Daily Health Policy Report

Thursday, June 13, 2013

Last updated: Thu, Jun 13

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Women's Health

Medicare

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

How Does The Health Law Affect Premiums For Smokers? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a question from a reader about how the health law affects insurance for smokers and programs may help them quit (6/13). Watch the video or read the transcript.

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Britain's National Health Service Visits D.C. For Some Pointers

Kaiser Health News staff writer Ankita Rao reports: "In the contentious debate over health care in this country, the United Kingdom’s single-payer, government-funded National Health Service has been held up by both sides as a system to be either emulated as an ideal or avoided as an abomination. Neither of those extreme views allow that British health providers might have something to learn from the way things are done on this side of the Atlantic" (Rao, 6/13). Read the story.

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Political Cartoon: 'Be All You Can 'B'?'

Kaiser Health News provides a fresh take on health policy developments with "Be All You Can 'B'?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:

HEALTH LAW ANXIETY OR ANTICIPATION?

Come to grips with costs?
For employers, the glass seems
to be half empty.  
-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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Health Reform

Survey: Employers 'Pessimistic' About Health Law Costs

The Wall Street Journal reports on a survey that finds companies increasingly "pessimistic" they can avoid health care cost increases they believe will stem from the overhaul. Politico reports that insurers are showing little interest in small business exchanges. Also in the news, Indiana House Republicans worry that schools are cutting employee hours to avoid health law penalties.

The Wall Street Journal's Risk & Compliance Journal: Employers Coming To Grips With Health Reform Costs: Survey
Companies have grown more pessimistic about their ability to avoid higher health-care costs as a result of the Affordable Care Act as the time draws near when all individuals will be required to have health insurance, according to a survey released on Wednesday by benefits consultant Mercer. Just 9% of companies feel the ACA will add less than 1% to their costs next year, compared to 25% that felt in 2011 they would see little or no impact come 2014, Mercer said. Beth Umland, director of research for health and benefits in Mercer’s health and benefits business, said 20% felt so sanguine last year (Murphy, 6/12).

Politico: Small-Business Exchanges Draw Few Insurers
Obamacare's new insurance marketplaces for small businesses, which have already stumbled before getting out of the gate, are facing another pressing question just months before millions can sign up for benefits: What happens if insurers don't show up to sell? (Millman, 6/13).

The Hill: GOP: Schools Cutting Workers' Hours To Avoid ObamaCare Penalty
A group of House Republicans criticized the Obama administration Wednesday over news that schools are cutting their employees' hours to avoid providing health insurance. Republican lawmakers from Indiana said several school districts in the state have cut the weekly hours of employees, including cafeteria workers, bus drivers and teachers' aides (Baker, 6/12).

Politico: Obamacare? We Were Just Leaving…
Dozens of lawmakers and aides are so afraid that their health insurance premiums will skyrocket next year thanks to Obamacare that they are thinking about retiring early or just quitting. The fear: Government-subsidized premiums will disappear at the end of the year under a provision in the health care law that nudges aides and lawmakers onto the government health care exchanges, which could make their benefits exorbitantly expensive (Palmer and Sherman, 6/13).

In other news related to the health law's implementation -

California Healthline: Could This Little-Watched Court Case Sink Obamacare?
Innovare may be Latin for innovate, but the values at Innovare Health Advocates are traditional: An "Old School" commitment to delivering "Healthcare the Way it Ought to Be."  The Missouri-based health practice is run by Dr. Charles Willey, a staunch tea party conservative who's been mentored by former Sen. Jim Talent, one of his patients. "I've personally, for a long time, been interested in politics," he told a radio show in 2010, noting that he'd been leading efforts "to get doctors excited about resisting Obamacare." But Willey's doing more than just resisting the health law these days -- he's become an active player in Halbig et al v. Sebelius, a lawsuit that threatens a key element in the Affordable Care Act: Whether the tax subsidies slated to help many Americans purchase coverage through many insurance exchanges are even legal under the ACA's language (Diamond, 6/12).

