Daily Health Policy Report

Monday, June 18, 2012

Last updated: Mon, Jun 18

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Medicare

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Uninsured And Unaware Of Supreme Court Case Against Health Law

Reporting for Kaiser Health News, and working in collaboration with The Tennessean and The New Republic, Alec MacGillis writes: "As Robin Layman, a mother of two who has major health troubles but no insurance, arrived at a free clinic here, she had a big personal stake in the Supreme Court's imminent decision on the new national health care law. Not that she realized that. 'What new law?' she said. 'I've not heard anything about that'" (MacGillis, 6/17). Read the story.

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Uncertainty Over Law Casts Shadow Over Health Care Innovations

Kaiser Health News staff writer Jordan Rau, working in collaboration with The Washington Post, reports: "The health care law placed the force and money of the federal government behind a decade's worth of ideas on how to improve patient care and change the ways doctors and hospitals function. While this part of the health care law is at the periphery of the Supreme Court challenge, these changes could be halted if the court throws out the entire law, and some experts say they might be hobbled even if the justices excise just parts of the Affordable Care Act" (Rau, 6/17). Read the story.

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California Bullish On Health Exchange – No Matter What

Capital Public Radio's Pauline Bartolone, working in partnership with Kaiser Health News  and NPR, reports: "Many states have done nothing to implement the health overhaul law, saying they'll wait and see how the Supreme Court rules. Not California. The country's most populous state got out in front first on implementing the law, and it hasn't slowed down in recent weeks as the rest of the country waits to hear from the High Court" (Bartolone, 6/15). Read the story.

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Different Takes: A Status Check On State-Based Exchanges

Kaiser Health News recently checked in with three states actively pursuing a state-based exchange. Commentaries follow from Rhode Island, Utah and Maryland. A common theme emerged: No matter how the court rules, change is not going to stop. Read commentaries from Christopher F. Koller, Rhode Island's health insurance commissioner; Patty Conner, Utah's exchange director; and Maryland Lt. Gov. Anthony G. Brown.

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Political Cartoon: 'By The Book?'

Kaiser Health News provides a fresh take on health policy developments with "By The Book?" by Monte Wolverton.

Meanwhile, here's today's health policy haiku:

COULD A JUSTICE HAVE SAID THIS?

Answers? What are those?
All we have to offer you
is an opinion.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

High Court Uncertainty Raises Stakes In Health Law Guessing Game

News outlets offer scene setters exploring the dynamics at play at the high court and the importance of the pending ruling on the constitutionality of the health law. They also look at how the decision will impact different parts of the health care sector, ranging from safety-net providers and investors to patient safety advocates and employers.

The Associated Press: Possible Outcomes In Pending Health Care Law Case
Some are already anticipating the Supreme Court's ruling on President Barack Obama's health care law as the "decision of the century." But the justices are unlikely to have the last word on America's tangled efforts to address health care woes. The problems of high medical costs, widespread waste, and tens of millions of people without insurance will require Congress and the president to keep looking for answers, whether or not the Affordable Care Act passes the test of constitutionality (Sherman and Alonso-Zaldivar, 6/18).

Bloomberg: Health-Care Ruling Cloaked in Court Secrecy Spurs Guessing Game
In the next two weeks, John Roberts will sit in his high-backed, black leather chair in the U.S. Supreme Court’s marble courtroom and tell a hushed crowd that the justices are about to rule on health care. It will be the most dramatic moment in Roberts's seven years as chief justice and one of the biggest for Barack Obama as president. The country will learn the fate of the law that has largely defined Obama’s presidency, a measure approved on a party-line vote in Congress with a promise to provide health insurance to almost every American while overhauling an industry that makes up about 18 percent of the economy (Stohr, 6/18).

CNN (Video): Looming Health Care Ruling Will Be Among Supreme Court's Most Important
Winners and losers are the natural consequence of the American legal system. In the Supreme Court, five majority votes among the nine members are enough to fundamentally change lives and legacies. The high court in coming days will issue rulings in perhaps its most important appeal in a dozen years: whether the sweeping health care law championed by President Barack Obama will be tossed out as an unconstitutional exercise of congressional authority. The stakes cannot be overstated -- what the justices decide on a quartet of separate questions will have immediate and long-term impact on every American, not only in the field of medicine but in vast, untold areas of "commerce." Health care expenditures alone currently make up 18% of the U.S. economy, and the new law promises to significantly expand that share (Mears, 6/18).

