Daily Health Policy Report

Wednesday, June 11, 2014

Last updated: Wed, Jun 11

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Coverage & Access


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Michigan To Reward Medicaid Enrollees Who Take ‘Personal Responsibility’

Kaiser Health News staff writer Phil Galewitz, working in partnership with USA Today, reports: “Delayed by state lawmakers, Michigan did not expand Medicaid until the day after the federal online insurance exchange closed March 31 – a move advocates feared would undermine sign-ups. Turns out, enrollment is exceeding expectations, which has pleased officials who seek to make the state among the first in the nation to add a heavy dose of 'personal responsibility' to the federal-state entitlement program” (Galewitz, 6.11). Read the story.

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Mass. Inches Toward Health Insurance For All

Reporting for Kaiser Health News in partnership with NPR, WBUR’s Martha Bebinger writes: “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 this week suggest Massachusetts is very close” (Bebinger, 6/10). Read the story.

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Capsules: Study: Health Law Boosts Hospital Psych Care For Young Adults; The Continuing Drama Over Medicaid Expansion

Now on Kaiser Health News’ blog, Jay Hancock reports on the study about the health law's coverage for young adults: “Expanded coverage for young adults under the Affordable Care Act substantially raised inpatient hospital visits related to mental health, finds a new study by researchers at Indiana and Purdue universities. That looks like good news: Better access to care for a population with higher-than-average levels of mental illness that too often endangers them and people nearby” (Hancock, 6/11).

Also on Capsules, you can watch Kaiser Health News' Julie Rovner and Judy Woodruff on PBS NewsHour discuss where Medicaid expansion stands in states across the country (6/11). Check out what else is on the blog.

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Political Cartoon: 'Second Nature?'

Kaiser Health News provides a fresh take on health policy developments with "Second Nature?" by Dan Danglo.

Meanwhile, here's today's haiku:


The leader loses...
causing caucus confusion.
Will health law feel heat?

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

Cantor's Primary Loss Creates Uncertainty Within House GOP

It's also unclear how the primary defeat of House Majority Leader Eric Cantor, R-Va., could impact efforts by some Republican lawmakers to advance an alternative to Obamacare.  

The Washington Post: Eric Cantor Succumbs To Tea Party Challenger Tuesday
In Washington on Tuesday, the idea of Cantor’s loss was so strange that there was no plan in place to deal with it. Other Republicans puzzled: Did Cantor have to resign his position as the House Republican leader immediately? … On Capitol Hill, Cantor’s defeat will create enormous uncertainty in the House. Cantor, 51, had been considered the next generation’s GOP leader, who would take over for House Speaker John A. Boehner (Ohio) when Boehner, 64, retired. In a caucus deeply divided between establishment Republicans and fire-breathing conservatives, these were the two who had shown some ability to keep order (Costa, Vozzella and Fahrenthold, 6/11).

Politico: The GOP Leadership Scramble
Cantor’s loss could also dramatically alter the Republican legislative agenda for the next five months. Cantor had been scrambling to craft GOP health care bill to replace Obamacare -- trying to piece together plans from wide corners of the party that could win support from a majority of Republicans. GOP leadership aides were tentatively planning for a series of health care related votes following the July 4th recess. If a number of Republican Study Committee members hop into the race, it could raise the prominence of their health care alternative. Scalise launched a push just last month to pressure Cantor to schedule a vote on that bill (French and Bresnahan, 6/11).

The Wall Street Journal: Eric Cantor Loses To Tea Party's David Brat In Virginia Primary
Mr. Cantor, responsible for setting the House's legislative schedule, had taken the lead organizing House Republicans' efforts to draft an alternative to the Affordable Care Act, an effort now cast into doubt. Mr. Cantor's defeat also scrambles the outlook for the future of the House GOP leadership. He had been seen as the likely successor to Mr. Boehner, who some had thought might be considering retiring after the next term (Peterson and Hook, 6/10).

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House Unanimously Passes Bill To Revamp VA Care

The measure would allow vets to seek private care if they couldn't be seen quickly by the VA and requires an evaluation of the VA health system.