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Details Emerging About Costs For Health Plans Available Through Health Exchanges

CNN Money reports that some consumers may be surprised by the out-of-pocket costs -- including deductibles and co-payments -- these plans include. Other news outlets report on developments related to online marketplaces in California, Minnesota and Colorado.

CNN Money: Obamacare: Is A $2,000 Deductible 'Affordable?'
Until now, much of the debate swirling around Obamacare has focused on the cost of premiums in the state-based health insurance exchanges. But what will enrollees actually get for that monthly charge? States are starting to roll out details about the exchanges, providing a look at just how affordable coverage under the Affordable Care Act will be. Some potential participants may be surprised at the figures: $2,000 deductibles, $45 primary care visit co-pays, and $250 emergency room tabs (Luhby, 6/12).

Los Angeles Times: Backers Of Rate Regulation Aren't Satisfied With Health Exchange
President Obama singled out California last week for getting better-than-expected rates in its rollout of the health insurance overhaul for millions of consumers. Yet some Obamacare supporters say those premiums are still too high, and they are continuing to push for a California ballot measure to regulate health insurance rates (Terhune, 6/12).

Los Angeles Times: Kaiser's Obamacare Rates Surprise Analysts
In California's new state-run health insurance market, Kaiser Permanente will cost you. The healthcare giant has the highest rates in Southern California and some other areas of the state, surpassing rivals such as Anthem Blue Cross and other smaller competitors. The relatively high premiums from such a strong supporter of the federal healthcare law surprised industry analysts, and it has sparked considerable debate about the company's motives (Terhune, 6/12).

MPR News: Call Center Coming To Answer Questions About MNsure
A call center will be open later this summer to provide information to consumers about health plans, enrollment choices and procedures regarding MNsure, Minnesota's new online health insurance marketplace. MNsure's executive director April Todd-Malmlov says Minnesota looked at the best practices of other states to develop the call center. If a phone staffer called can't answer a consumer's question, the staffer will conduct a "warm transfer" to someone who can (Stawicki, 6/13).

The Associated Press: For Minn. Health Insurance Marketplace, Operators Will Be Standing By Starting In September
The call center for Minnesota's new health insurance marketplace will be operational Sept. 3 to help prepare consumers for buying coverage when open enrollment begins a month later, officials said Wednesday (Karnowski, 6/12).

Health Policy Solutions (a Colo. news service): Health Guides At 55 Sites Receive $17 Million For Outreach
Fifty-five community groups and hospitals throughout Colorado have received $17 million in grants from Colorado’s health exchange to assist people in signing up for health insurance. Altogether 74 applicants had asked for more than $57 million, so the grant committee had to dramatically cut requested funds and some of the proposed assistance sites have backed out. … Many had made large requests for marketing, advertising and other outreach efforts that the exchange may already be doing statewide (Kerwin McCrimmon, 6/12).

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Ariz. Gov. Claims A Win As House Approves Medicaid Expansion Plan

The Arizona House early Thursday passed an $8.8 billion state budget that includes a proposal to pursue the health law's Medicaid expansion. News outlets also report on related action in Ohio and Michigan.

Arizona Republic: House Approves Medicaid Expansion, $8.8 Billion Budget
Five months after Gov. Jan Brewer vowed to expand Medicaid, a bipartisan Arizona House coalition voted early today to approve her high-stakes proposal, along with a budget that gives significant new funding to education and child welfare. The mostly 33-27 votes followed nine hours of debate and vitriolic speeches by conservative Republicans, who lashed out at fellow GOP members and Brewer for teaming with Democrats to steamroll them to approve a key piece of the federal health-care overhaul and the governor's top legislative priority (Reinhart, Sanchez, Rau, Pitzl, 6/13).

