Daily Health Policy Report

Friday, June 14, 2013

Last updated: Fri, Jun 14

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Public Health & Education

Women's Health

State Watch

Health Policy Research

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: California Insurance Chief Wants To Bar Anthem From Selling Small Business Coverage; Preparing For Flood Of Consumer Questions On Insurance Exchanges

Now on Kaiser Health News' blog, Julie Appleby reports on developments in California related to the small business insurance market: "Citing a pattern of 'unreasonable rate increases' for small business customers by Anthem Blue Cross, California Insurance Commissioner Dave Jones said Thursday he will recommend that the state's new online insurance marketplace exclude the firm from selling small business coverage" (Appleby, 6/13).

Also on the blog, Peggy Girshman looks at state-based coverage regarding how Minnesota is preparing for consumer questions about the health law’s online insurance marketplaces: "On Oct. 1, individual consumers and small businesses will be able to enroll in the online health insurance marketplaces known as exchanges. Minnesota, where the state is running the exchange, and Florida, where the federal government will be in charge, are preparing in different ways. Under the Affordable Care Act, most Americans who don't already have health insurance through employers, Medicare or some other source are required to get it as of Jan. 1 or pay a fine. Subsidies will be available for people who earn up to 400 percent of the federal poverty level to buy insurance" (Girshman, 6/13). Check out what else is on the blog.

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Political Cartoon: 'Daddy's Little Girl?'

Kaiser Health News provides a fresh take on health policy developments with "Daddy's Little Girl?" by Rick McKee.

Meanwhile, here is today's health policy haiku:


Jan Brewer's finger:
It wags at adversaries

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

Employers' Challenge: Offering 'Affordable' Coverage

The Associated Press reports on the health law's requirement that employers with more than 50 workers provide affordable health coverage or face fines. But what is affordable? And will workers be helped or hindered by the rule?

The Associated Press/Washington Post: Employers With 50 Or More Full-Time Workers Required To Offer 'Affordable' Coverage
Requirements that medium-sized and large employers offer insurance coverage or face fines are one of the most complicated parts of President Barack Obama's health care law. While most of the estimated 160 million Americans with job-based coverage will not see major changes when the law takes full effect next year, the so-called employer mandate will be important to millions of workers, particularly in low-wage industries (6/13).

The Associated Press/Washington Post: Affordability Glitch: Low-Wage Workers In Some Big Firms Could Get Left Out In Health Overhaul
It's called the Affordable Care Act, but President Barack Obama's health care law may turn out to be unaffordable for many low-wage workers, including employees at big chain restaurants, retail stores and hotels. That might seem strange since the law requires medium-sized and large employers to offer "affordable" coverage or face fines. But what's reasonable? Because of a wrinkle in the law, companies can meet their legal obligations by offering policies that would be too expensive for many low-wage workers. For the employee, it’s like a mirage — attractive but out of reach (6/13).

State Of Health/KQED: Will Proposed Obamacare Fines Help Or Hurt California Workers?
For many businesses Obamacare is downright intimidating. The requirement to provide coverage to full-time employees or potentially face thousands of dollars in fines is what’s really worrying some large companies. Most employees at large businesses already receive health insurance through their employer. But there are still some exceptions. Barbara Andridge is a sales associate at a Walmart near Sacramento. She’s not sure if she’s eligible for the company’s health insurance program because her hours are all over the map — from eight hours one week up to 36 hours the next (Weiss, 6/13).

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Arizona Legislature Approves Medicaid Expansion

After a months-long, high-stakes political battle, Arizona lawmakers endorsed a Medicaid expansion plan backed by Gov. Jan Brewer.

The Associated Press: Arizona Gov. Brewer Secures Medicaid Expansion 
Ending a six-month legislative session, Arizona lawmakers endorsed a key element of President Barack Obama’s health care law in a huge political victory for Republican Gov. Jan Brewer, after a lengthy fight over Medicaid expansion that divided the state's Republican leadership. The expansion that will extend health care to 300,000 more low-income Arizonans came after months of stalled negotiations, tense debates and political maneuvering as Brewer pushed the Medicaid proposal through a hostile Legislature (Christie and Silva, 6/14).

The Wall Street Journal's Washington Wire: Arizona Expands Medicaid In Win For Gov. Brewer
Ms. Brewer had held rallies across the state since January to persuade Republican legislators to go along with her decision to adopt a key part of the federal health-care law, the growth of the Medicaid health program to include millions more low-income adults, after the Supreme Court decision a year ago effectively allowed states to choose whether to participate. … Ms. Brewer faced an unusual situation because the state had already been covering most adults up to the poverty line, and accepting federal dollars for the program expansion in 2014 would have allowed it to continue to do so with more generous funding (Radnofsky, 6/13).