Los Angeles Times: A Primer On How The VA Crisis Broke The Usual Congressional Gridlock
The Veterans Affairs healthcare scandal has done something that few other issues have achieved in this hyper-partisan Congress: Unite members of opposing parties in support of swift action to reduce veterans' waits for care and hold VA officials accountable for misrepresenting waiting times. The bipartisanship was apparent Tuesday as the House overwhelmingly approved a bill that would allow veterans facing long waits for VA care to see private doctors, suspend VA bonuses and require an outside assessment of the VA healthcare system (Simon, 6/10).

Politico: House Passes VA Bill
The House approved legislation on Tuesday that gives veterans stuck on long wait lists for medical care the ability to seek treatment outside of the system established by the Department of Veterans Affairs. Sponsored by Committee on Veterans' Affairs Chairman Jeff Miller (R-Fla.), the bill passed 421-0 with overwhelming support from both parties (French, 6/10).

Meanwhile, in Phoenix where some of the VA's problems first surfaced, a key veterans group sets up a crisis center.

The Associated Press: Amid VA Troubles, Vets Flood American Legion Crisis Center In Phoenix Seeking Help With Care
The 71-year-old former Marine from Glendale went to the emergency room at the VA's Phoenix hospital on April 28 with chest pains. He said he was told he'd need surgery soon, but has yet to get an appointment. "They sent me home to die," Stoesser said Tuesday, surrounded by dozens of other veterans at a crisis center set up by the American Legion in downtown Phoenix in a first-of-its-kind event for the nation's largest veterans group. The move comes amid growing criticism of the VA's handling of patient care nationwide and allegations of misconduct, lengthy wait times and potential unnecessary deaths (Kashfi, 6/10).

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House Republicans Take Aim At Health Law Subsidy Overpayments

Lawmakers at a joint hearing of the Ways and Means health and oversight subcommittees heard testimony from conservative groups noting that the total of these overpayments to people newly enrolled in health plans could reach hundreds of billions of dollars, and, even though those consumers could face a tax hit, the actual funds could be difficult to recoup.

Reuters: Republicans Call Obamacare Subsidies A Risk To Taxpayers
Congressional Republicans sought to portray Obamacare subsidies for low-income families as a financial risk for taxpayers on Tuesday, a claim that could become a new avenue for campaign attacks on Democratic candidates this fall. At a hearing in the Republican-controlled U.S. House, witnesses from conservative groups said overpayments of federal subsidies to people newly enrolled in Obamacare health plans could reach hundreds of billions of dollars while jeopardizing the health coverage and federal tax refunds of subsidy recipients found to owe money (Morgan, 6/10).

The Wall Street Journal’s Washington Wire: GOP Says Tax Man Cometh For Health Law Enrollees
Republican lawmakers on Tuesday warned that Americans getting larger health-insurance subsidies than they should under the Affordable Care Act will face a tax hit come April. The Centers for Medicare and Medicaid Services, the agency overseeing the health law, has said that at the end of May there were around 1.2 million people whose insurance-exchange applications for coverage had income inconsistencies. That could include people who had misstated their income, had a change in family status, or who got a bonus or raise (Armour, 6/10).

CQ Healthbeat: Excessive Health Law Subsidies May Not Be Recovered, Panel Is Told
The government could lose more than $150 billion over a decade because it can’t accurately verify the incomes of people who qualified for subsidies to help buy insurance under the health law, House Ways and Means lawmakers were told on Tuesday. Some recipients who were overpaid will refuse to give back the difference while the government will remain unable to identify everyone who got too much money, Republicans and conservative policy experts said to a joint hearing of the Ways and Means Health and Oversight subcommittees (Adams, 6/11).

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Health Reform

Survey: Health Exchange Shoppers Have Choices Between Large And Small Provider Networks

The survey, done by consulting company McKinsey and Co., found the majority of online insurance marketplace customers have options that include both larger, more costly networks and smaller, more affordable ones. In addition, the latest on the SHOP program as well as a report about a new round of grants for navigators.

CQ Healthbeat: Exchange Customers Have Access to Broad Network Plans, Survey Shows
The overwhelming majority of health insurance exchange customers have a choice between large and more costly provider networks and smaller more affordable ones according to a new survey by the McKinsey and Co. consulting company. Critics of the health law have complained that exchange products limit choice of providers, even though in many instances shoppers in the marketplaces have no prior insurance and therefore had little or no choice of providers at all (Reichard, 6/11).

