Daily Health Policy Report

Friday, June 13, 2014

Last updated: Fri, Jun 13

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

What’s At Stake For Birth Control In Upcoming SCOTUS Decision

Kaiser Health News staff writer Julie Rovner reports: "One of the most watched cases before the Supreme Court this term may turn on the question of religious freedom. But it will also likely determine how women will be able to access a key provision of the Affordable Care Act – one seeking to guarantee no-cost prescription contraception in most health insurance plans. The justices ruling on Sebelius v Hobby Lobby Stores and Conestoga Wood Specialties Corp v Sebelius, expected by the end of this month, will decide whether those companies, and potentially all other for-profit companies, must abide by the so-called contraceptive mandate. It’s a complicated case, so here is some background" (Rovner, 6/13). Read the story.  

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A Reader Asks: As An Immigrant In The U.S. Illegally, Can I Buy Insurance?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (6/13). Read her response.

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Capsules: PhRMA, Advocates: Specialty Drug Costs For Patients Too High

Now on Kaiser Health News’ blog, Lisa Gillespie reports: “Here’s the next salvo in the back and forth between insurers and the drug industry over drug prices: the Pharmaceutical Research and Manufacturers of America are pushing the Department of Health and Human Services to take action to protect consumers who have gained insurance via the health law’s online marketplaces from high, out-of-pocket costs for specialty drugs” (Gillespie, 6/12). Check out what else is on the blog.

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Political Cartoon: 'Highest Bidders?'

Kaiser Health News provides a fresh take on health policy developments with "Highest Bidders?" by Harley Schwadron.

Meanwhile, here's today's haiku:


Defeat of Cantor
Tea Party at a gallop?
Whoa! Hold your horses!
-Beau Carter

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

Virginia Lawmakers Pass Budget Without Medicaid Expansion

The two-year spending plan, which will prevent a state government shutdown, includes an amendment designed to prevent Democratic Gov. Terry McAuliffe from pursuing efforts to expand the low-income health insurance program without legislative approval. The debate over the expansion had been at the crux of the budget impasse.  

The Associated Press: Virginia Passes Budget With Medicaid Restriction
The General Assembly passed a new state budget late Thursday night after adopting a Republican-backed amendment to ensure that Democratic Gov. Terry McAuliffe cannot expand Medicaid without legislative approval. The action just before midnight closed a tumultuous day of internal GOP wrangling over the last-minute amendment and ended a protracted budget impasse that had threatened to shut down state government when the current spending plan expires June 30 (6/13).

The Washington Post: After Hours Of Strife, Lawmakers Pass Budget Without Medicaid Expansion
The Virginia General Assembly adopted a long-delayed state budget late Thursday, acting after an hours-long debate among newly ascendant Senate Republicans who fought among themselves over whether the plan threw up sufficient barriers to Medicaid expansion. The Republicans, who gained control of the Senate Monday when a Democrat resigned from what had been an evenly split chamber, approved a spending deal hashed out by a bipartisan group of House and Senate negotiators. But they first amended it in a way intended to make it harder to expand the federal-state healthcare program for the poor under the federal Affordable Care Act — Gov. Terry McAuliffe’s top legislative priority (Vozzella, 6/13).

The Richmond Times-Dispatch: Virginia Lawmakers Pass Budget That Thwarts Medicaid Expansion
Senate Republicans on Thursday night used their new majority to pass a two-year budget that eliminates any opportunity for Gov. Terry McAuliffe or a year-old legislative commission to expand Medicaid or a private insurance alternative. They were backed by House Republicans who said they would not approve the budget -- even though Senate Democrats and moderate Republicans had removed an insurance marketplace -- unless it included language to prevent any expansion without the approval of the full General Assembly. The Senate passed the budget on a 21-18 vote. Sen. Lynwood W. Lewis Jr. of Accomack County was the only Democrat who backed the spending plan (Martz and Nolan, 6/12).

The Washington Post: Advocates For Poor Hope To Revive Debate Over Expanding Medicaid In Virginia
Advocates for the poor are pushing to revive the debate over expanding Medicaid coverage in Virginia even as lawmakers in Richmond passed a budget Thursday that strips out the additional health-care coverage. In rallies and candlelight vigils across the state, the advocates are highlighting the stories of some of the 400,000 low-income patients in Virginia who they say would be newly eligible for the government-funded program (Olivo, 6/12).

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Indicators Suggest Some Insurance Rates In Wash., Calif. To Increase Less Than 10%

The Los Angeles Times reports that Anthem Blue Cross's individual coverage premiums are expected to increase on average less than 10 percent next year. Also, the Associated Press notes that, though the rate approval process has just begun, the proposed average increase for Washington state rates is 8.25 percent.