Huffington Post: Arizona Medicaid Expansion Advances After Jan Brewer Forces Lawmakers' Hands
Arizona is among the 29 states and the District of Columbia with chief executives who support expanding Medicaid under Obamacare to anyone who earns less than 133 percent of the federal poverty level, which is $15,282 for a single person this year. Majority-Republican legislatures in a number of states have stymied expansions endorsed by their governors, including Florida's Rick Scott (R), Ohio's John Kasich (R), Michigan's Rick Snyder (R), Missouri's Jay Nixon (D) and others (Young, 6/14).

Politico: Jan Brewer Wins Medicaid Expansion In Arizona
The vote is the end of a chapter, though not the book, on Obamacare in Republican-led Arizona, where Brewer defied — and sometimes confounded — her base. ... Brewer, whose finger-wagging moment on the tarmac with Obama almost 18 months ago for a time came to represent conservative opposition to the president, sold the expansion plan as a sensible option for conservatives in Arizona. She said it’s good for people, health care providers and the state’s bottom line because the federal government pays the whole cost the first three years, then gradually cuts back to 90 percent (Millman and Cheney, 6/13).

Reuters: Arizona Lawmakers Pass Medicaid Expansion
Brewer, a staunch conservative in this desert southwestern state, has said Arizona had no choice but to agree to provide care to 300,000 poor and disabled residents through the federal-state program. She said the decision would also protect rural and other hospitals from being jeopardized by the rising costs of paying for uninsured patients, inject $2 billion into the state's economy and create thousands of jobs. ... Last June, the U.S. Supreme Court upheld Obama's healthcare overhaul but allowed states to opt out of a provision expanding the Medicaid program (Schwartz, 6/13).

Arizona Republic: Divisive Arizona Legislature Ends On Congenial Note
The unwavering bipartisan bloc of votes that supported those issues during the special session also dissolved as lawmakers voted on the last slew of bills ... Medicaid amendments intended to defeat or change the legislation — all beaten back by the bipartisan coalition — included a repeal of the hospital assessment that helps fund the expansion, an anti-abortion provision, a requirement for a two-thirds majority approval and proposals that would roll back expansion if federal funding fell short of what’s promised. Conservatives, some calling themselves the “minority party” though they outnumber Democrats, complained that the process shut out the public and most members of the GOP, which hold majorities in both chambers (Rau, Reinhart, Sanchez, 6/13).

And in Mississippi and Ohio-

The Washington Post’s Wonk Blog: How Mississippi Could End Up Killing Medicaid
The fight over expanding Medicaid has gotten ugly, and the latest state to grab the spotlight is Mississippi, where a standoff in the legislature is pushing the state toward a cliff. Without a last-minute agreement, Medicaid may cease altogether there on July 1. Most people think it won’t come to that, but given the unpredictable nature of the fight over Obamacare, advocates and hospitals there are growing understandably concerned. Some 700,000 people are on the Medicaid rolls in Mississippi, and the program represents about 16 percent of the state’s hospital revenue (Somashekhar, 6/13).

The Associated Press: Bipartisan Bill Tackles Ohio Medicaid Program
Ohio lawmakers introduced a bipartisan proposal Thursday aimed at curbing Medicaid costs and making the health program more efficient, as they try to find common ground on the issue. Gov. John Kasich's budget proposal initially called for expanding the Medicaid program to provide health coverage to more low-income Ohioans. But GOP leaders stripped the expansion measure from the House version of the state spending plan in April, and it's since remained out of the $61.7 billion, two-year budget. (6/14).

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Calif. Regulator Seeks To Bar Anthem From Small Business Health Exchange

Meanwhile, Minnesota officials announce the opening of a call center Sept. 3 to answer consumer questions about the state's online insurance marketplace, which will begin enrolling people a month later.

Los Angeles Times: Regulator Wants To Bar Anthem From Small-Business Health Exchange
California Insurance Commissioner Dave Jones wants industry giant Anthem Blue Cross barred from the state's new health exchange for small businesses because he says the company imposes excessive rate hikes. Jones said the state's largest for-profit health insurer should be denied access to the state-run market where thousands of small employers will purchase health coverage for their workers (Terhune, 6/13).

Kaiser Health News: Capsules: California Insurance Chief Wants To Bar Anthem From Selling Small Business Coverage
Citing a pattern of 'unreasonable rate increases' for small business customers by Anthem Blue Cross, California Insurance Commissioner Dave Jones said Thursday he will recommend that the state's new online insurance marketplace exclude the firm from selling small business coverage (Appleby, 6/13).