The Wall Street Journal: Some Small-Business Employees To Have Only One Health-Plan Choice
Small employers in 18 states will offer only one health plan to workers when the Affordable Care Act's small-business exchanges open this fall, federal officials said Tuesday. The 2010 law called for new online insurance marketplaces, which were supposed to open last year, for small businesses to pick group plans to cover workers. But those exchanges were delayed a year, and federal officials say they will lack some functions when they open in November (Radnofsky, 6/10).

Politico Pro: SHOP Flop: Obamacare For Small Businesses
The piece of Obamacare meant to help small businesses provide better health insurance options for their workers failed to launch in Year One, and the Obama administration on Tuesday gave the go ahead for 18 states to put part of it on hold once again. The Small Business Health Options Program is Obamacare’s neglected stepchild. As one of two new marketplaces set up by the health care law, SHOP was meant to encourage companies with up to 100 employees to cover their workers and give them a menu of insurance options. The delay leaves the exchange for small employers hobbled in large parts of the country until at least 2016 and creates another element of the law that’s inconsistent from state to state (Norman, 6/10).

The Hill: CMS TO Spend $60M On Navigators
The Centers for Medicare and Medicaid Services (CMS) said Tuesday it will spend at least $60 million on Obamacare navigators for the 2015 enrollment period. Navigators are counselors who help consumers register for plans under federal and state health insurance exchanges (Al-Faruque, 6/10).

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Va. Governor Examining Ways To Expand Medicaid By Executive Action

In related news, The Oklahoman reports that Mercy health system is blaming states' decisions to not expand the low-income health care program as the reason it is planning layoffs, and KHN details Michigan's expansion efforts.

The New York Times: Virginia Governor May Try To Expand Medicaid On His Own
Gov. Terry McAuliffe has lost his battle with the legislature over Medicaid expansion, an enormous retreat from the high expectations he set for a liberal agenda. However, he is thought to be studying how to press the issue by executive action -- a legally and politically uncertain course (Gabriel, 6/10).

The Oklahoman: No Medicaid Expansion Reason For Mercy's Plans To Lay Off Up To 300 Workers In Four States
Operators of the Mercy health system are looking to lay off up to 300 people in four states this month, citing less money coming into the health care system because of reductions in insurance payments and a lack of Medicaid expansion in most of the states the hospital system serves. ... The Mercy health system includes 33 acute-care hospitals, four heart hospitals, two children’s hospitals, two rehab hospitals, one orthopedic hospital, nearly 700 clinic and outpatient facilities, 40,000 employees and more than 2,100 Mercy clinic physicians in Arkansas, Kansas, Missouri and Oklahoma (Cosgrove, 6/9).

Kaiser Health News: Michigan To Reward Medicaid Enrollees Who Take ‘Personal Responsibility’
Delayed by state lawmakers, Michigan did not expand Medicaid until the day after the federal online insurance exchange closed March 31 -- a move advocates feared would undermine signups. Turns out, enrollment is exceeding expectations, which has pleased officials who seek to make the state among the first in the nation to add a heavy dose of “personal responsibility” to the federal-state entitlement program (Galewitz, 6/11).

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GOP Warns Health Law Change Could Use Taxpayer Money To 'Bail Out' Insurers

In the meantime, insurers say they want government money to help people who buy catastrophic plans to keep premiums for them low. Also, the employer mandate comes under further attack, and one insurer calls members to manage their health.

Fox News: Republicans Warn Obamacare Rule Tweak Could Trigger Taxpayer Bailout Of Insurers
Top congressional Republicans warned the Obama administration Tuesday it risks violating federal law if it proceeds with a backup plan to transfer "potentially billions" in taxpayer dollars into Obamacare to bail out insurance companies. The Affordable Care Act was originally signed into law with a provision that allows the government to cover insurers that lose money by paying them from a pool of cash collected from insurers that turned a profit. However, administration officials made a rule change in May to the so-called "risk corridors" program that, Republicans say, would allow them to use taxpayer funds from other federal programs -- GOP lawmakers say that's a decision only Congress can make (6/11).