The Associated Press/Washington Post: Ariz. House Passes Budget And Medicaid Expansion In Victory For Gov. Brewer; Senate Votes Next
The Arizona House passed an $8.8 billion state budget that includes Medicaid expansion early Thursday and puts Gov. Jan Brewer one Senate vote away from a huge political victory as she embraces a signature part of President Barack Obama's health care overhaul law. A newly formed coalition of Democrats and GOP moderates forced the budget and Medicaid expansion proposal to move in the Arizona Senate and House during a day filled with debate. The Senate took a break after giving its initial approval Wednesday afternoon, while the House toiled into the night as conservative Republicans railed against the Medicaid proposal and accused members of their party who supported Brewer of being turncoats before taking a final vote that ended after 1:30 a.m. PDT (6/13).

NPR: In Arizona, An Unlikely Ally For Medicaid Expansion
The Arizona Legislature is debating whether to extend Medicaid to about 300,000 people in the state. The expansion is a requirement to get federal funding under the Affordable Care Act. The big surprise is who has been leading the charge: Republican Gov. Jan Brewer. She's one of President Obama's staunchest critics and has confounded conservatives in her own party by supporting the expansion (Robbins, 6/12).

The Associated Press: Ohio Senate Chief: Medicaid Reform Not Part Of Budget
Changes to the Medicaid health program won't be included in Ohio's budget negotiations, though a separate proposal aimed at curbing the program's costs is expected to be introduced in the Legislature as soon as Thursday, the state Senate's leader said. Senate President Keith Faber, a Celina Republican, offered few details to reporters on Wednesday, though he said the Medicaid reform bill was bipartisan and has been worked on jointly by both chambers (Sanner, 6/12).

The Associated Press: Michigan House Panel Approves Medicaid Expansion
Hundreds of thousands of more low-income adults in Michigan would become eligible for government-funded health insurance under legislation backed Wednesday by a divided House committee. #The 9-5 vote, which came after months of talks in the Republican-controlled Legislature over expanding Medicaid eligibility, set the stage for a possible vote Thursday in the House. Republican Gov. Rick Snyder is pushing hard for Medicaid expansion before legislators break for the summer at the end of next week (6/12).

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Capitol Hill Watch

House Lawmakers Closer On Medicare Pay Overhaul, Medicaid Pay Increase

House lawmakers move closer to proposing a plan to overhaul how Medicare pays doctors and wonder how they can increase doctors' Medicaid pay -- typically the purview of states.

CQ HealthBeat: House Committee Leaders Suggest They're In Sync On SGR Overhaul
Influential lawmakers on two House committees that are pivotal to overhauling the Medicare physician payment system said Wednesday they are working together closely on legislation to replace the Sustainable Growth Rate formula, despite some raised eyebrows in recent days about whether they were on the same page (Reichard, 6/12).

Medpage Today: House Members Talk Higher Medicaid Pay
Republicans and Democrats agree on little about Medicaid reform but are in concert that provider reimbursements need to be higher, judging from a hearing on Capitol Hill Wednesday. The problem is that states control provider payment rates and not much can be done from Washington. However, Rep. Henry Waxman (D-Calif.), the top Democrat on the House Energy and Commerce Committee, suggested Wednesday that Congress do one thing that can be done from Washington: extend the temporary payment increase Medicaid primary care providers are seeing, bringing their reimbursements on par with those of Medicare. The change impacts general pediatricians, general internists, and family physicians (Pittman, 6/12).

The Indian Health Service also drew lawmakers' attention -

CQ HealthBeat: Democrats Complain To Indian Health Service Nominee About Administration's Progress
Democratic senators weighing the re-confirmation of Yvette Roubideaux to be director of the Indian Health Service slammed the Obama administration on Wednesday for making slow progress in significantly improving medical care for American Indians and for failing to pay tribes what the Supreme Court says they are owed (Adams, 6/13).

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House Panel Votes To Ban Abortions After 20 Weeks Of Pregnancy

An aide to House Majority Leader Eric Cantor, R-Va., said a vote by the full House is planned later this month. Rep. Trent Frank, R-Ariz., one of the bill's sponsors on the House Judiciary Committee, drew criticism for arguing against an amendment to exclude victims of rape and incest by saying that the pregnancy rate from rape is "very low."