The Associated Press: Minn. Health Insurance Call Center Opens In Sept.
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. MNsure's executive director, April Todd-Malmlov, updated board members on customer assistance plans for the exchange, where starting Oct. 1 about 1.3 million Minnesotans are expected to get their coverage, including 300,000 who don't currently have health insurance (Karnowski, 6/13).

Kaiser Health News: Capsules: Preparing For Flood Of Consumer Questions On Insurance Exchanges
On Oct. 1, individual consumers and small businesses will be able to enroll in the online health insurance marketplaces known as exchanges. Minnesota, where the state is running the exchange, and Florida, where the federal government will be in charge, are preparing in different ways. Under the Affordable Care Act, most Americans who don't already have health insurance through employers, Medicare or some other source are required to get it as of Jan. 1 or pay a fine. Subsidies will be available for people who earn up to 400 percent of the federal poverty level to buy insurance (Girshman, 6/13).

In other news related to health exchanges -

Health News Florida: Prepare For Launch Of 'Get Covered' Campaign
On June 22, consumer-health groups across the nation will launch what they hope will be a massive education and enrollment campaign to find uninsured people and get them ready to sign up for health coverage. The campaign will be called “Get Covered, America!” Its official launch is June 22 because that marks 100 days until the opening of state and federal online “marketplaces” where the uninsured can shop for coverage (Gentry, 6/13).

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Capitol Hill Watch

Immigrants' Health Care Costs Are Hot Topic On Capitol Hill

Other media reports detail Sen. Ron Wyden's proposal to allow accountable care organizations to focus on the sickest, most costly patients; questions from Rep. Darrell Issa, R.-Calif., about the navigator program's funding; and House Minority Leader Nancy Pelosi's, D-Calif., angry response to a reporter's question about late-term abortions.

Los Angeles Times: Boxer To Push Funding For Health Costs Of Uninsured Immigrants
Sen. Barbara Boxer plans to push for Washington to provide $250 million and perhaps more to help local and state governments pay the cost of healthcare to uninsured immigrants who seek legal status under legislation now before the Senate. Officials from Los Angeles County--home to an estimated 1.1 million people in the country illegally, one-tenth of the nation's total--have expressed concern that local taxpayers will be "left holding the bag" to pay for the healthcare costs (Simon, 6/13).

The Washington Post's Post Politics: House Democrat Says GOP 'Having A Relapse' On Immigration Reform
Gutierrez is part of a bipartisan House group that has been working privately on a comprehensive immigration reform bill, but the group has suffered delays and setbacks for months. Most recently, one of the original eight members, Rep. Raul Labrador (R-Idaho), dropped out of the coalition, citing a standoff over requirements related to health care for illegal immigrants (Nakamura, 6/13).

National Journal: Pelosi Lashes Out At Reporter's Question On Morality Of Late-Term Abortions
House Minority Leader Nancy Pelosi flashed unusual public anger and perhaps some confusion Thursday during a news conference when asked about the "moral difference" between late-term elective abortions and the infant deaths that led to murder convictions for Philadelphia abortion doctor Kermit Gosnell (House, 6/13).

The Hill: Issa: HHS Improperly Funding Part Of ObamaCare Implementation
Rep. Darrell Issa (R-Calif.) accused the Obama administration on Thursday of disobeying a ban on the use of certain funds to implement part of President Obama's healthcare law. Issa, the chairman of the Oversight and Government Reform Committee, said the Health and Human Services Department appears to have "intentionally circumvented an explicit federal funding ban in the interest of convenience and political expediency." He sought more information about how the HHS has funded a program to hire "navigators" to help people understand new coverage options under the healthcare law (Baker, 6/13).

The Hill: Wyden Calls For Changes In Key ObamaCare Program
Sen. Ron Wyden (D-Ore.) said Thursday that Congress needs to change a program in President Obama's healthcare law that aims to reduce healthcare costs and improve quality. ... He said Congress should remove a rule that requires ACOs to accept all patients who want to participate. The restriction was intended to prevent ACOs from cherry-picking healthy customers ... But Wyden said the requirement is having the opposite effect: barring doctors from creating ACOs that focus primarily on chronic conditions such as heart disease and diabetes (Baker, 6/13).

CQ HealthBeat: Save Medicare Through Tighter Focus On The Chronically Ill, Wyden Urges
Medicare's expanding effort to bring team-based care to seniors and the disabled is flawed because it prevents doctors from reaching out to treat the sickest, most costly patients and is limited to certain parts of the country, the senator next in line to chair the Senate Finance Committee said at a Washington, D.C., conference Thursday (Reichard, 6/13).

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Public Health & Education

In Unanimous Decision, Supreme Court Justices Rule Genes Can't Be Patented

The decision was applauded by many researchers and drew speculation that it could likely boost patient care. Meanwhile, the stock of Myriad Genetics tumbled after the court's finding invalidated the company's hold on testing for two breast cancer genes.