The Associated Press: Insurers Want Subsidies For People Buying Catastrophic Plans
Insurers want to change President Barack Obama's health care law to provide financial assistance for people buying bare-bones coverage. That would entice the healthy and the young, the industry says, holding down premiums. So-called catastrophic plans are currently not eligible for the law's subsidies, and only 2 percent of the 8 million consumers who signed up this year picked one. Subsidies bring down the cost of monthly premiums. The proposed change is part of a package of recommendations that America's Health Insurance Plans, the main industry trade group, plans to release Wednesday. Others address how to smooth transitions for consumers who switch insurance companies, as well as making it easier for patients to find out which hospitals and doctors are in particular plans and whether their medications are covered (Alonso-Zaldivar, 6/11).

The Washington Post: Obamacare's Employer Mandate Is Under Attack From Both Sides. Will It Survive? 
Critics of the health care law, including many business owners, have long bemoaned a provision that requires employers to provide health coverage to their workers. Now, some of the law's supporters are starting to call for the rule's elimination, too (Harrison, 6/10).

The New York Times: A Health Insurer Calls, With Questions
Not long after she signed up for health insurance under the Affordable Care Act, Judy Shoemaker received a phone call that puzzled her. The caller ... asked Ms. Shoemaker to take a survey about health care issues, so information could be provided to her physician. ... Lauren Perlstein, a spokeswoman for the Health Care Service Corporation, parent of Blue Cross Blue Shield of Illinois and plans in four other states, said in an email that the company contacted new policy holders to help "new members get the proper coverage and medical assistance they need, by helping guide them through the health care system." ... Ms. O’Leary said she was not aware of any consumers who had been improperly terminated from coverage, but that she considered the calls a "red flag." She advises clients not to answer health questions from their insurers unless they have an active claim. (Carrns, 6/10).

And on the issue of how the health law is affecting one woman's coverage in California --

The California Health Report: How The ACA Is Changing Lives
The federal health law known as the Affordable Care Act has become a partisan punching bag in Washington D.C., but for singer Nola Shepherd, the new law could not sound any sweeter. The law gave her peace of mind when she lost her job, and now she sees it as part of the foundation for a new business she is trying to get off the ground. Shepherd, a 50-year-old singer and songwriter who lives with her partner Jim Quealy in Seal Beach, was laid off from her executive assistant job at a Caterpillar dealership in February. The coverage available to her through the old COBRA Program for the unemployed was beyond her financial reach. Now, thanks to the Affordable Care Act, Shepherd is paying $1 a month, a rate based on the low income she currently receives from unemployment insurance (Portner, 6/11).

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Coverage & Access

Recovery Programs Are Expensive And Hard To Find For Addicted Teens

Families often struggle to get help for children with addiction problems. Also, a new study finds that young adults are making strong use of hospital care for mental health issues.

U.S. News And World Report: Teens With Addiction Have Few Recovery Programs
Within the last five years, drug overdoses have become one of the top three killers of 15 to 19 year olds, according to the Centers for Disease Control and Prevention. ​Even so, the resources for addiction treatment are hard to locate, expensive and rarely meet patients' needs. Most children's hospitals do not have psychiatry departments, let alone offer substance abuse treatment. And at the same time, addiction services are stifled by stigma within the medical industry and at the public policy level. ... most facilities that treat addiction are cost-prohibitive for families. ​Insurance plans vary on how long they will approve treatment for addiction, how much they will pay and whether repeat treatments will be reimbursed (Leonard, 6/10).

Kaiser Health News: Capsules: Study: Health Law Boosts Hospital Psych Care For Young Adults
Expanded coverage for young adults under the Affordable Care Act substantially raised inpatient hospital visits related to mental health, finds a new study by researchers at Indiana and Purdue universities. That looks like good news: Better access to care for a population with higher-than-average levels of mental illness that too often endangers them and people nearby. But it might not be the best result (Hancock, 6/11). 

Meanwhile, ProPublica examines the issue of mental health and the recent spate of mass shootings -

ProPublica: Myth Vs. Fact: Violence And Mental Health
After mass shootings, like the ones these past weeks in Las Vegas, Seattle and Santa Barbara, the national conversation often focuses on mental illness. So what do we actually know about the connections between mental illness, mass shootings and gun violence overall? To separate the facts from the media hype, we talked to Dr. Jeffrey Swanson, a professor in psychiatry and behavioral sciences at the Duke University School of Medicine, and one of the leading researchers on mental health and violence. Swanson talked about the dangers of passing laws in the wake of tragedy ― and which new violence-prevention strategies might actually work (Beckett, 6/10).