Kaiser Health News: Uncertainty Over Law Casts Shadow Over Health Care Innovations
The health care law placed the force and money of the federal government behind a decade's worth of ideas on how to improve patient care and change the ways doctors and hospitals function. While this part of the health care law is at the periphery of the Supreme Court challenge, these changes could be halted if the court throws out the entire law, and some experts say they might be hobbled even if the justices excise just parts of the Affordable Care Act (Rau, 6/17).

Market Watch: Health-Care Stocks Facing A Judgment Day
For the last 27 months, the health-care industry has been operating under the assumption that everyone has to get insurance, and insurers have to accept everyone who wants it. That all could be undone as early as Monday, when Supreme Court is expected to issue its rulings on the 2010 health-care overhaul measure. If the justices overturn any part of the law, expect significant portions of the health-care sector to be upended (Britt, 6/15).

Richmond Times-Dispatch: Health Care Reform Uncertainty Has Safety-Net Providers In Limbo
The court's decision could be a game changer for such organizations as Access Now, and the local free clinics, community health centers and private providers that make up a health care safety net, providing health care to patients who otherwise might go without. "If all the Obamacare goes through and everything's constitutional, and we go ahead, probably 50 to 60 percent of our patients are going to qualify for Medicaid," said Connie Moslow, executive director of the Free Clinic of Powhatan. "Now, does that mean they are going to take it? It puts the free clinics in kind of a precarious situation also, because our thing is we provide health care to the uninsured," she said. "How do we adjust" (Smith, 6/17)?

ProPublica: Could The Supreme Court's Health Care Ruling Kill Patient Safety Reforms?
In all the talk about the Supreme Court’s impending health care reform ruling, one question is often overlooked: What might happen to the many patient safety and quality of care provisions sprinkled through the Affordable Care Act? They include a new Center for Quality Improvement and Patient Safety, more reporting of infections, injuries and mistakes in hospitals, and incentives for doctors and other providers to improve the care they provide. Those among the nation’s 50 million uninsured who manage to get health coverage will also get better medical care than piecemeal or nonexistent version they now receive. We’ve been talking about quality of care on Facebook with more than 700 users who’ve joined our discussion group on patient safety. The Supreme Court could uphold the entire health care law or kill it, extinguishing its quality initiatives. Or the court could strike down the mandate to buy insurance alone — a possibility that has long-time SCOTUS watchers on the edge of their seats. What then happens to the rest of the law no one really knows (Pierce and Allen, 6/15).

CNN Money: For 20-Somethings, Health Care Hangs In The Balance
Millions of young adults have turned to their parents' health insurance plans since the Affordable Care Act went into effect. For Liz Wilson, and many others her age, it was the only option …The legal dispute is centered around the individual mandate provision, which requires most Americans to buy health insurance or face financial penalty. While the mandate is separate from the provision that protects young adults, the court could strike down the entire legislation. This could leave millions of young adults uninsured. About 2.5 million 19-to-26-year-olds obtained health coverage as a result of the provision, the U.S. Department of Health and Human Services estimated in December. Most have had a hard time getting employer-sponsored coverage in a down economy (Fox, 6/16).

Fox Business: Employers Still Plan To Provide Health Coverage In 2014
The Supreme Court is expected to issue its ruling on the constitutionality of President Obama’s health-care overhaul by the end of the month--forcing many corporations to stay in a holding pattern as they await the fate of their health plans. However, according to a new study by the International Foundation of Employee Benefit Plans, the majority of employers do not plan to change their health-care plans by 2014--even though they are bracing for added costs. According to the 2012 Employer Action Survey,  86.4% of employers do not anticipate making any changes in their employee’s health insurance offerings (Tuggle, 6/15).

The Hill: Supreme Court Police Prepared For Ruling On Health Care Reform Law
The Supreme Court is prepared to handle any protests that arise after the decision on President Obama’s healthcare law. Court Public Information Officer Kathleen Arberg would not comment on how many threats the court received during oral arguments in the politically charged case, but said Supreme Court police are prepared to maintain security after the opinion is delivered (Siegelbaum, 6/18).

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Party Leaders Stake Out Positions For The Health Law's Future

If the measure survives the Supreme Court review, GOP leaders say they will seek quick repeal -- but not until after the fall elections. Meanwhile, House Minority Leader Nancy Pelosi, D-Calif., says the overhaul is constitutionally "ironclad."

The Associated Press: GOP On Health Care: No Quick Replacement
Congressional Republicans intend to seek quick repeal of any parts of the health care law that survive a widely anticipated Supreme Court ruling, but don't plan to push replacement measures until after the fall elections or perhaps 2013. Instead, GOP lawmakers cite recent announcements that some insurance companies will retain a few of the law's higher-profile provisions as evidence that quick legislative action is not essential. Those are steps that officials say Republicans quietly urged in private conversations with the industry (Espo, 6/18).

