Daily Health Policy Report

Thursday, June 12, 2014

Last updated: Thu, Jun 12

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Administration News

Health Reform

Medicare

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

For Women Just Out Of Jail, Health Care Could Be Key To Better Life

Reporting for Kaiser Health News, in partnership with NPR, KQED’s April Dembosky writes: “The San Francisco Sheriff's Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they're released will help prevent them from committing another crime and coming back. One inmate – Sophia – recently requested help signing up for health insurance. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in the county jail. She says that was because she stopped getting treatment for her substance abuse and mental health problems when her health insurance expired” (Dembosky, 6/12). Read the story.

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Capsules: Obamacare Health Spending Surge? Not So Fast; Some Costly Hospital Complications Not Tracked by Medicare, Analysis Finds

Now on Kaiser Health News’ blog, Jay Hancock reports on developments related to health care spending estimates: “A growing economy and an Obamacare spending surge, many suspected, had ended five years of moderate health-spending growth. Early government figures showed medical-cost acceleration at the beginning of the year. … Not really. The preliminary estimates that prompted the story were off. Hospital revenue fell in 2014′s first quarter compared with the final three months of 2013, the Census Bureau estimated Wednesday. So did revenue for medical labs and outpatient care (Hancock, 6/12). 

Also on the blog, Jordan Rau reports on a new analysis regarding hospital complications: “Premier, Inc., a consulting company that works with hospitals on improving quality, analyzed 5.5 million patient records to identify 86 common complications that occurred in the hospital and were associated with patient deaths, higher costs or longer lengths of stays. The consultants offered estimates for each condition, which include heart attacks in the hospital, sepsis and acute kidney failure” (Rau, 6/12). Check out what else is on the blog.

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Political Cartoon: 'Roll Calling With The Punches?'

Kaiser Health News provides a fresh take on health policy developments with "Roll Calling With The Punches?" by Larry Wright.

Meanwhile, here's today's haiku:

SEEKING A SOLUTION TO VA HEALTH SYSTEM WAITING TIMES

Private care for vets?
Some say it's the best answer.
Some say use caution.
-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

After Cantor's Loss, GOP Efforts To 'Replace' Health Law Face New Challenges

Before his primary election defeat by challenger David Brat, House Majority Leader Eric Cantor was involved in drafting a GOP health law alternative.  

The Wall Street Journal: Eric Cantor To Step Down As House Majority Leader
On the policy front, the Cantor defeat squelches whatever slim chance remained for Congress to enact immigration reform later this year. The majority leader was also in the process of drafting a Republican alternative to the 2010 health law and building an agenda for the next Congress, when many expected him to assume the House speakership from John Boehner of Ohio (Peterson, O’Connor and Hook, 6/11).

Politico: No Eric Cantor, No Obamacare ‘Replace’ Vote
House Majority Leader Eric Cantor’s shocking primary loss Tuesday night all but kills any chance of the House voting on an Obamacare replacement bill this year. The prospects of Republicans rallying around a replacement policy and scheduling a vote was already an uphill endeavor -- one that few expected to actually happen. After all, the House GOP had been trying to agree to a plan for several years already (Haberkorn, 6/11).

Meanwhile, what about the candidate who won that congressional primary --

The Wall Street Journal: David Brat's Writings Give An Early Picture Of His Political Philosophy
He opposes government efforts to help the poor through unemployment and health insurance because it would, he warned, leave them entitled. He has said that a dictator like Hitler "could all happen again, quite easily" if Christian people don't strongly assert their faith (Epstein, 6/11).

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Senate Backs Bipartisan Bill To Overhaul Vets' Health Care System

The Senate measure, which was approved Wednesday by a 93-3 vote and has gained the White House's nod, has elements in common with a version unanimously approved Tuesday by the House of Representatives.   