The Wall Street Journal: Justices Strike Down Gene Patents
The Supreme Court unanimously held Thursday that human genes cannot be patented, even when isolated from the body, a ruling expected to quickly expand access to genetic testing while potentially allowing inventors to retain rights to artificially created DNA. The decision marked the latest step in the court's decade long march to toughen the requirements for patents. The justices repeatedly have declared that 21st-century innovation depends less on locking up intellectual-property rights than on expanding access to discoveries in order to spur further progress (Bravin and Kendall, 6/13).

The New York Times: Justices, 9-0, Bar Patenting Human Genes
The decision is likely to reduce the cost of genetic testing for some health risks, and it may discourage investment in some forms of genetic research (Liptak, 6/13).

Los Angeles Times: Supreme Court Rejects Gene Patents
The Supreme Court ruled that human genes are a product of nature and cannot be patented and held for profit, a decision that medical experts said will lead to more genetic testing for cancers and other diseases and to lower costs for patients. In a unanimous ruling Thursday, the nine justices declared that human genes are not an invention, so they cannot be claimed as a type of private property (Savage, 6 14).

Politico: Supreme Court Rules Genes Can't Be Patented
The court did uphold patents for a type of synthetic DNA called complementary or cDNA, which is widely used in commercial biotechnology. Francis Collins, director of the National Institutes of Health, praised the opinion (Norman, 6/13).

The New York Times: After Patent Ruling, Availability Of Gene Tests Could Broaden
Almost immediately after the Supreme Court ruled that human genes could not be patented, several laboratories announced they, too, would begin offering genetic testing for breast cancer risk, making it likely that that test and others could become more affordable and more widely available. The ruling in effect ends a nearly two-decade monopoly by Myriad Genetics, the company at the center of the case (Pollack, 6/13).

Reuters: U.S. Top Court Bars Patents On Human Genes Unless Synthetic
A unanimous U.S. Supreme Court on Thursday prohibited patents on naturally occurring human genes but allowed legal protections on synthetically produced genetic material in a compromise ruling hailed as a partial victory for patients and the biotechnology industry. The ruling by the nine justices, the first of its kind for the top U.S. court, buttressed important patent protections relied upon by biotechnology companies while making it clear that genes extracted from the human body cannot be patented (Hurley, 6/14).

Boston Globe: No Patenting Of Genes, Justices Rule
The U.S. Supreme Court unanimously ruled Thursday that human genes are "a product of nature" and cannot be patented, a landmark decision that scientists said could remove impediments to research and enhance patients' ability to learn the disease risks that lurk in their DNA (Johnson and Weisman, 6/13).

CBS News: Supreme Court's Gene Patent Ruling Could Boost Patient Care, Experts Say
The Supreme Court's ruling that human genes cannot be patented has been met with excitement from doctors over the implications for patient health. Other experts, however, questioned whether there will be a widespread impact (Jaslow, 6/13).

Los Angeles Times: Supreme Court Ruling A Game Changer For Patients? Doctors Weigh In
The court's 9-0 decision in the case involving the Utah-based Myriad Genetics was welcome news to Grody as well as other doctors and genetic counselors concerned about future research and genetic counselors who said they've had their hands tied by the company's high prices and tough patent enforcement. "I'm very happy," said Raluca Kurz, a certified genetic counselor with Cedars-Sinai Medical Center. "I think we've all been waiting for this to happen for a long time" (Khan, 6/13).

Baltimore Sun: Ban On Patenting DNA Cheers Researchers
Researchers hailed the Supreme Court ruling Wednesday that bans the patenting of human DNA, saying it would expand access to genetic testing for disease at lower cost to patients. In a unanimous decision, the justices said Myriad Genetics did not have exclusive rights to the BRCA 1 and BRCA 2 genes that are linked to significantly greater risk for breast cancer and thus should not be the only company allowed to test for it. "Myriad did not create anything," Justice Clarence Thomas wrote for his fellow justices. "To be sure, it found an important and useful gene, but separating that gene from its surrounding genetic material is not an act of invention" (Marbella, 6/13).

WBUR: Here & Now: Reactions From Both Sides On Gene Patent Ruling (Audio)
The high court's unanimous judgment reverses three decades of patent awards by government officials. It throws out patents held by Salt Lake City-based Myriad Genetics Inc. on an increasingly popular breast cancer test brought into the public eye recently by actress Angelina Jolie's revelation that she had a double mastectomy because of one of the genes involved in this case (6/13).

Modern Healthcare: Myriad Stock Falls As Competitors Offer Lower Prices For Gene Testing
Just hours after the U.S. Supreme Court invalidated Myriad Genetics' monopoly on testing for two breast cancer genes, the company's stock went tumbling as competitors announced plans to offer the same services at lower prices (Carlson, 6/13).