The Wall Street Journal's Washington Wire: House Panel Votes To Ban Abortions After 20 Weeks of Pregnancy
The House Judiciary Committee voted largely along party lines to approve legislation that would ban all abortions after 20 weeks of pregnancy, a move that is certain to keep the focus on a contentious social issue that splits Republicans and Democrats. The 20-12 vote Wednesday afternoon sends the bill to the House floor, and an aide to House Majority Leader Eric Cantor (R., Va.) said Republican leaders plan a vote by the full House later this month (Boles, 6/12).

Roll Call: House Pushes Abortion Bill Amid Controversy
Abortion politics — and the politics of rape — were back with a vengeance Wednesday, with House Judiciary Committee Republicans backing a nationwide ban on abortions after 20 weeks after the bill’s chief sponsor dismissed a Democratic push for exemptions for rape and incest (Dumain, 6/12).

CBS News: Rep. Trent Franks, R-Ariz., Stands By Comment That Pregnancy Rate 'Very Low' From Rape
Despite calls from Republican leaders for members of their party to stop talking about rape in the context of the abortion issue, Rep. Trent Franks, R-Ariz., waded directly into that territory Wednesday and is standing by his comment that the number of pregnancies resulting from rape is "very low." … In the aftermath of the Republicans' election day losses, numerous party leaders urged their fellow Republicans to move on from talking about rape and abortions. And in its 2012 election post-mortem report, the GOP stressed that its members need to watch what they say (Haven, 6/12).

Politico: Trent Franks: 'Incidence Of Rape Resulting In Pregnancy Are Very Low'
A House Republican pushing for a 20-week nationwide ban on abortions said Wednesday that the incidence of pregnancies resulting from rape is "very low" — then scrambled to clarify his comment after it went viral with comparisons to former GOP Senate candidate Todd Akin. "The incidence of rape resulting in pregnancy are very low," said Rep. Trent Franks (R-Ariz.) as the House Judiciary Committee debated his bill to ban abortions nationwide after 20 weeks including in cases of rape and incest (Smith and Gibson, 6/13).

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Women's Health

Judge OKs Administration Plan On 'Morning After' Pill

A federal judge Wednesday accepted the Obama administration's plan to make the Plan B One-Step "morning after pill" available over the counter to buyers of all ages, winding down a decade-long fight over the pill.

Politico: Judge Accepts Administration Plan On 'Morning-After' Pill
A federal judge approved Wednesday the Obama administration's plan to drop its lawsuit over the "morning after pill" and offer a form of emergency contraception over-the-counter without any age restrictions, winding down a controversy that has lasted for a decade. His acceptance means the Obama administration can move forward with its plan to let the FDA quickly take the steps necessary to get Plan B One-Step available over the counter with no age restrictions. The government promised in a proposal Monday to do so "without delay." It does require some regulatory drug labeling steps and paperwork from the FDA and the drugmaker but the judge did not see that as an obstacle (Smith, 6/12).

Los Angeles Times: Plan B Emergency Contraceptive Pill Battle: Confusion Endures
It was hailed as a significant step forward in women's reproductive rights, but this week's decision by the Obama administration to allow non-prescription, over-the-counter sales of the emergency contraceptive Plan B One-Step may do little to dispel widespread bafflement over the issue, say medical and legal experts (Morin, 6/12).

The Associated Press/Washington Post: NY Judge: Government Can Go Ahead With Plan To Make Morning-After Pills Available Over Counter
President Barack Obama's administration can go forward with its new plan to make the morning-after pill available to buyers of any age without prescriptions, but it needs to do it promptly or face potential sanctions in the long-running dispute over access to the emergency contraceptives, a federal judge ruled Wednesday. The finding by U.S. District Judge Edward Korman came in response to a Department of Justice decision this week to ditch rules barring over-the-counter sales to girls younger than 15 and comply with his April order to make the pills available to buyers of any age (6/12).