The Wall Street Journal: Senate Approves Bipartisan VA Overhaul Legislation
A Senate bill passed on Wednesday opens the door to widespread changes in the Department of Veterans Affairs health care system, including allowing more veterans to seek care from providers outside the VA and letting the department's secretary fire senior executives more easily. The bill—a bipartisan compromise struck by Sens. Bernie Sanders (I., Vt.) and John McCain (R., Ariz.)—was unveiled last week and in some respects resembles legislation passed Tuesday by the House (Kesling, 6/11).

The Associated Press: Senate Backs Bill To Improve Health Care For Vets
The Senate bill, approved 93-3, makes it easier for veterans who have encountered delays getting initial visits to receive VA-paid treatment from local doctors instead. The measure closely resembles a bill approved unanimously Tuesday in the House, prompting optimism among lawmakers from both parties that a compromise version could be on its way soon to President Barack Obama for his signature. The White House said Wednesday that Obama supports the Senate bill (Daly, 6/11).

Los Angeles Times: Senate OKs VA Reform Bill As FBI Launches Criminal Investigation
The Senate on Wednesday broke through the usual partisan gridlock to swiftly approve legislation aimed at reducing veterans' long waits for healthcare, as the FBI announced that it has launched a criminal probe in the Department of Veterans Affairs scandal. The bill would allow veterans facing long waits at VA facilities to seek care from private doctors, expand the VA secretary's authority to fire staff for poor performance, authorize the department to lease 26 new health facilities in 17 states, including California, and Puerto Rico. It also would provide $500 million for expedited hiring of new VA doctors and nurses (Simon, 6/11).

Politico: Senate Passes VA Reform Bill 
But if the Senate’s bill eventually comes law, there could be a large tab for Washington. The Congressional Budget Office estimated on Wednesday afternoon that increased veterans health-care access could cost the federal government an additional $50 billion a year (Everett, 6/11).

The Hill: Senate Passes Overhaul Of VA In 93-3 Vote
Lawmakers voted 93-3 in favor of a nearly $2 billion bill from Sens. Bernie Sanders (I-Vt.) and John McCain (R-Ariz.) that gives the VA secretary new authority to fire senior executives and provides veterans greater options for seeking medical care (Matishak and Cox, 6/11).

Reuters:  Senate Passes Bill Aimed At Fixing Veteran Health Care Delays
Among differences between the House and Senate versions are that the House proposes a top-to-bottom review of all aspects of VA's health care system, while the Senate calls for a review of appointment scheduling practices and systems. The Senate version offers protections for VA employees not in the House bill (Lawder and Dunham, 6/11).

In related news -

Des Moines Register:  Docs Willing To Work At VA Should Be Eligible For Loan-Repayment, Iowa Democrat Says
Doctors and nurses who are willing to work at VA hospitals and clinics should be eligible for a national loan-repayment program, Rep. Bruce Braley says. The Iowa Democrat has introduced a bill that would open up the National Health Service Corps to doctors, nurses and other health-providers who go to work for the Department of Veterans Affairs or state veterans' homes. The program now provides scholarships or college-loan repayments to health-care providers who agree to work in "underserved areas," which are mainly in rural America (Leys, 6/11).

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Administration News

FBI Announces Criminal Investigation Into VA Problems

Director James Comey says the FBI has opened a probe into allegations that employees at the Department of Veterans Affairs manipulated waiting lists and delayed care for veterans.

The Wall Street Journal: FBI Opens Criminal Probe Of VA's Practices
The Federal Bureau of Investigation has opened a criminal probe into scheduling practices at the Department of Veterans Affairs, escalating the stakes in a scandal that has already led to the resignation of the agency's leader. Law-enforcement officials had previously acknowledged the Justice Department is reviewing documents provided by the VA inspector general to see if any potential crimes were committed in how the agency managed its appointment schedules. The opening of a criminal probe takes that work a step further and could lead to criminal charges if law enforcement finds evidence of fraud or misuse of government resources (Barrett, 6/11).

The New York Times: FBI Begins Criminal Inquiry In VA Scandal
The F.B.I. has opened a criminal investigation into accusations that Department of Veterans Affairs officials manipulated medical waiting lists and delayed care for thousands of veterans, the F.B.I. director, James B. Comey, said Wednesday (6/11).