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Taking A Closer Look At Medicare Advantage Money, Lobbying

The Center for Public Integrity looks at Medicare Advantage plans -- the money surrounding them including for reimbursement and what they spend on lobbying Congress.

Center for Public Integrity: Home Is Where The Money Is For Medicare Advantage Plans
Some of the senior citizens who called Arizona insurance agent Denise Early wondered why their Medicare Advantage health plans were eager to send a doctor to visit them at home. A few worried that the offer might be a scam. After all, they asked, how many doctors make house calls these days? More than people might think. Home visits have risen sharply at many private Medicare health plans, which treat close to 16 million elderly and disabled people under contracts with the federal government (Schulte, 6/10).

Center for Public Integrity: Medicare Advantage Lobbying Machine Steamrolls Congress
[Sen. Al] Franken rebuked Republican Mitt Romney for his 2012 presidential campaign promise to “restore those billions and billions of dollars in overpayments to private insurance companies for no reason, for no good effect, just so that, I guess, these insurance companies could have more profit.” Yet less than four months later, Franken was in the company of more than 160 lawmakers publicly thanked by industry surrogates for their help in killing some of the same Medicare Advantage cuts he’d previously supported so forcefully. By most accounts it was a stunning policy reversal for many Democratic members of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing political might in Washington (Schulte, 6/10).

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8.5 Million On Medicare Get Opioids

Elsewhere, those who switch to a newer type of insulin find added cost.

USA Today: Seniors' Use Of Potent Meds Via Medicare Staggering
The number of senior citizens getting narcotic painkillers and anti-anxiety medications under Medicare's prescription drug program is climbing sharply, and those older patients are being put on the drugs for longer periods of time, a USA TODAY examination of federal data shows. From 2007-2012, the number of patients 65 and older getting Medicare prescriptions for powerful opioid pain medications rose more than 30 percent to upward of 8.5 million beneficiaries, the data show (Eisler, 6/10).

NPR: Switching To Newer Insulin For Type 2 Diabetes Comes At A Cost
Many people with diabetes have switched to newer forms of insulin called analogs, because they can make the disease easier to manage. But that switch can be expensive, a study finds (Shute, 6/10).

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State Watch

Mass. To Spend $20 Million To Combat Opioid Use

Gov. Deval Patrick announced the plan Tuesday that will also team with five other New England states to upgrade treatment and expand coverage to treat drug abuse.

The Boston Globe: Patrick Airs $20M Plan To Combat Opioid Use
Governor Deval Patrick unveiled plans Tuesday to upgrade treatment for opioid addicts, expand insurance coverage, and coordinate with the other five New England governors to stem an epidemic that has claimed hundreds of lives in Massachusetts since last fall. Key elements of the $20 million plan, which could create hundreds of new treatment beds, target the needs of adolescents and young adults, who made up about 40 percent of clients treated in fiscal 2013 by the state’s Bureau of Substance Abuse Services (MacQuarrie, 6/10).

WBUR: Patrick Endorses Plan To Address Opiate Addiction ‘Public Health Emergency’
The Patrick administration is ready to spend $20 million on two dozen initiatives aimed at curbing a surge in addiction to heroin and other opiates in Massachusetts. The details are in a task force report endorsed by Gov. Deval Patrick Tuesday. “We have a public health emergency,” Patrick said, repeating the reason he created the task force in late March. To combat that emergency, the state will spend $4 million on new residential treatment programs for adolescents, young adults, families with children, and two that will give priority to Latinos. There’s an enhanced prescription monitoring program. The state plans to spend $3 million on treatment for inmates, including Vivitrol, a drug that blocks the effects of opiates (Bebinger, 6/10).

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State Highlights: Conn. Patients To Get 'Facility Fee' Notice

A selection of health policy stories from California, Connecticut, Missouri, North Carolina, Massachusetts, Texas, Kansas and Michigan.