Los Angeles Times: Anthem's Obamacare Rates To Increase Less Than 10% In California
In the strongest indication yet where Obamacare rates are headed, industry giant Anthem Blue Cross said its California premiums for individual coverage will increase less than 10% on average next year. Health insurance rates in California during the initial rollout of the Affordable Care Act were better than expected, helping boost enrollment to 1.4 million people in the Covered California exchange (Terhune, 6/12).

The Associated Press: Washington Health Insurance Rates To Go Up In 2015
People who buy their own health insurance in Washington state can expect rates to go up in 2015, but probably not as fast as insurance costs increased in the years before federal health care reform took effect. The process of approving insurance rates in Washington has just begun, but the proposed average increase for the more than 320,000 people who buy their own health insurance is 8.25 percent, according to the Office of the Insurance Commissioner (Blankinship, 6/12). 

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3 States Report Number Of Insurers On Marketplace Will Grow In 2015

Officials in New Hampshire, Michigan and Illinois say plans that opted to sit out the first year of the health law are moving into the market now. Meanwhile, in Minnesota, health law opponents are planning to use problems in the state's exchange in the campaign against the governor.

The Hill: More Insurers Joining Obamacare Exchanges
A growing number of insurers say they intend to offer coverage on the ObamaCare exchanges next year. Insurance plans in New Hampshire, Michigan and Illinois are planning to enter into the federal marketplaces after deciding not to participate during ObamaCare’s first enrollment period, according to news reports. In New Hampshire, the number of ObamaCare insurers is set to rise from one to five next year; from 13 to 18 in Michigan; and from six to 10 in Illinois (Al-Faruque, 6/12). 

The Chicago Sun-Times: Ten Health Insurers Apply For Illinois Online Marketplace In 2015
Ten health insurers have applied to be part of the Affordable Care Act’s online marketplace in 2015 for Illinois, including for the first time, the state's second-largest insurer, UnitedHealthcare. And 504 health insurance plans were submitted to the Illinois Department of Insurance for 2015, including 306 individual plans and 198 plans for the small group insurance marketplace, the department said Thursday. Last year – the first year the 'Obamacare' marketplace existed – eight insurers offered 165 plans, including 120 individual plans and 45 small group plans (Thomas, 6/12).

Chicago Tribune: Interest Surges For Illinois Health Insurance Exchange
The state did not say which carriers submitted plans, which include 306 policies for individuals and 198 for small groups. "The significant increase in the number of carriers and the number of plans they are offering represents good news for Illinois health care consumers," said Jennifer Koehler, executive director of Get Covered Illinois, the state’s health care expansion enrollment arm. "It means consumers will have even more good options to choose from next year" (Frost, 6/12).

Minnesota Public Radio: DFLers Say They're Ready To Get Loud About Federal Health Law, MNsure
On Thursday, the Minnesota Jobs Coalition, a group working to help Republicans defeat DFL Gov. Mark Dayton, announced it will air a TV ad linking Dayton to MNsure, Minnesota's online health care exchange. But after taking some early lumps on MNsure — the rollout of the state website led to botched applications and the resignation of MNsure's executive director in December — Democrats are becoming more aggressive about promoting what they say are the program's benefits. "I think if the Republicans want to make this an issue, they're going to do so at their own peril," said DFL Party Chair Ken Martin (Scheck, 6/12).

The Star Tribune: GOP Group Blasts Dayton Over Health Insurance Overhaul
A leading group opposing Minnesota Democrats has launched its first television advertisement attacking DFL Gov. Mark Dayton and the state's health insurance exchange. The 30-second ad ties President Obama's health insurance overhaul with the troubled launch of the state's health insurance exchange, MNsure. "Barack Obama and Mark Dayton promised Minnesotans that Obamacare would help make things better," said Ben Golnik, chairman of the Minnesota Jobs Coalition. "MNsure remains a mess defined by missed goals, lost policies and bonuses for executives who failed in their jobs. Dayton is so out of touch with Minnesotans he even claimed Obamacare was working 'phenomenally well'" (Helgeson, 6/12).

The Associated Press: Group Targets Minnesota Gov. In TV Ad On Health Care Law
An independent political group's TV ad uses Gov. Mark Dayton's own words against him on the new health insurance law, prompting pushback from the Democrat's campaign. The Minnesota Jobs Coalition ad rolled out Thursday uses footage of Dayton from October saying MNsure was going "phenomenally well." MNsure is the Web-based exchange Minnesota is using to comply with the Affordable Care Act, known by many as "Obamacare." Minnesota's system had a choppy debut, which Republicans hope to turn into political advantage in a bid to defeat Dayton (6/12). 