Politico: FBI Opens Criminal Probe On VA Wait Lists
Attorney General Eric Holder had said previously that prosecutors were in regular contact with the Department of Veterans Affairs inspector general’s office, which conducted the initial probe into the allegations that VA employees doctored the waiting lists and kept multiple lists in order to make sure employees qualified for bonuses. However, in earlier comments, Holder did not announce a criminal investigation -- a status which means evidence of illegality has crossed a particular threshold (Gerstein and Kopan, 6/11).

Also, some experts suggest that new technologies may help ease the access problems at the VA.

CBS News: Can Private Business Help Fix The VA?
Can new technologies help to ease the bureaucratic logjam at the U.S. Department of Veterans Affairs while preventing future scandals such as those uncovered by the recent internal VA audits? Perhaps, say some analysts and business professionals who've been following the revelations of shoddy health care and lengthy wait times for care at the VA. Experts believe updated software systems could go a long way towards making the agency's massive bureaucracy more streamlined, cost-efficient and beneficial to the millions of U.S veterans who rely on it (Kennedy, 6/11).

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Health Reform

GOP House Panel Says Co-Ops Struggle To Enroll People

Elsewhere, Oregon officials are planning on limiting access to a new, pricey hepatitis C drug to state health plan members. Also, UnitedHealthcare is considering entering Georgia's health care exchange next year. 

The Wall Street Journal: Mixed Bag For Health Co-Ops
Many of the nonprofit health-insurance cooperatives created by the Affordable Care Act have enrolled far fewer people than they had hoped, according to figures obtained by a Republican-led House committee, calling into question their viability. Fourteen of the 23 co-ops reported to the panel that, as of April 1 or later, they had enrolled significantly fewer people than they had projected for 2014 when they obtained $2 billion in federal loans from a fund created under the health law. The shortfalls create steeper obstacles for the plans to succeed and repay the loans (Radnofsky, 6/11).

The Oregonian: Facing A $168-Million Price Tag For New Hepatitis C Drugs, Oregon Health Plan Balks
Eyeing a $168-million annual price tag for two costly new hepatitis C drugs, state officials hope to limit access to a small fraction of the 20,000 Oregon Health Plan members afflicted by the liver disease. The new drugs, Sovaldi and Olyssio, offer a cure that lacks the side effects of current treatment. But at $1,000 a pill, the cost adds up quickly -- to $84,000 for a three-month treatment. Other states by law must cover the drugs for their Medicaid programs. And private insurers are under pressure from Medicare to do the same (Budnick, 6/11).

Georgia Health News: Georgia Exchange May Get Another Big Player
UnitedHealthcare says it’s considering offering health plans in Georgia’s insurance exchange for 2015. The giant insurer’s potential entry into the state’s exchange could increase competition in terms of premiums and choice of medical providers. State exchanges, required under the Affordable Care Act, are designed to help consumers find and purchase health coverage. They can be run by either the individual state or the federal government. Georgia, like most other states, has opted for federal administration. Last year, just five health insurers offered plans in the Georgia exchange (Miller, 6/11).

More problems at health law coverage processing centers --

St. Louis Post-Dispatch: Wentzville Health Care Processing Problems Came From Computer Snafus, Feds Say
The same computer problems that hampered individuals from signing up for the Affordable Care Act last fall also plagued workers at an ACA processing facility in Wentzville, where whistleblowers have alleged that little work was being done, the government agency overseeing the project said Wednesday. The contractor, Serco Inc., a British firm with U.S. headquarters in northern Virginia, was the subject of allegations from employees and former employees that workers read, slept or played games while on duty because of the lack of work. On Wednesday, a spokesman for the Centers for Medicaid & Medicare Services said that Serco — whose workers process paper applications and check documentation submitted in support of Affordable Care Act applications — “experienced the same tech issues that were widely reported last fall with healthcare.gov” (Raasch, 6/12).

