auditors visited 731 VA hospitals and clinics nationally because of outrage over reports that VA administrators hid the fact that dozens of veterans had died while awaiting appointments in Phoenix, Ariz., and elsewhere. The auditors, who went over how patient appointments were scheduled at each site, recommended follow-up investigations at 132 sites. The auditors visited the Iowa sites, but did not recommend further investigations there (Leys, 6/9).

The Associated Press: Wisconsin’s Highest Average New VA Patient Wait In Madison
The average wait for a new patient to see a primary care doctor is nearly 51 days at the Veterans Affairs hospital in Madison, nearly three times the VA's own target, data released Monday as part of a wide-ranging audit showed. The wait for new patients in Madison is the longest for anyone seeking care at Wisconsin's three major VA medical centers, the nationwide audit of 731 VA hospitals and large outpatient clinics revealed (Bauer, 6/9).

The Associated Press: Michigan Veterans’ Centers Have Lengthy Waits
Newly enrolled patients seeking care at five Michigan medical centers for veterans wait an average of three to four weeks before getting an appointment, according to federal audit results released Monday. The delays in some cases are more than twice as long as the 14-day target set by the Department of Veterans Affairs in 2011, which the agency now says is unrealistic because of surging demand for services. Still, the Michigan facilities did considerably better than the worst performers nationwide, where average waits drag on for months (6/10).

The San Francisco Chronicle: Veterans In S.F. Wait Nearly A Month For Medical Care
New patients seeking care at the San Francisco VA Medical Center are waiting an average of 29.7 days for their first appointment with a primary care specialist - more than twice the goal of the Department of Veterans Affairs but still shorter than many VA centers in California and the rest of the country. A nationwide report released Monday by the VA in the aftermath of a patient-scheduling scandal shed light on the depth of the problems inside the agency. It said more than 57,000 new patients have been waiting at least 90 days for their initial appointments, a total that represents about 90 percent of all new patients (Colliver, 6/9).

The Richmond Times-Dispatch: New Patients At McGuire Wait 72 Days
New patients waited an average of 72 days for primary care appointments at McGuire Veterans Affairs Medical Center, which has been flagged for a more thorough review by the U.S. Department of Veterans Affairs. Established patients got appointments much quicker — waiting only about four days — and new mental health patients got appointments in about 36 days. The wait times at McGuire are in a national report released Monday that contains summary data on audits of 731 veterans facilities (Smith, 6/9).

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Health Reform

Virginia Budget Plan Moving Forward Without Medicaid Expansion

After the abrupt resignation of a Democrat switched the state Senate to Republican control, Democrats began negotiating on a spending plan that no longer includes the governor's priority of expanding health care coverage to low-income residents.

The Washington Post: GOP Has Claimed Control Of Va. Senate, Forced Democrats To Cave Over Medicaid Impasse
Virginia Republicans snatched control of the state Senate on Monday, immediately ending a budget stalemate by pushing Democrats to agree to pass a spending plan without Medicaid expansion, Gov. Terry McAuliffe's top priority. The power shift forced Senate Democrats to yield after a protracted standoff that had threatened to shut down state government in less than a month, according to several lawmakers with direct knowledge of the deal. Democratic negotiators agreed in a closed-door meeting Monday to pass a budget without expanding health coverage to 400,000 low-income Virginians (Vozzella and Laris, 6/9).

The New York Times: State Senator's Resignation Deepens Political Turmoil In Virginia
The resignation of a Democratic state senator in Virginia that flipped control of the Senate to Republicans set off charges on Monday of an unseemly deal and threatened Gov. Terry McAuliffe's chances of expanding Medicaid under the president's health care law (Gabriel, 6/9).

The Wall Street Journal: Senator's Resignation Complicates Medicaid Expansion Plan In Virginia
Republicans claimed temporary control of the Virginia Senate Monday after veteran Democratic state Sen. Phillip Puckett resigned, giving the GOP a one-seat majority. The move for now allowed the GOP to block Democratic Gov. Terry McAuliffe's plan to expand the federal-state health insurance program for the poor to as many as 400,000 Virginians. … Democrats on Monday reached a budget agreement that won't include Medicaid, though the governor could use a special session to again debate expansion (Armour and O’Connor, 6/9).