And on the troubled Massachusetts exchange -

The Boston Globe: Mass. Health Connector Website Faces Critical Test In July
An assessment of the new software for the Massachusetts Health Connector website, set for early July, will provide the first read on whether the state is likely to succeed at running its own health insurance marketplace in 2015 or will default to the federal system. Meanwhile, the state will extend until the end of this year the transitional programs that have enabled people to obtain coverage despite the Connector site’s failure to work properly since it was launched last October (Freyer, 6/12).

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Ill. Staged Costly Enrollment Campaign; Calif. College Sign-Ups Exceed Expectations

In health law implementation news, The Associated Press examines the $33 million that Illinois spent to promote enrollment. And a new California poll finds a significant drop in uninsured students at the California State University campuses.

The Associated Press: Illinois Health Campaign Among Costliest
President Barack Obama's home state agreed to spend $33 million in federal money promoting his health care law, hiring a high-priced public relations firm for work that initially was mocked and spending far more per enrollee on television ads than any other large state. After getting a late start and facing intense pressure to avoid more embarrassment for the much-maligned law, Illinois officials last summer inked the most lavish contract in the history of FleishmanHillard's Chicago office. The goal was getting uninsured residents to sign up for coverage. More than 90 people, including executives from the firm and its subcontractors, billed at least $270 an hour for salary and overhead during the first four months (Johnson, 6/12). 

Los Angeles Times: Share Of CSU Students Who Now Have Healthcare Exceeds Expectations
During the open enrollment period that ended in April, some officials worried that if not enough young, healthy people signed up for coverage, insurance companies would be left with too many sick and expensive customers, which would eventually cause carriers to raise premiums. According to a poll released Thursday, at the 15 largest CSU campuses, approximately 30% of students were uninsured before enrollment began, and 10% were uninsured after. The drop accounts for 60,000 students who became insured, and illustrates the late surge of young people who signed up for policies (Karlamangla, 6/12).

In Colorado -

Denver Post: Decision To Allow Noncompliant ACA Plans Came Despite No Law Change
Last fall, when President Barack Obama allowed states to extend policies that didn't comply with the Affordable Care Act, Colorado Division of Insurance Commissioner Marguerite Salazar didn't believe she had the authority under state law to make that change. Six months later, Salazar reversed that decision and allowed insurance companies a one-year extension through 2015. In March, Obama allowed states up to a two-year extension (Kane, 6/13).

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Countdown To The High Court's Decision On The Health Law's Birth Control Coverage Requirement

News outlets report on pending legal actions against the health law. The Supreme Court is expected to rule this month regarding challenges to the overhaul's contraceptive mandate. In addition, arguments will be heard before a Wisconsin district court judge next month regarding a challenge to the health law provision that allows the federal government to pay a portion of the coverage costs for Capitol Hill staffers and lawmakers.   

Politico: Obamacare Hill Subsidy Case To Go To Court
A long-running fight involving Obamacare coverage for Hill staff and lawmakers is getting its day in court this summer. Sen. Ron Johnson’s lawsuit against the Obama administration policy that allows the federal government to pay for a portion of lawmakers’ and staffers’ health insurance policies in the Obamacare exchanges will go before a Wisconsin district court judge on July 7 (Haberkorn, 6/12).

Kaiser Health News: What’s At Stake For Birth Control In Upcoming SCOTUS Decision
One of the most watched cases before the Supreme Court this term will may turn on the question of religious freedom. But it will also likely determine how women will be able to access a key provision of the Affordable Care Act – one seeking to guarantee no-cost prescription contraception in most health insurance plans. The justices ruling on Sebelius v Hobby Lobby Stores and Conestoga Wood Specialties Corp v Sebelius, expected by the end of this month, will decide whether those companies, and potentially all other for-profit companies, must abide by the so-called contraceptive mandate. It’s a complicated case, so here is some background (Rovner, 6/13).

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Administration News

Poll: Fixing Vets' Health Care High Priority

Elsewhere, a senator defends his vote against legislation to try to improve the VA's health care, and The Associated Press looks at doctor's appointment wait times for all Americans.

Politico: Poll: Fixing VA Health Care Top Issue
The most widespread legislative concern for Americans is improving health care for veterans, a new poll says. According to a Gallup poll released Friday, 87 percent of Americans say it is extremely or very important for the White House and Congress to address health care services for veterans. Among the nine options presented in the survey, improving care for veterans scored 15 percent higher than the second-place issue, equal pay legislation for women (Topaz, 6/13).