NBC News: Judge OKs Fed's Plan B One-Step Offer, Cautions Against Exclusivity Deals
A federal judge has approved the Obama administration's concession to make the Plan B One-Step "morning after" pill available to all girls and women without prescriptions or restrictions on where it can be sold.  U.S. District Court Judge Edward Korman's ruling applies only to the brand-name, one-pill version of the emergency contraception product, not to the cheaper, two-pill versions.  But he said the government's reversal on its position in a decade-long fight over the pills that prevent unintended pregnancy should be approved due to the efforts of the women's groups who fought so hard to achieve it (Aleccia, 6/12).

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Medicare

End-Of-Life Care: Study Finds Quality Improving But Costs Increasing

A brief by the Dartmouth Institute finds that Medicare spending for chronically ill patients at the end of life went up more than 15 percent from 2007 to 2010.

The Medicare NewsGroup: End-Of-Life Care Improves But Costs Increase, Study Finds
Improvements in end-of-life care have occurred rapidly for Medicare patients but costs have increased, according to a new Dartmouth Institute brief that was released today. The study revealed that beneficiaries in their last six months of life spent fewer days in the hospital and that more patients received hospice services in 2010 as compared to 2007. However Medicare spending for chronically ill patients at the end of life increased more than 15 percent during that time period, while the consumer price index rose only 5.3 percent (Mitchell, 6/12).

Los Angeles Times: Los Angeles Leads Nation In Medicare Spending On End-Of-Life Care
More money was spent in the Los Angeles area on chronically ill patients in their final years than anywhere else in the United States, according to new data on Medicare patients released Wednesday. Spending in the last two years of life was about $112,000 per patient in Los Angeles as of 2010, about 60 percent higher than the national average, the report by the Dartmouth Atlas Project showed (Gorman, 6/12).

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Health Care Marketplace

Accenture: Boom Ahead For Retail Health Clinics

According to the consulting firm Accenture, the number of retail clinics will likely double by the end of 2015 -- a trend fueled by the demand for care by consumers who will become insured under the health law. Meanwhile, the Fiscal Times examines why some physicians are choosing not to accept any health insurance.

The Associated Press/Washington Post: Accenture Predicts Growth Surge For Retail Health Clinics As Overhaul Adds Insured Patients
The number of retail health clinics that have been popping up in places like drugstores for years is expected to double by the end of 2015, according to the consulting firm Accenture. Accenture said in a report released Wednesday that a flood of newly insured patients from the national health care overhaul will help stoke demand for those clinics, which typically treat minor illnesses when a patient doesn’t have a doctor or the physician isn’t available (6/12).

Medpage Today: Boom Years Expected For Retail Clinics
The number of retail health clinics will double in the next 3 years, a prominent healthcare consulting firm said, citing a need for care for newly insured patients under the Affordable Care Act. Accenture projected the number of retail health clinics will grow at 25 percent to 30 percent annually in the coming years and roughly double in number, from 1,400 in 2012 to 2,800 in 2015 (Pittman, 6/12).

The Fiscal Times: Why Docs Are Bailing Out Of Health Insurance
...Ironically, the multiplication of mandates and other regulations in the ACA on both private insurers and government-run programs like Medicare and Medicaid have more doctors opting out of the third-party-payer system altogether (Morrissey, 6/13).

Also in the news -

The Associated Press/Washington Post: Govt. Cautions Health-Related Schools About Possibly Discriminatory Enrollment Decisions
The federal government has cautioned the nation’s medical schools and other health-related schools that their enrollment decisions may be based on an incorrect understanding of the hepatitis B virus, resulting in discrimination. The government says updated recommendations from the Centers for Disease Control and Prevention dispel many myths associated with hepatitis B and provide guidance to health-related schools on managing students with the virus (6/12).

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Public Health & Education

Surgeon General To Step Down

Surgeon General Regina Benjamin will step down from her post next month.