Los Angeles Times: L.A.County Board Said Unaware Of U.S. Focus On Mentally Ill Inmates
Supervisor Mark Ridley-Thomas said board members and their staffs were not privy to communications sent by the U.S. Justice Department to Sheriff's Department and county mental health officials regarding ongoing problems until September. That's when county officials received a letter announcing a federal civil-rights investigation of the jail system (Sewell, 6/10).

Los Angeles Times: San Quentin Plans Psychiatric Hospital For Death Row Inmates
The court-appointed monitor of mental health care in California's prison system reported to judges Tuesday that about three dozen men on death row are so mentally ill that they require inpatient care, with 24-hour nursing. For now, they are being treated in their cells, but the state plans to have a hospital setting ready for them by November, according to documents filed Tuesday in federal court (St. John, 6/10). 

The CT Mirror: Patients Will Get Notices About 'Facility Fees' Starting In October
Starting in October, patients will receive advance notification if they will face extra charges for getting outpatient care at hospital-owned facilities, under a bill Gov. Dannel P. Malloy signed into law. Medical practices owned by hospitals can charge patients facility fees, which are separate from doctor bills. Many patients who received them have said they didn’t know they would be charged the fees, which can amount to hundreds or thousands of dollars. Hospitals say the fees reflect the higher costs and standards that hospital-based practices face. The new law doesn’t stop hospitals from charging facility fees (Becker, 6/10).

The Associated Press: California Hispanics Worry About Long-term Care
When it comes to planning for old age, Hispanics in California worry much more than whites about their ability to pay for care they may need and the prospect that they will be left alone without family and friends. Yet, Hispanics are also more reticent to discuss plans for long-term care with their families, a new poll indicated. Fewer than one in five California Hispanics have discussed with a loved one the type of living assistance they would want, compared with nearly half of whites, according to the Associated Press-NORC Center for Public Affairs Research poll (Freking and Hamilton, 6/10).

St. Louis Post-Dispatch: Health Care Hiring Hits Lull In St. Louis 
For years, stories about the St. Louis job market always mentioned the steady hiring in health care. The medical sector has grown by more than 25 percent over the past decade, and at times during the recession of 2008 and 2009 it was just about the only part of the local economy that was expanding. Sometime last year, though, the hiring stopped. According to the Bureau of Labor Statistics, the St. Louis area’s health care industry employed 2,700 fewer people in April 2014 than it did a year earlier. The year-over-year comparison has been negative for every month since October (Nicklaus, 6/10).

Modern Healthcare:  Some States Begin Implementing ACA’s Medicaid Stop-Smoking Provisions 
North Carolina has become the latest state to formally implement a provision of the health care reform law requiring state Medicaid programs to cover drugs used for smoking cessation both in their traditional and managed-care programs. A number of states still haven't formally adopted the provision in their state Medicaid plans. But Medicaid officials in most states say they support the coverage provision and were already covering the drugs (Dickson, 6/10).

Kaiser Health News: Mass. Inches Toward Health Insurance For All
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 this week suggest Massachusetts is very close (Bebinger, 6/10).

Texas Tribune: 2 Abortion Docs Settle Suit Over Revoked Privileges
Two Texas abortion doctors who filed a lawsuit against a Dallas hospital after losing their admitting privileges have settled their case with the hospital, which will reinstate their privileges. In April, Lamar Robinson, owner of Abortion Advantage, and Jasbir Ahluwalia, the medical director of Routh Street Women’s Clinic, said they received letters from University General Hospital in Dallas revoking their admitting privileges at the hospital after anti-abortion protesters targeted the hospital. In the settlement, University General Hospital was “restrained from directly or indirectly” revoking the doctors’ admitting privileges because of their “willingness to participate in an abortion procedure” at another facility (Aaronson and Ura, 6/10).

Kansas Health Institute News Service:  Kansas Prepares For New Federal Assisted Living And Nursing Home Rules 
Providers of home- and community-based (HCBS) Medicaid services and their state overseers are preparing for a raft of new federal rules that are intended to assure that the people who receive the services have more say in how they are helped and that their living conditions are “non-institutional.” The regulations could have major consequences for many beneficiaries and the businesses and organizations that help them, particularly for some senior care providers who operate assisted living facilities attached to or in near proximity to nursing homes (Shields, 6/10).