The Milwaukee Journal Sentinel: Ron Johnson Defends Vote Against VA Funding
In an interview with the Milwaukee Journal Sentinel Thursday, U.S. Sen. Ron Johnson, a Republican from Oshkosh, defended his vote against a bipartisan measure to address scheduling problems at Veterans Affairs facilities but vowed to continue to work to fix what he called a broken system. "The finest among us deserve the best quality health care system," Johnson said. "They need to be able to access it and access it in time." On Wednesday, Johnson was one of only three Senators to vote against the legislation that would allow the VA to contract with private medical facilities, enabling veterans facing long waits to get quicker treatment. The VA would also be able to use $500 billion from its current budget to hire more medical staff (Glauber, 6/12).

The Associated Press: Outside The VA, Waits For Doctors Can Vary Widely
It’s not just veterans who sometimes have to wait for health care. Depending on where you live and what kind of care you want, in parts of the country it’s not always easy for new patients to get a quick appointment. Need routine primary care? The average wait to see a family physician for the first time ranged from 66 days in Boston to just five days in Dallas, according to a survey in 15 large cities by health care consulting firm Merritt Hawkins. And doctors are bracing for new demand from millions of people newly insured through the federal health care law (Neergaard, 6/13).

States, too, are trying to address the problems at the VA in their own ways --

Texas Tribune: Perry Proposes Fix For Texas Vets Health Care
Gov. Rick Perry on Thursday announced that the state has reached agreements with health facilities to provide care for veterans who cannot get timely treatment from the U.S. Department of Veterans Affairs. Now, he’s asking federal officials to approve the plan designed to help the 1.7 million veterans living in Texas. The U.S. House and Senate this week both passed bills that would help veterans access health care outside the VA system if they cannot get a prompt VA appointment or do not live near a VA clinic (Edelman, 6/12). 

Texas Tribune: Vets Discuss Wait Times At Senate Committee Hearing
Georgia Hernandez says her father’s medical care at VA clinics in recent months had been mired by long wait times for appointments that left him with no other option than to seek care at a Houston hospital. It was there that doctors discovered George Barraza, a Vietnam War veteran, had liver cancer and that he was suffering from hepatitis C and cirrhosis. After doctors ran several tests and sent Barraza and his daughter back to the VA, they were told to come back two months later, but Barraza died before his appointment. Hernandez was among several who testified before the committee at the Port of Houston in Pasadena. Committee members collected information from veterans and state officials who work with the veteran community as they prepare to task the Texas Veterans Commission with assisting veterans in obtaining medical services and filing complaints for long wait times (Ura, 6/12). 

MinnPost: Despite Audit's Red Flags, Vets Give Minnesota's VA Clinics High Marks
While Minnesota Veterans Affairs officials anxiously seek an explanation why a federal audit identified the Minneapolis VA Medical Center and the Rochester VA clinic as trouble spots needing more review, many Minnesota veterans are praising the state’s VA medical facilities. Rank-and-file vets and those employed by county Veterans Services offices throughout the state said they’ve received superb care from the Minneapolis VA hospital. And Twin Cities medical professionals who work closely with the Minneapolis system say providers offer solid care to patients (Cronin and Henry, 6/12).

McClatchy: Fla. Lawmakers Deride VA For Problems But Counsel Caution On Overhaul
A bipartisan collection of Florida lawmakers piled on the Department of Veterans Affairs on Thursday in a special delegation meeting – although one of the most common refrains heard was some variation of “the VA does many things well.” About 20 representatives from both sides of the aisle took testimony from veterans groups and from an official of the VA’s Florida health operations. The VA has been caught in a scandal over scheduling practices that hid how long veterans actually waited to see their doctors (Adams, 6/12)

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Health Care Marketplace

States, Insurers Wrestle Over Decisions To Offer Costly Hepatitis C Drug

The medication, named Sovaldi, has shown great promise in fighting the deadly disease, but it is very expensive: The treatment regimen runs about $84,000 per patient.

The Wall Street Journal's Pharmalot: Will Oregon Restrict Coverage For A Pricey Gilead Pill For Hepatitis C?
Mention the Sovaldi hepatitis C pill to insurers and you are certain to hear complaints. The Gilead Sciences treatment has excited Wall Street amid the promise of a booming, multi-billion-dollar market for drugs to cure the disease. But the flip side of this excitement is a great of fretting over the cost – $84,000 per patient. Even though Gilead argues this is cheaper than alternative remedies, such as liver transplants, payers are complaining to no end (Silverman, 6/12).

McClatchy: New Hepatitis C Wonder Drug Shakes Up The Health Care Industry
In the first quarter of 2014, 30,000 U.S. patients were treated with Sovaldi, generating a whopping $2.3 billion in sales for Gilead, of Foster City, Calif. The company says Sovaldi’s price reflects its 90 percent-plus cure rate for hepatitis C and the savings that produces by cutting patients’ long-term treatment costs, which can include hospitalizations, surgeries and even liver transplants. But private insurers, drug benefit managers, health care advocates and Medicaid officials say the drug’s steep price tag will drive up insurance premiums, limit patient access and squeeze the budgets of state Medicaid programs, which have a disproportionate share of hepatitis C patients (Pugh, 6/12).