Politico: Surgeon General To Step Down
Surgeon General Regina Benjamin announced today that she plans to step down from her post, which she has held since 2009. "I loved serving as #SGReginaBenjamin, putting prevention in all we do. I leave next month confident we created a more healthy & fit nation," she posted on her Twitter account (Haberkorn, 6/12).

The Hill: Report: Surgeon General Regina Benjamin To Step Down
Surgeon General Regina Benjamin announced on Wednesday that she would step down from her post next month (Mali, 6/13).

Elsewhere, some groups are pushing back against a plan to put mental health records into a national gun background-check database --

The Wall Street Journal: Medical Groups Push Back At Gun-Law Change
An Obama administration proposal to speed the flow of mental-health records into the national gun background-check database has run into opposition from medical groups and state authorities, threatening another element of the flagging effort to strengthen federal gun controls in the wake of the Newtown, Conn., school shootings. The debate involves a plan by the Department of Health and Human Services to amend a federal privacy rule (Palazzolo, 6/12).

And doctors may have a new prescription to battle obesity -- standing at work --

Bloomberg: U.S. Doctors May Order Office Workers Out Of Their Chairs
Sitting in front of a computer monitor all day may soon be officially against doctors' advice. The American Medical Association, which represents 225,000 doctors in the U.S. and recommends ways to improve public health and medical care, will consider whether to recognize the dangers of sitting all day -- at work, in the car or at home -- at its annual policy meeting. The proposed resolution is among about 150 to be debated at AMA's meeting starting June 15 in Chicago (Armstrong, 6/13).

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State Watch

Nonsurgical Abortions To Resume In Wis. As Lawmakers There Pass Pre-Abortion Ultrasound Bill

In Wisconsin, a judge's ruling is allowing nonsurgical abortions there to resume. In the state Senate, lawmakers passed a bill requiring women get an ultrasound before they get an abortion.

The Associated Press/Washington Post: Wisconsin Clinics To Resume Offering Nonsurgical Abortions After Judge's Ruling
Some Wisconsin clinics will resume offering nonsurgical abortions after a judge halted a state law requiring three doctor visits for women seeking them. Under the law, a woman seeking a nonsurgical abortion must meet with a doctor who ensures she isn't being coerced into having the procedure. The doctor also must be present when a woman takes the pills that induce an abortion. Web-based consultations are prohibited (6/12).

The Associated Press: State Senate Passes Abortion Bill Requiring Ultrasound
Wisconsin Senate Republicans abruptly shut off debate Wednesday before a dramatic vote in which they approved a bill that would require women seeking an abortion to first undergo an ultrasound. Democrats tried in vain to be recognized to speak as the roll call vote proceeded despite their objections. Senate President Mike Ellis, R-Neenah, repeatedly banged his gavel so forcefully he broke the base (Bauer, 6/12).

Milwaukee Journal Sentinel: GOP Senators Pass Abortion Measure Requiring Ultrasounds
In a raucous clash on the state Senate floor Wednesday that recalled the bitter divides of 2011, Republicans abruptly cut off debate and forced a vote requiring that women seeking abortions get ultrasounds. The morning's brief floor session included sharp exchanges and one senator contending that abortions "became the thing to do" in the 1960s. Democrats protested the bill's merits and the process by which it was passed, saying Senate Majority Leader Scott Fitzgerald of Juneau and his fellow Republicans were trampling on democracy by ending debate after about 25 minutes (Marley, 6/13).

Meanwhile, in Texas -

The Texas Tribune: Senate Panel To Consider Omnibus Abortion Bill
A panel of state senators will convene on Thursday to respond to Gov. Rick Perry's call to add legislation related to abortion procedures, providers and facilities to the special session. On the Health and Human Services Committee’s afternoon agenda: an omnibus abortion regulation bill by Sen. Glenn Hegar, R-Katy, that blends four bills that failed to reach either chamber during the regular session (Aaronson, 6/13).

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State Highlights: Calif. Health Care Companies Deal With Data Breaches; Nevada Faces 'Patient Dumping' Lawsuit

A selection of health policy stories from California, Georgia, Massachusetts, Nevada and Oregon.