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Virginia Lawmakers To Consider Fast-Track Budget Plan Without Medicaid Expansion

The $96 billion spending plan unveiled by state House leaders yesterday could break the logjam and prevent a looming state government shutdown after a partisan battle over Gov. Terry McAuliffe's plan to expand the low-income health insurance program was resolved earlier this week with the resignation of a Democratic senator.

The Washington Post: Va. Leaders May Vote On Stripped-Down Budget
House budget leaders on Wednesday unveiled a two-year, $96 billion spending plan that their Senate counterparts indicated they would be willing to accept and fast-track to Gov. Terry McAuliffe (D). But at least a few Republicans are expressing concern that the long-stalled budget process is suddenly moving too quickly. They fear that there could be language buried deep in the budget bill that would authorize the governor to expand Medicaid, McAuliffe’s top legislative priority (Vozzella, 6/11).

The Associated Press: Virginia Lawmakers Return To Vote On Budget
The budget stalemate was caused by a disagreement between Democrats, including Gov. Terry McAuliffe, who wanted to expand Medicaid and Republicans who refused. The logjam broke when Democratic Sen. Phil Puckett resigned, giving Republicans a one-seat advantage in the Senate (6/12).

Meanwhile, Kansas hospital officials cite benefits for uninsured vets as part of arguments for the expansion --

Kansas Health Institute: Medicaid Expansion Would Help Thousands Of Uninsured Kansas Vets
The chief executive of the Kansas Hospital Association is using a recent report about uninsured veterans to make the case for Medicaid expansion. In an opinion piece sent to newspapers on Wednesday, Tom Bell said approximately 15,000 Kansas veterans and 10,000 of their family members lack health insurance, according to the report written by the Urban Institute with funding from the Robert Wood Johnson Foundation. In Missouri, approximately 30,000 non-elderly veterans and 22,000 of their family members are uninsured (McLean, 6/11).

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Medicare

Some Medicare Practices On Quality, Patient Stays Questioned

A new study examines how Medicare categorizes hospital errors, and the controversy over "observation care" continues.

Reuters: Medicare Patients, Be Aware Of 'Observation' Status In Hospitals
People on Medicare who spend one or two nights in the hospital are finding out, and often too late, that they weren’t really “admitted” to the hospital. ... Even though they were in a bed in a hospital room, the hospital may have categorized them as being there for “observation,” rather than being formally “admitted.” But patients being “observed” might face some unpleasant surprises when they leave the hospital. For example, Medicare might not pay the tab for a rehab facility or a nursing home (Kanne, 6/11).

Related, earlier KHN story: FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries (Jaffe, 9/4/13)

Kaiser Health News: Not So Fast; Some Costly Hospital Complications Not Tracked by Medicare, Analysis Finds
An analysis released Thursday identified dozens of potentially avoidable hospital complications that are not being tracked by the government even though some occur frequently and are expensive to treat. Premier, Inc., a consulting company that works with hospitals on improving quality, analyzed 5.5 million patient records to identify 86 common ‘complications’ that occurred in the hospital and were associated with patient deaths, higher costs or longer lengths of stays (Rau, 6/12).

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State Watch

State Highlights: Mental Health Care Changes In Maryland, Colorado

A selection of health policy stories from Minnesota, Maryland, Colorado, New York, California, Washington state, Michigan and Massachusetts.

Minnesota Public Radio: Federal Health Law Helped Minnesota's Uninsured Rate Drop 41 Percent
The number of uninsured Minnesotans has fallen by nearly 41 percent since September, largely due to the federal Affordable Care Act, University of Minnesota researchers said Wednesday. About 180,000 Minnesotans gained health insurance as a result of the law, mainly through enrollments in government-sponsored coverage such as Medical Assistance and MinnesotaCare, according to the university's State Health Access Data Assistance Center. The sign-ups dropped the rate of uninsured Minnesotans from 8.2 percent to 4.9 percent (Stawicki, 6/11).