In related news -

Kaiser Health News: Capsules: PhRMA, Advocates: Specialty Drug Costs For Patients Too High
Here's the next salvo in the back and forth between insurers and the drug industry over drug prices: the Pharmaceutical Research and Manufacturers of America are pushing the Department of Health and Human Services to take action to protect consumers who have gained insurance via the health law’s online marketplaces from high, out-of-pocket costs for specialty drugs (Gillespie, 6/12).

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State Watch

State Highlights: La. Abortion Restrictions; New Mass. Hospital Deal

A selection of health policy stories from Louisiana, Massachusetts, New Jersey, Wisconsin, Georgia, Missouri, Maryland, New York, Kansas and Washington state.

The Associated Press: Louisiana: Governor Signs New Abortion Restrictions
Gov. Bobby Jindal on Thursday signed into law new restrictions against abortion, saying they will protect women and the unborn. The biggest change will require doctors who perform abortions to be able to admit patients to a hospital that is within 30 miles of where the procedure is performed and that provides obstetric or gynecological health services (6/12).

WBUR: Health Care Leaders Call For Closer Scrutiny Of Partners Deal
In an unusual, perhaps unprecedented move, leaders from across the health care industry are calling for closer scrutiny of a deal that would cap prices for Partners HealthCare in the short term but would let the state’s largest hospital network add four more hospitals. The deal that is fueling letters, analysis, statements and meetings is between Partners HealthCare and Attorney General Martha Coakley. She says it will limit Partners’ clout and the health care “Goliath’s” (her word) ability to drive up costs. That might be true. But no one has seen any details (Bebinger, 6/12).

ProPublica: Medicare Taken For Ride By Ambulance Company In New Jersey
To grasp Medicare's staggering bill for ambulance rides in New Jersey, just visit the busy parking lot of the DaVita St. Joseph's dialysis clinic in the town of Paterson. More than 20 ambulances and a handful of wheelchair vans were parked outside on a recent morning there. Emergency medical technicians wheeled patients in and out on stretchers. As soon as one ambulance departed, another took its place (Ornstein, 6/12).

The Wall Street Journal: Governors Remain Cautious On Spending, Even As Tax Collections Grow
When states decide to increase spending, they often boost funding for K-12 and higher education. More money is also going to health care programs for poor and disabled residents. Enrollment in Medicaid has jumped in part because of the federal health care law, which pumps more money into the states to expand the number of residents who are covered. The association expects the Medicaid rolls to grow by 18.9 percent from 2013 through 2015 (Peters, 6/12).

The Milwaukee Journal Sentinel: Physician Fees 50% Higher In Southeastern Wisconsin, Study Finds
Physician fees in southeastern Wisconsin are almost 50 percent higher on average than other Midwest markets for commercial health plans, according to a study released Thursday. The study for the Greater Milwaukee Business Foundation on Health found that health plans paid physicians fees that were 30 percent to 74 percent higher than other Midwest markets, with the exception of Minneapolis, in 2012. The difference is estimated to increase premiums for employers and individuals in southeastern Wisconsin by 15 percent compared with other Midwest markets (Boulton, 6/12).

Georgia Health News: Agencies Unite In Crackdown On Illegal Care Homes
The state’s main health agency said Thursday that it has formed a partnership with the GBI to crack down on unlicensed personal care homes. Clyde Reese, the commissioner of the Department of Community Health, told the agency’s board that the partnership, which includes Adult Protective Services from the Department of Human Services, will mount “an aggressive effort to put [unlicensed homes] out of business.”  These facilities deliver “substandard care to the elderly and disabled,’’ Reese said (Miller, 6/12).

The Associated Press: Missouri Medicaid Can't Count On Tobacco Proceeds 
Missouri's budget concerns are continuing to mount. Attorney General Chris Koster's office says the state cannot count on receiving $50 million of tobacco settlement proceeds in time to be used during the 2015 budget year that starts July 1. The Legislature had assumed the money would be available to help pay pharmaceutical costs in the state's Medicaid program (6/12). 

Politico: Abortion Becomes Issue In Louisiana Senate
Louisiana’s rightward tilt on abortion rights is opening up one of the brightest political contrasts in the race between Democratic Sen. Mary Landrieu and GOP Rep. Bill Cassidy. The rivals have, for now, battled to a stalemate on some of Louisiana’s parochial issues like flood insurance and energy expansion. But Gov. Bobby Jindal’s (R) Thursday signing of restrictive abortion rights legislation is underscoring the yawning gap between the two candidates on social issues (Everett, 6/12).