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Women's Health

Complications Emerge To Administration's Plan B Proposal

NPR reports on Judge Edward Korman's response to the Obama administration's Plan B proposal while CNN Money explores how the "conscience clause" creates challenges for drugstores as they sell the morning-after pill over the counter.  

NPR: Judge Reluctantly Approves Government Plan For Morning-After Pill
An obviously unhappy Judge Edward Korman has approved the Obama administration's proposal to make just one formulation of the morning-after birth control pill available over the counter without age restrictions. But in a testily worded six-page memorandum, the federal district judge made it clear he is not particularly pleased with the outcome. He has been overseeing the case in one way or another for more than eight years (Rovner, 6/13).

CNN Money: Drugstores In A Pickle Over 'Conscience Clause' On Plan B
Pharmacists aren't required to sell the morning-after pill if they're morally opposed to it. But now that a leading form of emergency contraception is set to hit shelves as an over-the-counter drug, the question facing drugstores is whether they will extend the same choice to all its employees, including cashiers. For more than a decade, Plan B One-Step, the most common morning-after pill, has been kept behind pharmacy counters (Fox, 6/14).

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State Watch

Texas Scrambles To Find Money For Approved Health Care Projects

In Texas, revenue woes are hampering a series of health care experiments, including ones for its poor and uninsured. Federal approval for the projects came in May. In California, lawmakers get set to add some dental coverage for the state's poorest residents.

The Texas Tribune: Lack Of Revenue Limits Experimental Health Projects
Texas received federal approval in May to begin more than 1,100 experimental projects that could transform the way health care is delivered to the state's poor and uninsured. But there is a catch: To receive billions of dollars in federal financing, health care providers across 20 Texas regions must start the projects using local financing and meet some performance benchmarks (Aaronson, 6/14).

The Texas Tribune: Interactive: Financing Health Care Transformation Across Texas
This interactive shows the regional distribution of $3.2 billion for projects the federal government approved in May and the percent of each region that is uninsured. Underneath the map is a detailed description of the approved projects from the Health and Human Services Commission (Aaronson, 6/14).

California Healthline: Medi-Cal Dental Coverage Partially Restored
Legislative leaders and Gov. Jerry Brown (D) agreed on a budget plan this week that restores partial funding for dental services in Medi-Cal, California's Medicaid program. … Although not the complete restoration of $131 million sought, the state plans to spend about $16.9 million this fiscal year and $77 million next year on dental coverage. The money will provide preventive care, dental restorations and full dentures for adult beneficiaries of Medi-Cal (Edlin, 6/13).

But in North Carolina --

North Carolina Health News: Health Issues Absent From House Budget Debate
The House tentatively approved its biennial budget Wednesday afternoon after a marathon session. But health and human services were hardly mentioned throughout the seven-hour debate (Hoban, 6/13).

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State Highlights: Ga. Ponders Higher Health Plan Rates For Employees

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

Oregonian: Oregon's Home Health Care Industry Faces Major Federal Cuts; Access Cited
Home health care providers in Oregon and their allies say their industry is in a bind. The state's rural home health providers don't make as much as they should from serving Medicare patients, and the state's providers overall are slated for an even bigger hit next year, according to the industry's advocates and allies in Congress. Last week, Oregon's Congressional delegation signed a letter to Marilyn Tavenner, administrator of the Center for Medicare and Medicaid Services, asking her to adjust the 2013 reimbursement rates for the state's rural home health providers, saying unusually low wages at one rural hospital in Coos Bay had unfairly brought down the wage index used to set federal reimbursement the entire state's rural home health sector -- amounting to a six percent cut (Budnick, 6/13).

Richmond Times Dispatch: Northern Virginia Clinic Sues To Challenge Abortion Rules
A Northern Virginia health clinic has filed the first legal challenge to new state Board of Health regulations governing Virginia's first-trimester abortion facilities. The Falls Church Healthcare Center filed the lawsuit this week in Arlington County Circuit Court against the regulations -- passed by the Board of Health in April -- which reclassified Virginia’s 19 clinics as new hospitals and subjected them retroactively to building standards for new hospital construction (Nolan, 6/14).

Georgia Health News: Schools, Agencies To Pay Higher Health Plan Rates
Georgia officials are raising the employer contribution rates for school districts and state agencies to cover employees in the State Health Benefit Plan. Those employees also may face premium increases for 2014, though their rates won’t be announced until later this summer. This year, teachers, other school personnel, state employees and retirees in the state's benefit plan had an average increase in their health insurance premiums of 9.5 percent. In recent years, the SHBP has shrunk a deficit of more than $800 million. Part of the reduction has come from charging school systems more to cover their non-certificate personnel --  administrative assistants, custodians, bus drivers, cafeteria workers and the like (Miller, 6/13).