The Associated Press: Senator Quits, Imperiling Virginia Medicaid Push
The resignation of a Democratic state senator on Monday has dealt a serious blow to his party's push for Medicaid expansion in Virginia and cleared a path for Republicans to pass a budget without compromising on the health care plan. Sen. Phil Puckett's resignation gives the GOP a 20-19 majority in the chamber to go with their control of the House. Senate Democrats had linked passage of the state’s $96 billion biennial budget to expanding Medicaid, creating the threat of a government shutdown on July 1 if Republicans wouldn't relent (Suderman, 6/9).

Reuters:  Virginia Medicaid Expansion In Doubt As State Senator Quits
Governor Terry McAuliffe's bid to expand Medicaid in Virginia was dealt a blow on Monday by a Democratic lawmaker's resignation that may have been propelled by Republican maneuvering. The resignation of state Senator Phillip Puckett gives Republicans a one-vote majority in the chamber. McAuliffe, a Democrat, had hoped the Senate would support a widening of Medicaid to 400,000 Virginians under the federal Affordable Care Act, a proposal Republicans oppose (Robertson, 6/9).

Virginian-Pilot: General Assembly Will Meet This Week
His resignation also enhances GOP leverage on getting a new budget without yielding on Medicaid expansion, as Democrats would prefer. Mindful of that and an anticipated $1 billion-plus shortfall over the next two years, some of Puckett's former Senate colleagues huddled for hours Monday, devising cuts to offset that revenue downturn. That means slashing $700 million in spending .... Legislators emerged from those talks with plans to reconvene the Senate and House of Delegates on Thursday with an eye on a budget deal, but without a clear path forward on the proposed "Marketplace Virginia" private insurance alternative to Medicaid expansion (Walker, 6/10).

Richmond Times-Dispatch: Senate Returns Thursday To Act On Budget
The Senate will convene Thursday to enact a two-year state budget that will have about $700 million less in new spending .... The apparent breakthrough in the budget impasse was hastened by the political firestorm that followed the surprise resignation of Sen. Phillip P. Puckett, D-Russell, who said Monday he had decided not to accept a job on the staff of the state tobacco commission. ... But the severity of the expected revenue shortfall already had prepared leaders of the Senate Finance Committee to agree to a budget that will not include Marketplace Virginia, a commercial insurance alternative to expanding the state’s Medicaid program for hundreds of thousands of uninsured Virginians (Martz and Nolan, 6/10).

The Richmond Times-Dispatch: City Council Passes Resolution Favoring Medicaid Expansion
The Richmond City Council voted overwhelmingly Monday to express its support for Medicaid expansion in Virginia, a symbolic gesture that comes as the state budget fight is heating up across the street from City Hall. The council voted 8-0 to approve a resolution urging the General Assembly to "develop and implement in the Commonwealth of Virginia a plan to provide more Virginians with access to affordable health care coverage and services" (Moomaw, 6/9).

The Wall Street Journal’s Washington Wire: Virginia Drama Puts Spotlight On Medicaid Expansion Holdouts
When the Supreme Court gave states the option of opting in or out of the Affordable Care Act’s Medicaid expansion, the thinking among Democrats was that after some initial grumbling states would eventually opt in. … Perhaps more revealing is the fact that, some two years after the Medicaid expansion became available for states, 24 still have not done so. Of those only five – Indiana, Missouri, Pennsylvania, Utah and Virginia – are even considering it, according to the Kaiser Family Foundation. And of the states that haven't moved and aren't debating the expansion, only Florida, Maine and Wisconsin have competitive state elections this year in which a Democrat could feasibly win and seek to change the dynamic (Epstein, 6/9).

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Insurers Revisit Plans To Narrow Provider Networks

The Wall Street Journal reports that some insurers are beefing up the provider networks included in health-law plans in response to concerns about access to care. Meanwhile, Kathleen Sebelius passes the baton to Sylvia Mathews Burwell, the new Health and Human Services secretary. 

The Wall Street Journal: Insurers Fill Gaps in Health-Law Plans
Health insurers in several states are adding to the choices of doctors and hospitals in their health-law plans amid concerns among some consumers and state officials about access to care. In states including New York, Connecticut and Ohio, insurers have bolstered their health-care provider networks in recent months. In California, three of the biggest insurers -- WellPoint Inc. 's Anthem Blue Cross, Blue Shield of California and Health Net Inc. have all added substantially to their lists (Wilde Mathews, 6/9).

The Hill:  Sebelius Hands Reins To Successor
Kathleen Sebelius handed leadership of the Health and Human Services Department to her successor on Monday and wished new Secretary Sylvia Matthews Burwell the best of luck. Sebelius, who oversaw the passage and implementation of ObamaCare at the agency, is concluding an up-and-down tenure (Al-Faruque, 6/9).