Baltimore Sun: Health care Lobbyists Run Negative Ad Against Baltimore Democrat
Maryland health care lobbyists have launched a negative radio ad against East Baltimore Democrat Julius Henson, who is challenging State Sen. Nathaniel McFadden in this month's primary election. The ad, paid for by Maryland Citizens' Health Initiative Inc., praises the public health record of McFadden and criticizes Henson, a long-time campaign operative who does not support a plan to increase the tobacco tax (Broadwater, 6/12). 

The New York Times: Anti-Overdose Drug Becoming An Everyday Part Of Police Work
Once the exclusive purview of paramedics and emergency room doctors, administering lifesaving medication to drug users in the throes of an overdose is quickly becoming an everyday part of police work amid a national epidemic of heroin and opioid pill abuse (Goodman and Hartocollis, 6/12).

The Associated Press: Hearing Probes Jail Violence, Mental Health Care
New York City lawmakers peppered correction and health officials with questions about how to reduce violence and better care for a growing mentally ill inmate population in the nation's second-largest jail system during a specially called oversight hearing Thursday. In three hours of testimony, the commissioners for the departments of correction and health and mental hygiene detailed both the bureaucratic inner-workings of how their two agencies, tasked respectively with both the custody and health care of roughly 11,000 daily inmates, interact now -- and what they can do better to reform a jail system advocates, lawmakers and even the department of correction commissioner himself have called troubled (6/12). 

Kansas Health Institute News Service: Kansas Hospitals, Physicians Agree to Pre-surgery Checklist
A coalition of Wichita-area doctors and hospitals on Wednesday announced the adoption of a pre-surgery checklist designed to put the city’s operating rooms among the safest in the nation. “If you go to the Hospital Compare website and look at ‘antibiotic prophylaxis ordered’ under ‘procedures and core measures,’ you’ll see that we’re at 99-plus percent,” said Dr. Randall Morgan, an obstetrician and chair of the Wichita Quality Health Collaborative’s Surgical Safety Committee. “We’re meeting all of the quality-of-care markers, and we’re at or above all the state averages and all the national averages. We’re where we’re supposed to be. “But you wouldn’t want to be in the 1 percent that didn’t get the antibiotic,” he said. “That’s what this is about" (Ranney, 6/12).

Seattle Times: Big Cuts Possible At King County Public Health Clinics
Budget cuts are nothing new to local public health departments, but this time it’s different, Dr. David Fleming told his staff at Public Health -- Seattle & King County on Thursday. Facing a shortfall of $15 million per year for the next two years, Public Health is proposing to close up to four of its 10 public health clinics, said Fleming, director and public health officer. The clinics provide family planning, and maternity and infant support services for patients with income, language, social or mental difficulties who have trouble getting help elsewhere (Ostrom, 6/12). 

Seattle Times: Officials Vow To End "Deplorable" Practice Of Boarding Mentally Ill
King County’s top mental-health administrator has pledged to eliminate the controversial practice of warehousing severely mentally ill patients in hospital emergency rooms while they await proper treatment. It’s an admittedly ambitious goal, given that nine of every 10 patients who were involuntarily admitted for psychiatric care in King County this February experienced the practice -- officially called “psychiatric boarding” -- according to data Jim Vollendroff presented to a Metropolitan King County Council committee hearing this week. That’s a sharp increase from the same month in 2013, when six of every 10 were boarded (Mannix, 6/12). 

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Health Policy Research

Research Roundup:Hospital Readmissions; Wash. State Premiums

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

JAMA Surgery: Evaluation Of Hospital Readmissions In Surgical Patients
Reducing hospital readmissions is a major target for current quality improvement and cost-containment efforts. National policy makers have developed a tool that uses administrative data to analyze all-cause hospital readmissions and determine whether each readmission is susceptible to financial penalties. This tool is yet to be implemented, however. Using a cohort of general surgery patients, the current study demonstrates that administrative data failed to correctly identify the reason for hospital readmission in nearly one-third of cases. Similarly, the readmission measure failed to identify nearly two-thirds of planned readmissions. ... Implementation of this readmission measure may result in unwarranted financial penalties for hospitals. (Sacks et al., 6/11).

JAMA Internal Medicine: Association Of Marketing Interactions With Medical Trainees’ Knowledge About Evidence-Based Prescribing
In recent years, numerous US medical schools and academic medical centers have enacted policies preventing pharmaceutical sales representatives from interacting directly with students. ... We surveyed a nationally representative sample of first- and fourth-year medical students and third-year residents. ... Among physician trainees, our survey showed an association between positive attitudes toward industry-physician interactions and less knowledge about evidence-based prescribing and greater inclination to recommend brand-name drugs. Policies intended to insulate trainees from pharmaceutical marketing may promote better educational outcomes (Austad et al., 6/9).