Lund Report: Billing, Provider Issues Top List Of Oregon Health Plan Complaints
Billing issues, provider rudeness and access to primary care -- particularly for people living with chronic pain -- top the list of complaints that Oregon Health Plan patients have with providers and the plan itself, said Ellen Pinney, patient ombudsperson for the Oregon Health Authority, at last week's meeting of Health Share of Oregon's community advisory council. During her discussion with the coordinated care organization's advisory body, Pinney stressed the importance of looking at all the feedback the plan gets from patients -- not just the formal complaints (McCurdy, 6/13).

San Francisco Chronicle: Home Care Worker Can Sue County For Pay
In a case that could affect many low-paid home-care workers in California, the state Supreme Court has left intact a ruling allowing a caretaker to sue Sonoma County after her disabled client failed to pay her. The county had appealed a lower court ruling in February that allows a jury to decide whether a county social services agency was the worker's "co-employer" and therefore responsible for unpaid wages. Statewide organizations of county governments and the state of California joined Sonoma in asking the court to review the case. The court unanimously denied review on Wednesday (Egelko, 6/13).

California Healthline: Yamada Takes A Lonely Stand On ADHC Bill
The Senate Committee on Health yesterday rejected a bill designed to perpetuate adult day health care services in one of the strangest votes in recent memory. The legislators on the committee voiced strong support for the bill and said they wanted to vote for it, but bill author Assembly member Mariko Yamada (D-Davis) adamantly refused to consider an amendment removing a restriction on for-profit adult day health businesses. After a long and awkward discussion of personal philosophy, the committee rejected the bill. It failed to garner a single vote. In fact, no actual vote was taken on AB 518 because no legislator would even move the bill (Gorn, 6/13). 

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Health Policy Research

Research Roundup: Studying States' Readiness For Insurance Exchanges

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

Health Affairs: Unauthorized Immigrants Spend Less Than Other Immigrants And US Natives On Health Care – Unauthorized immigrants' options for health care generally consist of hospital emergency rooms and community health centers. Using nationally representative survey data from 2000 to 2009, researchers compared medical spending for unauthorized immigrants, legal residents, naturalized citizens, and natives of the United States and found that "unauthorized immigrants have lower health care spending overall but higher rates of receiving uncompensated care than legal immigrants and US natives."  They note: "Just 7.9 percent of unauthorized immigrants benefited from public-sector health care expenditures (receiving an average of $140 per person per year), compared to 30.1 percent of US natives (who received an average of $1,385). Policy solutions could include extending coverage to unauthorized immigrants for the prevention and treatment of infectious diseases or granting them access to the Affordable Care Act’s insurance marketplaces, which start in 2014" (Stimpson, Wilson and Su, 6/12).

The Dartmouth Atlas Project: Tracking Improvement In The Care Of Chronically Ill Patients: A Dartmouth Atlas Brief On Medicare Beneficiaries Near The End Of Life – According to the authors, the quality and efficiency of care given to patients during the last six months of life improved from 2007 to 2010. "Overall, patients spent fewer days in the hospital and more received hospice services in 2010 compared to 2007," they report, adding the "changes reflect the preferences of most patients to spend their last weeks and months in a home-life environment whenever possible, avoiding procedures that have little chance of improving the quality or length of their lives. But the pace of change varied across hospitals, with some experiencing rapid change while other health systems showed little improvement." They conclude: "Less intensive and expensive care can both save money and improve quality, satisfaction, and outcomes for many Medicare beneficiaries" (Goodman et al., 6/12).

Centers For Studying Health System Change/California HealthCare Foundation: Ready Or Not: Are Health Care Safety-Net Systems Prepared For Reform? – When it comes to implementing the Affordable Care Act, safety-net providers – public hospitals and community health centers – are falling behind, according to the authors: "Almost all safety-net providers in the study reported concerns about sufficient funding and workforce to care for newly insured people and for those who remain uninsured." They add that "at the same time, these safety-net providers are bracing for potential competition for insured patients from other providers and a consequence reduction in revenue." They studied six California communities in 2011 and 2012. "The findings ... indicate that community activities to prepare for health care reform can help mitigate the stress on the health care system to enroll and care for people come 2014," they conclude (Felland and Cross, 6/12).