Detroit Free Press:  State’s Health Budget Trims Funding For Infant Mortality
Harper and Hutzel hospitals lost out on $6.5 million in state money to help fund their infant mortality and high-risk pregnancy programs in Detroit, when the Department of Community Health budget was approved by a conference committee today without the funding. In addition, the Department of Human Services saw $287.6 million in cuts to the money it’s spending on public assistance for poor Michiganders as the economy recovers and more people reach the 48-month limit for benefits and are kicked off welfare rolls (Gray and Erb, 6/10).

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Editorials and Opinions

Viewpoints: Cantor Was No RINO; Battles Over Medicaid In Va. And Ind.; Reforms Moving For VA

Richmond Times-Dispatch: Stunning Upset
Ideas have consequences. Elections sure do, too. David Brat's victory over Eric Cantor is stunning, to state the glaringly obvious. ... Brat's victory also moves the Virginia GOP even further to the right. No one ever could have mistaken Cantor — who organized 50 votes to repeal Obamacare — for a RINO, let alone a limousine liberal. But for many GOP diehards, he was insufficiently confrontational (6/11).

The Washington Post: Virginia's Low-Income Population Needs Obstruction On Health Coverage To End
For months now, Gov. Terry McAuliffe (D) has been battling Republicans over whether Virginia should take $2 billion per year of federal money to expand Medicaid within the state, covering some 400,000 people. Amid this deadlock, Phillip Puckett (D-Russell), a state senator, suddenly resigned on Monday, shifting power in the Senate from the Democrats to the Republicans. The newly configured Senate now appears ready to pass a state budget without Medicaid expansion in it, possibly jamming the governor with a spending plan that does not include his top priority. Mr. McAuliffe could try to amend the bill and send it back to the legislature, but it's also very possible that the governor will be thwarted in delivering on his push to expand Medicaid in this legislative round (6/11). 

The Fiscal Times: The Pol Who Sold Out 400K Uninsured Constituents
When they went to bed on Saturday night, the 400,000 Virginians currently without health insurance stood at least a fighting chance of getting coverage through an expansion of the state’s Medicaid program. They woke up Sunday to rumors, quickly confirmed, that that chance had virtually disappeared. ... Sen. Phillip P. Puckett, a Democrat representing a poverty-stricken district in the southwestern part of the state suddenly announced his resignation. ... It was a mortal blow to the Democrats’ control of the Senate. The district Puckett used to represent contains part of Wise County, where poor residents wait anxiously to get free medical care from a mobile clinic that visits once a year (Rob Garver, 6/10).

The Wall Street Journal: The Short Unhappy Life Of ObamaCare
President Obama claims the debate over the Affordable Care Act is "over," but in coming weeks and months expect it to intensify. Health-insurance companies will soon begin releasing preliminary rate estimates for next year's plans. Industry experts say consumers should once again brace for significantly higher premiums. Fearing the political fallout before November's elections, the administration last month quietly increased by billions of dollars the "risk corridor" funds that insurance companies can use to staunch their losses (Stephen T. Parente, 6/10).

USA Today: For Obama, Inaction Speaks Louder Than Words
Now new revelations about the handling of Obamacare subsidies and health care for our nation's veterans paint a startling picture of incompetence at the highest level of our government. President Obama must act now to correct these deficiencies before the faith of the American people in our federal government — already at record lows — is further undermined. Since its enactment, Obamacare has lurched from crisis to crisis, the result of fundamental flaws in rushed legislation with no bipartisan support and without proper consideration or necessary amendments. Based on new information that has come to light, Obamacare's broken subsidy provision may end up being among the most costly of these flaws (Sen. Rob Portman, R-Ohio, 6/10).

The New York Times' The Conscience Of A Liberal: The Pundits And The President
Obama’s signature initiative, health reform, made a stunning comeback from a rocky start and will almost surely be irreversible by the time he leaves office. He's taken the most important step on environmental policy since the Clean Air Act. … If the point of being president is to do things with lasting effect, Obama has delivered. So why the bashing? Part of the answer, I think, is that these are the wrong achievements. He was supposed to be serious in the approved way, slashing entitlements to deal with the fiscal crisis. The fact that there wasn't actually a fiscal crisis, and that anyone who really cares about the long run should worry a lot more about carbon emissions than about the Medicare age, doesn't change the bias; strong presidents are supposed to use that strength on behalf of the elite's pet obsessions, not other stuff (Paul Krugman, 6/10).