Health Affairs: Translating Research For Health Policy: Researchers' Perceptions And Use Of Social Media
Academic journals, public health agencies, and health care organizations are increasingly using social media to communicate health information. ... We conducted a survey of health policy researchers about using social media and two traditional channels (traditional media and direct outreach) to disseminate research findings to policy makers. Researchers rated the efficacy of the three dissemination methods similarly but rated social media lower than the other two in three domains: researchers’ confidence in their ability to use the method, peers' respect for its use, and how it is perceived in academic promotion. Just 14 percent of our participants reported tweeting, and 21 percent reported blogging about their research or related health policy in the past year. Researchers described social media as being incompatible with research, of high risk professionally, of uncertain efficacy, and an unfamiliar technology (Grande et al., 6/6).

The Kaiser Family Foundation: A Look At CBO Projections For Medicaid And CHIP
Generally once a year, the Congressional Budget Office (CBO) releases a detailed "baseline" for federal spending for Medicaid, CHIP and the ACA that serves as a neutral benchmark for Congress to measure the budgetary effect of proposed legislation and as a reference point for analysis of Medicaid enrollment and spending. This baseline assumes current law remains in place, but adjusts for changes in the economy and other factors ... Compared to the CBO Medicaid baseline from March 2012, federal spending projected for 2020 in the April 2014 baseline is 14% lower due to a number of factors including the Supreme Court decision effectively making the ACA Medicaid expansion an option. ... Due to the ACA, the number of uninsured is expected to decline by 26 million by 2024 (Rudowitz, 6/5). 

Related: Medicaid Enrollment: An Overview Of The CMS April 2014 Update

The Kaiser Family Foundation: Visualizing Income And Assets Among Medicare Beneficiaries: Now And In The Future
Many Medicare beneficiaries live on fixed incomes supplemented by the savings they accumulated during their working years. Their income and accumulation of savings is tied to many life experiences, including their education, health status, marital status, number of work years, household income, periods of unemployment, investments, years of homeownership, access to employer retirement benefits, inheritance, other financial supports, and various economic factors. This interactive tool describes the income, savings and home equity of people on Medicare in 2013, and in 2030 (6/12). 

Avalere Health: Washington State Rate Analysis: Carriers with Low 2014 Market Share Hold Down Premiums in 2015
A new analysis from Avalere Health finds that proposed rate increases for 2015 exchange plans in Washington state were lowest among carriers with the smallest share of the 2014 market. Molina, which captured only 1 percent of 2014 exchange enrollment in the state, proposed a nearly 7 percent average rate decrease for 2015. In addition, other low enrollment carriers, Kaiser Permanente and BridgeSpan Health, each proposed average increases of less than 2 percent. Washington state is the first to release both 2015 rate filings ... “Consumers enrolling through the exchange are extremely price sensitive and tend to focus primarily on premiums,” said Dan Mendelson, CEO at Avalere Health. “In this vibrant market, plans that gained a minimal share in 2014 will naturally want to price their products more competitively in 2015” (6/12).

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

Reuters: Putting Dying Wishes In Medical Record Helps Them Happen
When patients' end-of-life preferences are entered as instructions in their medical record, their wishes are more likely to be honored, a new study suggests. The study was done in Oregon, one of two states with an end-of-life planning program called POLST (Physician Orders for Life-Sustaining Treatment). ... “POLST records and honors wishes in a way that (medical professionals understand) and can implement across settings of care,” said Dr. Susan Tolle, an internist at Oregon Health and Science University in Portland and the study’s senior author. ... “Although it is probably more important how you die than where you die, where you die can strongly affect how you die,” they write in the Journal of the American Geriatrics Society (Belisomo, 6/9).

NPR: Doctors Don't Know What Women Want To Know About Birth Control
Women have choices in contraception, from pills and injections to intrauterine devices and the NuvaRing. ... Doctors tend to think it's most important to discuss how to use contraceptives and which methods are most effective at preventing pregnancy, according to the poll , which was published in the journal Contraception. Women, on the other hand, are often more concerned about safety, side effects and how the contraceptives work (Singh, 6/10).

The Associated Press: Healthy Seniors Tested In Bid To Block Alzheimer's
In one of the most ambitious attempts yet to thwart Alzheimer's disease, a major study got underway Monday to see if an experimental drug can protect healthy seniors whose brains harbor silent signs that they're at risk. Scientists plan to eventually scan the brains of thousands of older volunteers in the U.S., Canada and Australia to find those with a sticky build-up believed to play a key role in development of Alzheimer's — the first time so many people without memory problems get the chance to learn the potentially troubling news (Neergaard, 6/9).