Centers For Studying Health System Change/Robert Wood Johnson Foundation: Denver: Competitive Insurance Market Awaits National Health Reform – The authors note that Colorado is a leader compared to other states in preparing for the health law's insurance marketplaces. Based on interviews, they write that "Denver-area health plan executives, benefits consultants, brokers and others expressed concerns about the market’s readiness for open enrollment in the exchange on Oct. 1. Top concerns include the uncertainty about the impact of health reform on risk selection and premium costs." Respondents expected "most of the major Denver carriers –Anthem, United and Kaiser – to participate in the exchange," the authors write and also highlight other top concerns including uncertainties in setting premiums and possible rate shock (Felland, Carrier, Lechner and Gourevitch, 6/13).

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Weekend Reading

Weekend Reading: Seeking Better Health Outcomes For Homeless People; What Becomes Of The Women Denied Abortions?

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Nation: Revealed: Letters From Republicans Seeking Obamacare Money
Even before President Obama signed the Affordable Care Act into law, Republicans were vowing to repeal it. It's no wonder, because polls showed that the basic elements of the ACA were quite popular, and there was a real danger that it would become more so as people found out that the plan denounced as a "monstrosity" by the National Republican Senatorial Committee would not trample on their liberties so much as help protect their health. ... Now letters produced by a Freedom of Information Act request reveal that many of these same anti-Obamacare Republicans have solicited grants from the very program they claim to despise (Lee Fang, 6/5).

Forbes: Why Conservatives Shouldn't Cheer The Cadillac Tax (And Neither Should Anyone Else)
Jonathan Cohn would like you to believe that conservatives are so irrational in their hatred of Obamacare that they even despise parts of the law that should make them cheer, such as the Cadillac tax on high cost health plans. Mr. Cohn is correct in asserting that “writers like James Capretta and Robert Moffit have long called for reducing or eliminating the tax breaks for employer sponsored insurance.” But there’s a world of difference between how conservatives would cap or eliminate the current employer tax exclusion and the Cadillac tax (Chris Conover, 6/5).

The New York Times Magazine: What Happens To Women Who Are Denied Abortions?
S. arrived alone at a Planned Parenthood in Richmond, Calif., four days before Christmas. As she filled out her paperwork, she looked at the women around her. Nearly all had someone with them; S. wondered if they also felt terrible about themselves or if having someone along made things easier. … When Diana Greene Foster, a demographer and an associate professor of obstetrics and gynecology at the University of California, San Francisco, first began studying women who were turned away from abortion clinics, she was struck by how little data there were. A few clinics kept records, but no one had compiled them nationally. And there was no research on how these women fared over time (Joshua Lang, 6/12).

The Atlantic: When People Seem To Want To Be Sick
Münchausen syndrome is sometimes referred to as "hospital addiction syndrome" or "thick chart syndrome," because patients present again and again to physicians' offices and hospitals. ... We usually suppose that no one would ever want to be sick, but this is clearly not the case. Some patients with Münchausen syndrome fake laboratory test results by contaminating blood and urine samples, and others are so desperate that they will actually inject themselves with urine or feces in order to make themselves sick. Such extraordinary acts remind us that the role of patient offers many rewards in addition to attention, including relaxed responsibilities in work and family life, and for some, perverse enjoyment at fooling others (Dr. Richard Gunderman, 6/11).

Los Angeles Times: Experts Seek Better Health Outcomes For Homeless
Years after facing patient dumping allegations and hefty legal settlements, Southern California hospital executives have begun working with advocates for the homeless to improve the health of homeless patients and to reduce their use of area hospitals. Hospital administrators are driven by the national healthcare law, which offers incentives to provide better care at lower cost and imposes penalties when patients are unnecessarily readmitted to hospitals. Homeless patients are among the most frequent users of the region's medical centers, often because they lack regular medical care (Anna Gorman, 6/10).

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Editorials and Opinions

Supreme Court DNA Ruling Leaves Questions Unanswered

Editorial boards weigh in on what Thursday's Supreme Court ruling means for medical research and for the medical industry.

Boston Globe: Ruling Against Gene Patents Is Victory For Open Research
In its unanimous ruling Thursday that human genes cannot be patented, the US Supreme Court removed a worrisome source of uncertainty hanging over the biotechnology industry. ... The landmark ruling frees up endless amounts of genetic material for the free use of science. It sets a significant precedent that will ultimately benefit researchers, business, consumers, and, most importantly, patients (6/14).

The Washington Post: After DNA Patent Ruling, Encouraging Genetic Research
No, a unanimous Supreme Court ruled Thursday, genes cannot be patented, no matter how much effort a company expends in finding them. It is the right call but can’t be the last word. ... Congress should examine whether government-funded research and persisting market opportunities are enough to motivate genetic research, or whether it should offer more narrowly drawn patents, prize money or other new incentives for companies to continue sorting through the genome (6/13).