And more on why the Congressional Budget Office won't score parts of the health law --

Kaiser Health News: Health On The Hill: Budget Referees Make It Harder To Evaluate Obamacare Costs
The Congressional Budget Office will no longer evaluate the fiscal implications of some parts of the Affordable Care Act, partly because of all the changes made during implementation. Kaiser Health News' Mary Agnes Carey and The Fiscal Times' Eric Pianin discuss the developments (6/9).

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Colorado Exchange Board Approves Fee On Small Group, Individual And Stop-Loss Policies

Meanwhile, in other state exchange news, more detail has emerged regarding the safety of health data for hundreds of Access Health CT customers, and a federal agency will examine MNsure's enrollment procedures.

Denver Post:  Colorado Health Exchange Board OKs Fee
The state health exchange board approved a $66 million budget and a $13 million funding stream Monday to run the nonprofit as the federal grant money runs out. Connect for Health Colorado board members, in a nearly unanimous vote, approved the 2015 fiscal year budget and $1.25 monthly assessment on all small group, individual and stop loss (policies by self-insured entities to cover catastrophic losses) health insurance policies in the state (Kane, 6/9).

Health News Colorado: Exchange Board Approves $66 Million Budget Including $13 Million Fee
Colorado’s health exchange board on Monday approved a $66.4 million budget for the next fiscal year to be funded in part by a $13 million fee on all Coloradans with health insurance. The costs to run the exchange are far higher than the $26 million a year that managers have long anticipated. They are continuing to spend federal tax dollars for some of the expenses and have vowed to reduce costs to about $26 million in future years (McCrimmon, 6/10).

The CT Mirror: Backpack With Access Health Data Taken To House GOP Office
The backpack containing personal information on hundreds of clients of Connecticut’s health insurance exchange was left outside a Hartford deli Thursday afternoon by a worker from the exchange’s call center. His employer believes the man, who sat outside the deli while waiting for a ride, left it behind accidentally. Another man later found the backpack, then called the office of his state representative, Republican Jay Case of Winsted. After the man brought the backpack to the Legislative Office Building, a GOP staffer notified the exchange’s chief executive around noon Friday (Becker, 6/9).

Minnesota Public Radio: Federal Agency To Review MNsure Procedures
A watchdog agency within the U.S. Department of Health and Human Services will audit Minnesota's online health insurance marketplace to determine if its internal controls were effective in ensuring that individuals who enrolled in qualified health plans met federal requirements. MNsure leaders expect the review to be part of an audit of state-based insurance marketplaces, said MNsure spokesman Joe Campbell. "Our understanding is that it's part of a national audit requested by Congress," he said (Stawicki, 6/9).

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Capitol Hill Watch

Democrats Vying To Run For Virginia's Eighth Congressional District Embrace Health Law

The candidates in this race back the overhaul -- a different take than many vulnerable Democrats in other races around the country.    

The New York Times: For Virginia Democrat, Obama’s Still A Positive
A candidate running for the Democratic nomination in Virginia’s Eighth Congressional District, which includes the suburbs outside Washington, [Don] Beyer said in a radio ad that the president was "absolutely right" about health care, and that is just the start. "In Congress, I'll fight all efforts to repeal Obamacare, because making sure millions of Americans get affordable health care is the right thing to do," he continued. ... In other parts of the country, Democrats are running from the president, eager to distance themselves from the Affordable Care Act and its bungled rollout (Parker, 6/9).

The Wall Street Journal: In Northern Virginia, Democratic Contenders See Obama As Asset
Virginia is one of six states holding primary elections or runoffs Tuesday. In South Carolina, the focus is on whether Sen. Lindsey Graham can top 50% in the GOP primary and avoid a runoff. In the Richmond, Va., area, House Majority Leader Rep. Eric Cantor, the chamber's No. 2 Republican, is expected to beat a conservative challenger, but his margin of victory will be watched for clues to the depth of unhappiness with House leadership among GOP voters. … [Virginia's] 8th District race presents a world where Mr. Obama is on the right course and the threat comes from forces that would push his party to the center. The candidates are uniform in backing the Affordable Care Act, a higher minimum wage and efforts to rein in greenhouse gases. That is a contrast to the message some vulnerable Democrats elsewhere have been sending, as they emphasize how they would fix the health-care law, for example, rather than hail its benefits (Ballhaus, 6/9).