The Hill: Cancer Survivors Keep Paying Cancer Costs Long After Recovery
Even after fighting off cancer, survivors often face severe challenges, such as high medical costs and productivity loss from missed work, according to a new study from the Centers for Disease Control and Prevention. The CDC analyzed cancer survivors' medical cost data between 2008 and 2011 and found they face serious financial burdens because of clinical follow-ups, managing long-term and late effects of their treatments, and monitoring for recurrence of the disease and other cancers because of increased risk (Al-Faruque, 6/12).

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Editorials and Opinions

Viewpoints: VA Fix Comes With Big Pricetag; Safety Outside Abortion Clinics; Questions About Medicaid Eligibility

The Fiscal Times: The Government's Next Big Health Care Experiment
As an example of how the normally sclerotic Congress can act extremely quickly when properly motivated, both chambers passed bills this week to ameliorate the Veterans Affairs health services scandal. The Senate version, negotiated by the mismatched pair of Bernie Sanders (I-VT) and John McCain (R-AZ), spends $500 million on more doctors for the VA and authorizes leases for 26 new medical facilities. But until the expansion gets up and running, between now and 2016, VA recipients who run into long delays or live more than 40 miles from a clinic would be able to access private care facilities like community health centers or private hospitals. ... Congress moved so fast that they skipped the part where they wait for the Congressional Budget Office to deliver a cost estimate (David Dayen, 6/13).  

Politico: Running The Gauntlet: The Supreme Court Is About To Decide Whether America's Abortion Clinics Become Dangerous No-Go Zones
In McCullen v. Coakley, the Massachusetts buffer-zone case currently before the Supreme Court, which will be decided by the end of June, lawyers for abortion protesters have tried to portray their clients as "plump grandmothers" wanting to quietly hand out pamphlets. ... What Scalia's argument doesn't acknowledge is that the civility of those encounters is largely dependent on laws ensuring buffer zones themselves. In September 2013, the National Abortion Federation or NAF, the professional association of abortion providers in the United States, reported that 92 percent of providers in areas without buffer zones said they were concerned about the safety of their workers and their patients in the areas directly surrounding the clinic (Robin Marty, 6/11).

Forbes: Federal Bungling Of ObamaCare Verification Creating Nationwide Chaos In Medicaid Departments
Increased Medicaid enrollment has long been heralded as a rare "success" of the ObamaCare rollout. Recently, CMS released a new report boasting about increasing enrollment in Medicaid. "These gains are made possible by collaboration between CMS and the states that operate these programs," CMS said. But how many of the new 6 million enrollees actually meet the eligibility requirements for Medicaid? Some state officials have started to push back on the claims of the Obama Administration on Medicaid, and a few have quietly started to remove ineligible individuals that have been enrolled due to continued issues with the federal website. The few examples that have become public from around the country call into question the validity of these Medicaid enrollment numbers, painting a dire picture for taxpayers and the truly needy (Josh Archambault and Nic Horton, 6/14).  

The New York Times: Under The Skin
Transgender Americans scored a major victory for equality last month, when the Department of Health and Human Services overturned a decades-old ban on Medicare coverage for gender-confirming surgeries. But the decision is hardly a final triumph. Though thousands of people will now receive insurance coverage, many, many more will continue to be denied because of state-level restrictions on coverage. Indeed, only five states and the District of Columbia require that private insurance companies cover transition-specific care (Parker Marie Molloy, 6/12). 

The Wall Street Journal: Transgender Surgery Isn't The Solution
The government and media alliance advancing the transgender cause has gone into overdrive in recent weeks. On May 30, a U.S. Department of Health and Human Services review board ruled that Medicare can pay for the "reassignment" surgery sought by the transgendered—those who say that they don't identify with their biological sex. Earlier last month Defense Secretary Chuck Hagel said that he was "open" to lifting a ban on transgender individuals serving in the military. Time magazine, seeing the trend, ran a cover story for its June 9 issue called "The Transgender Tipping Point: America's next civil rights frontier." Yet policy makers and the media are doing no favors either to the public or the transgendered by treating their confusions as a right in need of defending rather than as a mental disorder that deserves understanding, treatment and prevention (Paul McHugh, 6/12).

The New York Times' Well Blog: When a Stressful Hospital Stay Makes You Sick
The woman was rolled into the emergency department by paramedics. Struggling to breathe, she bent forward, hands on her knees, using gravity to help expand her chest. "This all started when she was admitted, and now she's worse," her husband told me. A few weeks earlier, pneumonia had put her in the hospital for five days. When her oxygen levels improved she was discharged, but at home she struggled to get out of bed, and couldn't shake a deep fatigue. The day I saw her in the E.R., her breathing was becoming increasingly labored (David H. Newman, 6/12). 

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Stephanie Stapleton

Andrew Villegas

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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.