The Hill: Two Sides Of The Medicaid Expansion Coin
Is it possible for more Republican-led state governments to expand their Medicaid programs without politically endorsing the extension of ObamaCare under the Affordable Care Act (ACA)? Indiana Gov. Mike Pence (R) says he can, but he hasn't convinced a number of conservative Republican critics. ... The overriding judgment call is whether Indiana is sending a signal of counterrevolutionary resolve, or disguised take-the-money-and-run capitulation, to the remaining states holding out against Medicaid expansion as part of broader efforts to overturn ObamaCare. The evidence for the former would be stronger if Indiana officials truly were still prepared to walk away from a bad waiver deal. But at this point, it appears that Pence and his state allies need even a watered down version of [Healthy Indiana Plan] 2.0 more than the Obama administration needs to add another red-state political trophy to its list of ACA-compliant jurisdictions (Tom Miller, 6/11).

Fort Wayne Journal Gazette: HIP Replacement: Pence Plan Needs To Be Ready To Go On Day 1
Later this month, the state will file its request for federal permission to substitute HIP 2.0 for an expansion of Medicaid. A meeting at Ivy Tech Monday was one of nine "conversations" state officials are having around the state. As Indiana Health Commissioner William VanNess and Indiana Medicaid Director Joe Moser fielded questions from about 50 participants, it became clear that the focus of concern was whether anyone has thought through how to get 2.0 off the ground. "We don't expect major challenges in implementation and enrollment," VanNess said. This was a tough audience, though; sprinkled with experienced health care workers and administrators, the questions they raised need to be seriously addressed (6/11).

And on other health issues -

The Washington Post: Congress Reforms Of VA System Could Be A Move In The Right Direction
For those of us who have been struck by the high rhetoric-to-fact ratio in the uproar over alleged misconduct at the Department of Veterans Affairs, Monday brought a needed infusion of hard data in the form of a department-wide audit. ... As the new department audit clearly demonstrates, the root cause of scheduling chicanery is not the inherent corruption of VA staff but the fact that there are too many veterans pursuing too few physicians, which, the audit said, made the 14-day goal "simply not attainable." ... "Privatization" is a dirty word to many VA supporters on the Hill and in the veterans’ lobby. But if the Sanders- McCain bill’s two-year experiment in letting vets seek care outside the system becomes law, and if it proves to be effective, Congress may well see the wisdom of this approach and want to continue and expand it (6/10). 

Bloomberg: Medicare Can Afford A Bit Of Fraud
Medicare fraud is not OK. You shouldn't do that, doctors, and if you are committing Medicare fraud, you should be very ashamed of yourself and stop. But that doesn’t mean the folks who run Medicare should do everything in their power to stop you. Every organization should work hard to prevent malfeasance, but it should not go after every possible case of fraud ever. As the frauds get smaller or more sophisticated, the cost of preventing the fraud starts to exceed the cost of the fraud itself (Megan McArdle, 6/10).

Journal of the American Medical Association: Addressing The Burden Of Diabetes
If the current epidemic is not addressed, the US Centers for Disease Control and Prevention estimates that as many as 1 in 3 people in the United States could have diabetes by the year 2050. ... Addressing the epidemic of diabetes will involve reducing the effects of the disease on patient outcomes and quality of life, as well as lowering cost to the health care system. Ultimately, this will require new strategies to prevent the disease in those at risk and cure those who have already developed diabetes. More research is necessary to understand the pathogenesis of all forms of the disease to address the root causes. Until then, physicians, other health care professionals, and patients must focus on implementing evidence-based prevention and treatment approaches in determining how to best use the currently available tools (Dr. Elizabeth R. Seaquist, 6/10). 

Journal of the American Medical Association: Comparative Effectiveness Research And Outcomes Of Diabetes Treatment
Randomized clinical trials (RCTs) are the gold standard for advancing the science of medicine. However, many important clinical questions probably will never be answered by RCTs simply because many trials are extraordinarily expensive and RCTs might not always be appropriate for addressing some research questions. ... Comparative effectiveness research is creating new challenges as it generates much needed new evidence (Dr. Monika M. Safford, 6/10).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.