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Coverage & Access

Study: Lifetime Cost Of Supporting Person With Autism Could Be In Millions

Researchers listed among the main factors contributing to this price tag were special education for children and residential care for adults as well as lost productivity for parents.

Kaiser Health News: Capsules: Study Puts A Price Tag On Autism
Autism exacts a heavy toll on families across the country, but what is the financial cost of the disorder? Now we have an actual price tag: the lifetime cost of supporting a person with autism ranges from $1.4 million to $2.4 million in the United States, depending on whether the person also has an intellectual disability (Gold, 6/10).

Reuters: Cost Of Autism Adds Up: Study
The cost of supporting people with autism spectrum disorders throughout their lives could be as high as $2.4 million per person, according to a new estimate. The main drivers of costs among children with autism spectrum disorders (ASDs) were special education and lost productivity for parents, researchers found. Among adults, the main drivers of costs were residential care and their own lost productivity (Seaman, 6/9).

In related news --

CQ Healthbeat:  Lawmakers Strike Bipartisan Pact to Renew Autism Programs
Lawmakers have reached a bipartisan, bicameral agreement on a five-year reauthorization of federal autism programs, boosting the package’s chances of clearing Congress before central provisions of the Combating Autism Act sunset at the end of September. New Jersey Democrat Robert Menendez and Wyoming Republican Michael B. Enzi plan to introduce the compromise legislation in the Senate on Monday, according to a Senate source involved in the negotiations, while the House Energy and Commerce Committee is expected amend the current bill (HR 4631) to report out the new language at a Tuesday markup (Attias, 6/9).

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Health Care Marketplace

Some Doctors Bill Medicare Far More Often For Unusual Procedures

Elsewhere, a former editor of a prominent medical journal says many or most doctors have had conflicts of interest that could harm patients. And, doctors look for new ways to thrive -- or survive -- economically.

The Wall Street Journal: Taxpayers Face Big Medicare Tab For Unusual Doctor Billings
The government data show that out of the thousands of cardiology providers who treated Medicare patients in 2012, just 239 billed for the procedure, and they used it on fewer than 5 percent of their patients on average. The 141 cardiologists at the Cleveland Clinic, renowned for heart care, performed it on just six patients last year. Dr. Weaver's clinic administered it to 99.5 percent of his Medicare patients -- 615 in all -- billing the federal health insurance program for the elderly and disabled 16,619 times, according to the data (Carreyou, Stewart and Barry, 6/9).

MinnPost:  Shining Light On Physician Conflicts Of Interest
“Many, if not most physicians practicing today have, or have had, conflicts of interest that clearly to do not result in their patients’ best interest,” charges Dr. Catherine DeAngelis, former editor of the Journal of the American Medical Association (JAMA), in an op-ed article in the June issue of the Milbank Quarterly. And those conflicts of interest -- which DeAngelis defines as “a conflict between the private interests and the official responsibilities of an individual in a position of trust” -- have become rampant over the past two decades or so, she says, as pharmaceutical companies merged their marketing and scientific divisions (Perry, 6/9).

Miami Herald: Doctors’ Dilemma:  Physicians Weigh Ways To Thrive Economically -- And Sometimes To Survive 
It’s getting harder to be a doctor. Gone are the days of Marcus Welby, when a doctor focused solely on treating the sick, assured that bountiful compensation would follow. Today, physicians are as much business people as healers, hamstrung by rising staffing and technology costs, increased paperwork demands by the government, stratospheric malpractice premiums and limited reimbursements from muscle-flexing insurance companies (Madigan, 6/8).

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State Watch

State Highlights: Mass. Near 0 Percent Uninsured; Ga. Scraps Medicaid Contract Bidding; States Turn To Public Health Issues

A selection of health policy stories from Massachusetts, Georgia, Wisconsin, Illinois and Arizona.

WBUR: Latest Look Finds Mass. Near Zero Percent Without Health Insurance
When Massachusetts passed its landmark health coverage law under Gov. Mitt Romney in 2006, no one claimed the state would get to zero, as in 0 percent of residents who are uninsured. But numbers out today suggest Massachusetts is very close. Between December 2013 and March of this year, when the federal government was urging people to enroll, the number of Massachusetts residents signed up for health coverage increased by more than 215,000. If that number holds, the percentage of Massachusetts residents who do not have coverage has dropped to less than 1 percent (Bebinger, 6/9).