The Star Tribune: 95% Of Minnesotans Now Have Health Insurance
The percentage of uninsured Minnesotans has dropped to the lowest level in state history, and the second-lowest level in the nation, following the end of enrollments under the Affordable Care Act. About 180,500 Minnesotans gained health insurance from last September to this May, with the vast majority getting coverage through one of the state’s public health programs, a report from the University of Minnesota found. That left just 4.9 percent of all Minnesotans lacking health coverage on May 1, about a month after the federal health law’s first major sign-up deadline. That’s down from 8.9 percent last Sept. 30 (Crosby, 6/11).

Baltimore Sun:  Maryland County Establishes Task Force To Address Mental Health Gaps 
Howard County is creating a task force charged with developing of a comprehensive behavioral health action plan for the county -- one that officials say is needed in response to the January shooting deaths at the Mall in Columbia. On Jan. 25, Darion Marcus Aguilar, 19, entered a store at the mall and shot and killed two clerks, Brianna Benlolo, 21, of College Park and Tyler Johnson, 25, of Mount Airy, before taking his own life. Police later said Aguilar had been urged by a doctor to seek psychiatric help. County officials said goals for the Behavioral Health Action Plan Task Force include assessing what community groups now provide to support those with mental illness; identifying gaps in care and providing policy, program and funding recommendations (Davis, 6/11). 

Denver Post:  Colorado To Move Ahead With Mental Health Revamp After Suit Settled 
Colorado's plans to revamp the response to the mental health crisis can move forward after months of delay, during which the state awarded, revoked and fought in courts over the multimillion-dollar contracts. A judge on Tuesday signed an order lifting a preliminary injunction that stopped the state from proceeding with a second bidding process to award new contracts for mental health services. As a result, the Colorado Department of Human Services on Wednesday announced that it intends to give the contracts to four existing community mental health centers, with each serving a quadrant of the state (Robles, 6/11).

The Wall Street Journal: Abortion-Bill Backers In Albany Split On Strategy
Abortion-rights supporters are divided over how to pass legislation in Albany, as Gov. Andrew Cuomo's Women's Equality Act remains opposed by state Senate Republicans over the abortion issue. One faction, led by Assemblywoman Amy Paulin, a Westchester Democrat, is pushing to break apart Mr. Cuomo's 10-part package of women's rights legislation and vote separately on the bills, saying it has no chance of passing the state Senate with the abortion provision. The package died in the Senate over abortion last year (Gay, 6/11). 

Kaiser Health News: For Women Just Out Of Jail, Health Care Could Be Key To Better Life
The San Francisco Sheriff's Department is implementing a new city law allowing its staff to enroll inmates into health insurance under the Affordable Care Act. Sheriff Ross Mirkarimi believes that making sure people have health coverage when they're released will help prevent them from committing another crime and coming back. One inmate -- Sophia -- recently requested help signing up for health insurance. Sophia, who asked that her last name not be used, was caught driving a stolen car in January and sentenced to three months in the county jail. She says that was because she stopped getting treatment for her substance abuse and mental health problems when her health insurance expired (Dembosky, 6/12).

Seattle Times: Insurers Want Judge’s Decisions Thrown Out 
Two insurers involved in a case that suddenly ground to a halt after intrigue and the precipitous removal of the judge handling it are demanding that the case start over from scratch. In a motion filed Wednesday, Premera Blue Cross argued that the “extraordinary set of circumstances” surrounding the removal of Chief Presiding Officer Patricia Petersen, the administrative-law judge for the Office of the Insurance Commissioner, means that she was not impartial and all her decisions should be set aside. BridgeSpan Health Company, another insurer, joined in Premera’s motion (Ostrom, 6/11).

The Associated Press: 12,500 Patients In Michigan To Get Surgery Boot Camp To Cut Costs 
About 12,500 people in Michigan will get the chance to go through a surgery boot camp in the weeks leading up to their operations as part of an effort to help them more swiftly recover from surgery and cut hospital costs, officials said. The Ann Arbor-based University of Michigan Health System is helping roll out the program, which will be expanded to 40 Michigan hospitals. The Michigan Surgical and Health Optimization Program will help patients do things such as walk more, eat healthier and learn stress-reduction techniques (Runk, 6/11).