The Wall Street Journal: Supreme Gene Splitting 
"Groundbreaking, innovative, or even brilliant discovery does not by itself satisfy" the requirements of patent law, Justice Clarence Thomas wrote. Patenting the natural elements which are the "basic tools of scientific and technological work" could "'tie up' the use of such tools and thereby 'inhibit future innovation premised upon them.'" This kind of patent on the natural building block of life would have inhibited both research and investment (6/13).

The New York Times: Clarity On Patenting Nature 
The price of Myriad’s stock went up 10 percent in early trading after the court’s decision, an indication that Myriad is benefiting from its investment even as the court, properly, has safeguarded the ability of other researchers to work with the genes (6/13).

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Viewpoints: Good News From Medicare Trustees; Medicaid No 'Cure-All' For Access To Care

A selection of editorials and opinions on health care from around the country.

The Washington Post: Medicare Policy Should Balance Cuts With Quality Care
The 2013 Medicare Trustees Report had some good news. Costs per beneficiary grew just 0.7 percent in 2012, down from a 5.4 percent annual average since 1990. This is the third year of slow growth, and if the trend continues, our national finances will dramatically improve. But the reasons for the slow growth are uncertain, and the trustees left their projection of annual future growth in costs per beneficiary unchanged at 4.3 percent. And that is the optimistic scenario: For the fourth straight year, the report included an appendix, prepared by Medicare's staff, that outlines alternative projections in which costs grow faster (Bryan R. Lawrence, 6/13). 

The Washington Post: Expanding Medicaid Coverage Is Not A Cure-All
The debate over "Obamacare" has focused largely on the number of uninsured Americans and how the regulations will be implemented. Not enough attention is being paid to the difficulties our health-care system imposes on those with Medicaid insurance, which is being extended to millions who lack coverage. Frequently, people blame patients for using emergency departments "inappropriately." But some Medicaid patients do everything they can to see a doctor, to no avail, and must resort to emergency department visits. My own experience has been instructive (Roberta Capp, 6/13). 

The Wall Street Journal: Rebooting The Budget Talks
That neglect has been a gift to Democrats, allowing them to talk only within the coming 10-year budget window—the period before entitlement programs go nuclear. The White House gets to claim it is committed to preserving Social Security and Medicare, as the president offers token adjustments to make the programs look better in the near-term. To this day, Mr. Obama insists we need a mere $1.5 trillion more in deficit reduction (for a supposed grand total of $4 trillion) to make everything hunky-dory (Kimberley A. Strassel, 6/13).

MinnPost: Rape, Pregnancy, Statistics And The Ignorance Of Some Politicians
Here we go again with the whack-a-mole idea that rape rarely results in pregnancy. This time, however, I’m not sure if the politician who’s promulgating that bogus idea is actually ignorant about rape and female biology or is simply using statistical language to be misleading (Perry, 6/13).

Los Angeles Times: New Abortion Rules Assume Women Are Really Stupid
The House Judiciary Committee, dominated by Republican men who still have not learned to avoid the subject of rape and pregnancy, took up the issue of abortion this week. Normally, the news about abortion focuses on the machinations of conservative state legislatures, which have spent tremendous time and energy, often with great success, chipping away at women’s constitutional right to end a pregnancy (Robin Abcarian, 6/13).

The New York Times: Keep The Women’s Rights Bill Intact
State Senate leaders, for example, are trying to remove crucial sections of the bill that would ensure abortion rights in New York even if the United States Supreme Court erodes or overturns those protections in Roe v. Wade. It’s particularly distressing that Senator Diane Savino, who has been an abortion rights proponent and is part of a breakaway group of Democrats in the Senate, has said it’s time to set aside the abortion issue for now and pass the rest of the bill. There are others in the Senate and Assembly who are trying to weaken protections, including those for young victims of sex trafficking (6/13).

Los Angeles Times: A Restrained California State Budget
Notably, it also would expand Medi-Cal (the state's health insurance program for low-income Californians) to the maximum extent allowed by the 2010 federal healthcare law, bringing coverage to millions of the working poor. That step comes with some financial risk — the state will eventually be responsible for 10 percent of the medical costs of the newly eligible, with federal taxpayers picking up the rest of the tab. But it is the right thing to do not just morally but also for public health and the economy over the long term (6/13).

USA Today: Six Months After Newtown, Focus On Mental Health: Column
What haunts me the most is to think that in those few awful moments on Dec. 14 before her gruesome and untimely death, Mary might have recognized her assassin. He did, after all, go to Sandy Hook Elementary during her tenure there. Given published information it seems highly probable that he would have been identified as needing assistance. What might have flashed through her mind in that moment? Could more have been done to help him and his family? Was he beyond help? Was it offered and refused? Was assistance offered at an early enough age? (Bill Sherlach, 6/14). 

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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