Georgia Health News: Bidding On Medicaid Contract Scrapped
A state agency has canceled the contract bidding to offer care coordination services to more than 400,000 Medicaid beneficiaries who have disabilities or are elderly. The contract proposals that were received were “over budget,’’ according to a state website that announced the bid cancellation. Care coordination for the “aged, blind and disabled’’ population was envisioned as part of the state’s effort to improve services and reduce spending. This beneficiary category represents roughly 28 percent of Medicaid enrollees in Georgia, but it accounts for 60 percent of the overall costs of the program (Miller, 6/9).

Chicago Tribune: Medicaid Managed Care Kickoff Delayed For Much Of Illinois
Illinois is delaying the launch of all Medicaid managed care programs by at least a month in much of the state, including the Chicago area, a state official confirmed Monday. The state, which originally intended to start moving Medicaid patients into managed care July 1, still has not signed final contracts with some insurers and has yet to mail patients informational packages asking them to select health plans (Frost, 6/10).

Stateline: State Lawmakers Tackle Public Health Issues
Four years into implementing the Affordable Care Act, state politicians turned their attention to other pressing health care issues such as preventing drug overdose deaths, limiting e-cigarettes and making medical marijuana more available. States also grappled with the question of who should receive a costly and highly effective cure for hepatitis C. A few states also launched programs aimed at controlling two of the costliest chronic conditions -- asthma and diabetes. And throughout the first half of the year, states still debated the highest-profile questions about the ACA: whether to expand Medicaid and how to improve their insurance exchanges. Here’s a look at the top public health issues addressed in state legislatures this year (Vestal, 6/10).

The Milwaukee Journal Sentinel: Scott Walker Misses Deadline For Appointing Mental Health Board Members
Gov. Scott Walker missed the deadline Monday to name all members to a new board to oversee mental health care in Milwaukee County. Walker named seven of his 11 appointments but needs more information before he can name the other four, according to Laurel Patrick, his spokeswoman. Patrick said in an email Monday that two more members -- a substance abuse specialist and a consumer of mental health services -- would be named later this week, once they are vetted (Kissinger, 6/9).

Georgia Health News: Looking For Answers To The Rural Health Care Crisis 
Four hospitals have closed in the past two years. Many areas can’t attract doctors, or have trouble keeping the ones they have. Some counties are without a hospital or other critical health services. Those rural health care problems in Georgia were among the issues discussed at the initial meeting Monday of the Rural Hospital Stabilization Committee, recently appointed by Gov. Nathan Deal (Miller, 6/9).

NPR: A Reason To Smile: Mexican Town Is A Destination For Dental Tourism
Sitting in a dentist's chair hardly rates as a vacation. But every year, tens of thousands of people go to a tiny border town near Yuma, Ariz., that has proclaimed itself the dental capital of Mexico. Los Algodones is a virtual dental factory. Some 350 dentists work within a few blocks of downtown Algodones. With low prices and fast service, most patients come for major work (Robbins, 6/9).

WBUR: McInnis House Provides End-Of-Life Care For The Undocumented And Homeless
The roughly 160,000 undocumented immigrants in Massachusetts do not have access to most public health insurance programs. Some doctors and nurses in Boston have noticed this can pose particular challenges at the end of life, where the undocumented do not have access to nursing facilities or hospice care. Some health care providers are stepping in to help these undocumented and dying individuals (Emanuel, 6/10).

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Editorials and Opinions

Viewpoints: 'Bureaucratic Ninja' For The VA; Soap Opera In Virginia; Hospital Readmissions

Bloomberg: The VA Needs A Bureaucratic Ninja
By pulling out of the running to be the next secretary of Veterans Affairs, Cleveland Clinic head Toby Cosgrove has given the administration a chance to think harder about what the VA needs most right now. Does it need an excellent director of an innovative, medium-scale health-care center? Or does it need somebody who can run an army of middle managers on a tight budget? (Christopher Flavelle, 6/9).

The Wall Street Journal: The VA Conspiracy
Washington would like nothing better than for the Veteran Affairs fuss to evaporate, but the department's fraud and access-to-care scandals continue to effloresce. A new audit reveals that 57,000 new VA patients, or 90% of incoming veterans, stood by for three months or more on their first appointment—and worse, 13% of administrative schedulers were instructed by their supervisors to falsify wait-time records (6/9).