WBUR: Partners Showdown: Hospital Coalition Wants More Scrutiny Of AG Deal
A group of Massachusetts health care providers is asking Attorney General Martha Coakley (who also happens to be running for governor) to make public details of a deal which will allow Partners HealthCare to acquire three hospitals. WBUR’s Dan Guzman spoke with Tufts Medical Center CEO Michael Wagner, who says the deal would have a big impact on the state’s health care marketplace. “The concern is that Partners is a system that has currently three times of the size of any system in Massachusetts,” he said. “With the proposed AG deal, this would take it to four times the size of the next largest system.” The coalition also includes executives from Beth-Israel Deaconess Medical Center and Lahey Health (Zimmerman, 6/11).

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Weekend Reading

Longer Looks: Tech-Savvy Health Care Ads; Cautions About Hospital Data

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

WBUR: Troubled Future For Young Adults On Autism Spectrum
"Mom, Dad, what's wrong with me?" Michael Moscariello was a smart, thoughtful 10-year-old when that question burst out one evening before dinner. ... May Moscariello, Michael's mom, had taken him to Franciscan Hospital for Children in Boston three years earlier, in 1988. "They evaluated him and came up with Asperger’s syndrome. It was their first case," May says. ... Today, Asperger's is folded into the broad diagnosis of autism spectrum disorder (ASD). This includes people like Michael who are bright and articulate. ... Their lives, as adults with autism, raise troubling questions about whether the flood of children receiving this diagnosis will find meaningful work, safe housing and networks that will help them become happy and productive adults (Martha Bebinger, 6/9).

New York Magazine: Does Oscar Sound Cooler Than Aetna?
For a very long time, health-¬≠insurance advertisements, like health-¬≠insurance companies, were stolid and -¬≠relatively predictable things. ... Then, last October, a new breed of health-care ad began cropping up on the subway. The tone was Nickelodeon meets Manhattan Mini Storage—cuddly cartoon avatars and exceedingly clever copy, intended to make New Yorkers feel good about cottoning on to the in-jokes. In one, a man bear-hugged by an overaffectionate grizzly seeks help for a broken pelvis. Another reads: "Get a bright, articulate doctor to call you without having to join a dating site." The campaign was the work of Oscar, which bills itself as the first new health insurer in New York in 15 years and the only "tech-driven" insurance company in the country (Matthew Shaer, 6/11).

The New York Times: The T.M.I. Pregnancy
Becoming a mother was so simple when I became a mother. Pregnancy was treated as a natural experience. You peed in a cup, and then once a month the obstetrician pressed his stethoscope against your belly and you watched his face for a smile. "We’re going to have a baby," my son, Peter, calls. I think about being a grandma and the grand continuum. I think about the wondrous ways my boy's life is going to change. I do not think about sonograms, DNA testing and preeclampsia. I do not think about the endless forbidding stream of fetal data (Patricia Volk, 6/4).

The Wall Street Journal: The Experts Blog
It's Time for Doctors to Be Honest About Their Stress ... Baby Boomers Aren’t Prepared Financially for a Long Life ... The Limits of Current Health-Care Data ... Beware Bad Data About Hospitals ... What Doctors Are Doing When They Aren’t Seeing Patients ... The Gaps in Health-Care Data ... Doctors Should Be Role Models ... Why Doctors Should Follow Their Own Advice (6/11).

The New Statesman: How Mistakes Can Save Lives: One Man's Mission To Revolutionise The NHS
Martin Bromiley is a modest man with an immodest ambition: to change the way medicine is practised in the UK. ... Naturally, we respect and admire doctors. We believe that health care is scientific. We think of hospitals as places of safety. For all these reasons, it comes as something of a shock to realise that errors still play such a significant role in whether we leave a hospital better or worse, alive or dead (Ian Leslie, 6/4).