The Washington Post: State Budgets Are On The Mend
In addition, while states are budgeting for modest increases in Medicaid spending next year, those expenditures are poised to increase in future years, he said. Health care costs are rising at a slower rate than in the past, but it is unclear how long that will last (Fletcher, 6/12).

The Wall Street Journal's CIO Journal: Rash Of Data Breaches Strikes California Health Care Companies
California health care companies have reported a rash of data breaches, exposing information that included the medical conditions and treatments of patients. The state's hospitals, medical vendors and health insurers have reported at least eight breaches of customer data since the start of the year, according to records maintained by the state's attorney general. It's not known if that number is rising, as the state only began tracking data breaches last year. But many of the cases showed providers failed to take basic precautions to protect patient data, like encrypting health information stored on hardware. For example, in several cases patient records were stolen when health care workers left unencrypted laptops, containing patient data, in cars (Schectman, 6/12).

The Associated Press: U.S. Rights Group Backs Psychiatric Patient In Federal 'Patient Dumping' Lawsuit
A U.S. psychiatric patient has filed a federal civil rights lawsuit accusing Nevada officials of giving him a one-way bus ticket to neighboring California, where he arrived without money and identification in a city where he didn't know anyone and had never been (6/13).

Georgia Health News: Steering Patients Away From Needless ER Visits
When Alvin Dye Jr. of Athens has a health problem, and over-the-counter treatments don't help, he doesn't make an appointment with a doctor. He heads for the nearest hospital emergency room. "A regular doctor visit for me was probably about 10 years ago," says Dye, 35. Dye isn't the only uninsured person who uses the ER for non-life-threatening emergencies. Research shows that uninsured people are more likely to postpone needed care and avoid preventive care, such as annual exams and routine check-ups, because of costs. As a result, medical conditions can worsen, forcing these people to seek treatment, often in the ER (Bailey, 6/12).

San Jose Mercury News: Death Rates At Bay Area Hospitals Vary Widely, New Report Reveals
While some hospitals excelled at keeping patients alive, more than half of institutions around the Bay Area had worse-than-average death rates for at least one medical procedure or patient condition in 2010 and 2011, a new state report reveals. Washington Hospital in Fremont had the dubious distinction of being among only a handful of hospitals statewide with worse-than-average death rates in several categories. Others, however, topped their peers with better-than-average death rates in two or more areas, including Alta Bates Summit Medical Center in Oakland, Eden Medical Center in Castro Valley, John Muir Medical Center in Walnut Creek, and Kaiser Permanente in Redwood City (Sandy Kleffman, 6/12).

Boston Globe: McLean Hospital Wins Approval For Belmont Expansion
McLean Hospital won state approval Wednesday for a $12.5 million expansion of its Belmont campus. The project features a three-story addition to its existing admissions building and 31 new beds for psychiatric patients. The Public Health Council approved the project, which the hospital said is needed because of increasing demand for psychiatric treatment, particularly in its short-term care and psychotic disorders units (Kowalczyk, 6/12).

Oregonian: OHSU Nursing Students, Wallace Medical Concern Team Up To Improve Health Care In Rockwood
A group of nursing students is working to steer more Rockwood residents, particularly those living in poverty, to preventive health care that reduces their hospital stays and trips to emergency rooms. Oregon Health & Science University nursing students have joined forces with Rockwood's Wallace Medical Concern to connect health care more closely to the community (6/12).

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Editorials and Opinions

Viewpoints: 'Tyranny' Over Insurers; Obama's Promises; Rep. Franks's Abortion Claim

The New York Times: Insurance Tyranny
Many of us wish that Obamacare were a simpler system, one that directly provided health insurance. Political reality, unfortunately, ensured that many people will receive coverage from private insurers, selling policies — often with subsidies — on the “exchanges”. And naturally enough, the Obama administration is teaming up with the insurers and other parts of the health industry to help inform Americans of the benefits to which they will be legally entitled, starting Jan. 1 (Paul Krugman, 6/12). 