The New York Times' Taking Note: If Virginia Doesn't Expand Medicaid, Blame This Guy
But what's happening in Virginia right now may rival or even top that level of brazenness, proving yet again that personal ambition and venality often outweigh political principle. As The Washington Post reported today, Republicans in Virginia persuaded a Democratic state senator to give up his seat by engineering job offers for him and his daughter. The loss of that seat puts Republicans in control of the closely divided state Senate, and probably means the end of any hope to expand Medicaid in that state (David Firestone, 6/9). 

The Washington Post: By Resigning, Virginia Lawmaker Phillip Puckett Betrayed His Own People
This summer, hundreds of sick, desperate people will gather daily in the pre-dawn darkness of a Southwestern Virginia parking lot, part of a late July pilgrimage as predictable as the state’s tobacco crop. They come with festering cancers, rotting teeth, wheezing lungs and aching joints .... Now, if you're a state senator watching what looks like a refugee camp medical tent, staffed by 800 volunteers who come into your town to perform eye surgery and root canals and remove cysts for about 3,000 of your constituents, who have no health insurance and live on about $14,000 a year, wouldn't you do everything in your power to help them? It seems that [Sen. Phillip P.] Puckett has decided that, no, he's not going to help the people who elected him and who are in dire need of every bit of medical care they can get (Petula Dvorak, 6/9). 

The Virginian-Pilot: Usual Business In Richmond
With the former governor and his wife set to be tried on federal corruption charges, and state lawmakers having tweaked Virginia's porous ethics laws to appease public outcry, it seems only fitting that an effort to break the current budget stalemate would involve allegations of personal, pecuniary interests. Sen. Phil Puckett, a pro-gun, pro-life Democrat from southwestern Virginia, is at the center of a firestorm that raised eyebrows across the commonwealth. He abruptly announced his resignation, effective Monday. ... On Monday, Republican leaders said they intended to move for a quick resolution to the budget stalemate, which has broken down between the chambers over whether to use federal funds to cover private health insurance for lower-income Virginians (6/10). 

Richmond Times-Dispatch: Politics: As The State Turns
Now the capital is deadlocked — as it has been for months — over whether to expand Medicaid. The dispute has stalled the state budget, and without a resolution soon many state agencies could shut down. ... Democratic State Sen. Phil Puckett rocked the political establishment on Sunday night by announcing his immediate retirement. That will clear the way for the legislature to appoint his daughter, Martha Ketron, to a six-year term on the state judicial bench .... Puckett’s departure tilts the Senate to the GOP, which could call members back into session and ram through a budget without Medicaid expansion, breaking the deadlock. That would force [Gov. Terry] McAuliffe either to declare defeat or to veto the budget and shoulder sole responsibility for the ensuing government shutdown (6/9). 

The New York Times' The Conscience Of A Liberal: Meanwhile, On The Health Front
You still encounter people claiming that Obamacare has been a disaster, that more people have lost insurance than gained it, etc., etc. But the reality is that it has already made a big dent in the number of uninsured; and the quality of insurance has gone up, too, because canceled policies were canceled because they offered little real protection (Paul Krugman, 6/9). 

Cleveland Plain Dealer: Ohio Entrepreneurs Should Learn About New Health Coverage Options
In case you're not already familiar with it, Ohio's marketplace has two branches — one for individuals, the other for small businesses. ... if you're an employer with fewer than 50 employees looking for a plan for your workers, you've still got time! The small business portal, nicknamed SHOP for Small Business Health Options Program, is open to any employer with fewer than 50 employees and provides year-round enrollment (Grant Lahmann, 6/10). 

The New York Times' Well Blog: Revolving Doors At Hospitals
Everyone on the ward fell hard for the patient in the room at the end of the hall. ... The doctors joked with her, the nurses stroked her head and brought antibiotics and nebulizers right on time, and her private-duty attendant organized her pillows and fed her little snacks. She looked like a million dollars when they sent her home. Two days later she was back in the emergency room, wheezing and choking all over again, her readmission an embarrassment to the professional staff — and, for the hospital, a big fat fine from Medicare in a new effort to discourage these repeat performances. Cases like hers torture health policy makers, partly because nobody can quite figure out who is to blame (Dr. Abigail Zuger, 6/9). 

The New York Times: Progress On Transgender Rights And Health
Progress on civil rights typically comes in incremental steps that discard old policies for new approaches advancing fair treatment. The Obama administration recently took such a step by reversing a 1981 policy that excluded gender reassignment surgery from coverage under Medicare (6/9). 

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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.