The New York Times: How To Beat Malaria, Once And For All
Malaria is a seasonal disease; with tropical rains come the fevers. In the news media, malaria is also seasonal. Every spring around World Malaria Day we hear about its devastating effects, including deaths in the hundreds of thousands. This year the reports were encouraging: Infections have been reduced and many lives saved. In May, researchers reported in Science that yet another potential malaria vaccine may be around the corner. Malaria seems to be on the retreat. But is it really? (Francois H. Nosten, 6/7). 

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Editorials and Opinions

Viewpoints: GOP And Governing; Va. Medicaid Expansion Chances Falling Fast; Private Care For Vets

The New York Times: In GOP, Far Right Is Too Moderate
The forces of political nihilism not only remain alive and well within the Republican Party, but they are on the rise. Witness the way they shook Washington on Tuesday by removing from power Eric Cantor, the House majority leader, who had been one of the most implacable opponents to the reform of immigration, health care and taxation. His crime (in addition to complacent campaigning)? He was occasionally obliged, as a leader, to take a few minimalist steps toward governing, like raising the debt ceiling and ending a ruinous shutdown (6/11). 

The Washington Post: In Week’s Political Tumult, Terry McAuliffe Is Long-Term Loser And Md. Status Quo Is Winner
A pair of political earthquakes rocked Virginia this week, while seismograph needles in Maryland stood still as can be. … Virginia's governor sustained a critical reversal when his fellow Democrats lost control of the state Senate with the surprise resignation of Sen. Phillip P. Puckett (D-Russell). … So much for hopes for a progressive agenda, highlighted by Medicaid expansion, following the Democrats' sweep of the three top state offices in November. Now the gridlock is broken. The legislature is set to approve a budget. Financial turmoil is averted. In addition, a perfect excuse has fallen in the Democrats' lap to explain why McAuliffe failed to broaden Medicaid as promised (Robert McCartney, 6/11). 

The Washington Post's All Opinions Are Local: Does Cantor's Defeat Kill Virginia’s Medicaid Expansion?
If our iron law is right, there is no way Medicaid expansion can pass the General Assembly, even in a special session, unless the political landscape fundamentally changes on the GOP side of the field (Norman Leahy and Paul Goldman, 6/11). 

The New York Times' Opinonator: The Power To Cure, Multiplied
Ten years ago Dr. Sanjeev Arora, a hepatologist at the University of New Mexico in Albuquerque, realized that he would need to change the way he practiced medicine if he was going to prevent his patients from dying. Today, the solution he developed could transform health care (David Bornstein, 6/11).

Los Angeles Times: Time For The State To Patch Up Medi-Cal
State lawmakers are nearing a deal on a budget for the fiscal year that begins July 1, and the projected revenue bounty makes it possible for Sacramento to undo some of the most damaging cuts made to state programs during the economic downturn while still paying off debt and building reserves. That's good news for the state's schools, courts, colleges and universities, and welfare-to-work program, all of which are in line to recover some lost funding. But lawmakers shouldn't forget Medi-Cal, the health insurance program for impoverished Californians, which has been weakened by a cut of up to 10% in the fees paid to doctors and other providers. The arbitrary cut has made it more difficult to provide care to the poorest Californians in a cost-effective way. In that sense, it's self-defeating (6/11). 

USA Today: Private Veterans Care? Caution
Sometimes, crisis can bring opportunity. On Wednesday, the Senate approved legislation sponsored by Sens. John McCain, Ariz., and Bernie Sanders, I-Vt., to increase funding for Veteran Affairs, build 26 facilities and make access to private health care easier. But as the House considers whether to allow veterans to seek private care, it should bear in mind that offering treatment outside of the VA health system could also spawn new problems, even as it cuts wait times (Jessica L. Adler, 6/11). 

Reuters: How To Recruit More Primary Care Physicians -- For The VA And Nationwide
Access to primary care has been a national problem for years. Recent attention has focused on access for military veterans, but access has been just as bad -- if not worse -- for many rural and lower socioeconomic populations. Even in otherwise well-served areas, someone seeking a primary care physician may have few to no options, with visit delays lasting months (Dr. Davoren Chick, 6/11).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
Lisa Gillespie
Shefali Luthra

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