Bloomberg: Obama Guesses His Way To Trillions In Health Savings
During his 2008 presidential campaign, Barack Obama relied on a standard applause line, a promise that his health-care plan would “lower premiums by up to $2,500 for a typical family per year.” Cue cheers -- or jeers if you were a health-policy expert. For them, his vow was ridiculous. There was no time frame attached to the promise. There was no plan for realizing it. It was change no one quite believed in. He might as well have promised every American a puppy (Ezra Klein, 6/12).

The Washington Post: Trent Franks's Abortion Claim And The Manly Republican Party
In all, the nameplates of 23 misters lined both rows on the GOP side; there isn't one Republican woman on the panel. The guys muscled through a bill that, should it become law, would upend Roe v. Wade by effectively banning all abortions after 20 weeks. With the grace of Charlie Sheen and the subtlety of a sitcom, the manly men voted down a Democratic effort to add enhanced protections for the life and health of the mother. They voted down a Democratic amendment that would allow exceptions for women with heart or lung disease or diabetes. They even voted down an amendment that would have made exceptions for victims of rape or incest (Dana Milbank, 6/12). 

Arizona Republic: Rep. Franks: Pregnancy From Rape 'Low'
Rep. Trent Franks of Arizona isn't the kind of politician who sticks his foot in his mouth; he's the kind of politician who never takes his foot out of his mouth. Franks is proposing legislation that would ban abortions after the 20th week of pregnancy (current law bans abortions after viability, about 24 weeks.) Not only would Franks ban abortions much earlier but he does not want there to be exceptions in the case of rape or incest. Already there have been several Congressional Republicans who’ve proved their ignorance on this issue by making ridiculous statements. As when Missouri Rep. Todd Akin said the female body can prevent pregnancy from occurring after a "legitimate rape" (EJ Montini, 6/12).

The Washington Post: Va.'s Cuccinelli Plays Fast And Loose With The Facts On Abortion
E.W. Jackson, the fire-breathing pastor who stunned the Republican establishment by storming the party convention in Virginia and snatching the nomination for lieutenant governor, has been roundly mocked for saying Planned Parenthood has been "far more lethal to black lives" than has the Ku Klux Klan. In fact, the idea that Planned Parenthood is a racist, even genocidal enterprise, while scurrilous and estranged from the truth, is an article of faith among some right-wing Republicans — among them Herman Cain, the flash-in-the-pan presidential contestant in last year's GOP primaries, and Mr. Jackson's running mate, Virginia Attorney General Ken Cuccinelli II, the party's candidate for governor (6/12).

The New York Times: Lung Transplant Rules for Children
The cases of two desperately ill children in need of lung transplants raised questions about the criteria used to determine eligibility for such transplants. One case involves a 10-year-old girl with cystic fibrosis, who received a transplant from an adult donor on Wednesday. The other case involves a boy, 11, also with cystic fibrosis (6/12).

The Washington Post's Wonk Blog: What Happened To U.S. Mental Health Care After Deinstitutionalization?Deinstitutionalization has, on the whole, worked well for the intellectually disabled because they and their supporters could crank the political valves required to make it work. Equally worthy claimants who lacked the same political muscle or public embrace fared much worse. That's one key lesson of the deinstitutionalization fight (Harold Pollack, 6/12).

New England Journal Of Medicine: Guantanamo Bay: A Medical Ethics-Free Zone?
American physicians have not widely criticized medical policies at the Guantanamo Bay detainment camp that violate medical ethics. We believe they should. Actions violating medical ethics, taken on behalf of the government, devalue medical ethics for all physicians. The ongoing hunger strike at Guantanamo by as many as 100 of the 166 remaining prisoners presents a stark challenge to the U.S. Department of Defense (DOD) to resist the temptation to use military physicians to "break" the strike through force-feeding (George Annas, Sondra Crosby, and Leonard Glantz, 6/12).

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Stephanie Stapleton

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Andrew Villegas

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