National Journal: Both Parties Lack A Clear Path Forward On Health Care
Even with no shortage of debate over the merits and flaws of President Obama's health care reform law, two influential lawmakers on both sides of the aisle made it clear on Sunday that neither party has a plan if the law is thrown out. Republican Sen. John Barrasso of Wyoming and Democratic Rep. Chris Van Hollen of Maryland faced off on CNN's State of the Union on Sunday, offering party-line arguments in opposition to or defense of the law, which currently awaits a Supreme Court decision on its constitutionality. ... but when asked what plan B was, if the Supreme Court throws out the law, neither offered a clear path forward (Jaffe, 6/17).

Roll Call: Barrasso: GOP Will Target Health Care Law In Wake Of Court Ruling
If the Supreme Court strikes down part of the health care law, Congressional Republicans will try to repeal the rest of the statute and to pass a more limited alternative, Sen. John Barrasso (R-Wyo.) said today. ... Van Hollen repeatedly asserted that the Patient Protection and Affordable Care Act was the Democrats' plan and that Republicans have done nothing but promise to repeal any remaining provisions and leave nothing in its place if the law is invalidated (Becker, 6/17).

National Journal: Pelosi: Health Care Law Constitutionally 'Ironclad'
The Supreme Court has yet to decide whether the 2010 health care law is constitutional, but House Minority Leader Nancy Pelosi says the law is "ironclad." In an appearance on CBS’ This Morning on Friday, Pelosi said "I think we're ironclad on the Constitutionality of the bill” and reiterated her prediction of a 6-3 favorable decision. Still, she says Democrats are girding themselves for a negative ruling. "We'll be prepared for any eventuality," she said (Miller, 6/15).

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As Nation Awaits The High Court's Decision, Health Issues Grab Some Voters' Attention

The National Journal reports that health policies have become voters' number 2 concern -- edged out only by the economy. On the ground in Tennessee, though, many people who don't have insurance and were seeking care at a free clinic were not aware of of how what they had at stake in the law's future.    

National Journal: Voters Care More About Health Care In This Election—Sort Of
For the first time in a long time, health care has rocketed to the top of voters' big issues in the presidential election. With the future of health care reform in the balance, several recent surveys have put health care as the No. 2 concern after the economy, a position it has rarely enjoyed in recent elections. ...  In this election, health has become something of a proxy issue for voters' larger views about the appropriate role of the federal government. For opponents, it's a symbol of government overreach; for supporters, it's a sign of how government can help solve people's problems. Those preferences better reflect voters' partisan preferences than they do their actual experiences with the health care system (Sanger-Katz, 6/16).

Kaiser Health News: Uninsured And Unaware Of Supreme Court Case Against Health Law
As Robin Layman, a mother of two who has major health troubles but no insurance, arrived at a free clinic here, she had a big personal stake in the Supreme Court's imminent decision on the new national health care law. Not that she realized that. "What new law?" she said. "I've not heard anything about that" (MacGillis, 6/17). 

Meanwhile, the media is watching, waiting and preparing for the decision. 

Politico: Media Preps For Health Care Ruling
If you thought the Supreme Court's recent hearings on President Barack Obama's health care plan drew a lot of media coverage, just wait for the ruling. With the high court set to hand down its opinion on the Affordable Care Act some time before the end of the month, the major television networks and news outlets are standing by on call, ready to dispatch teams of reporters, analysts, and cameras to the courthouse to air special reports on what could be a landmark decision with major implications for the presidential contest (Byers, 6/18).

Politico: Bloggers Fret Over SCOTUS, Kennedy
Many anxious conservative activists gathered at the annual RightOnline bloggers conference this weekend expressed fear that the Supreme Court is going to uphold President Barack Obama's health care plan -- and some worried that Justice Anthony Kennedy will provide the swing vote to do so (Mak, 6/17).

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Key Health Law Official Leaving Post For UnitedHealth VP Job

Steve Larsen, director of the federal Center for Consumer Information and Insurance Oversight, is leaving his post to join UnitedHealth as an executive vice president, sparking speculation on the move.

Politico: HHS Insurance Official Exits Over Personal Issue
From the outside, the timing of the announcement that Department of Health and Human Services' top insurance regulator is leaving for a job with UnitedHealthcare couldn't have looked any worse. But health care experts from both parties who know the department's inner workings are convinced that concerns about education, not health care, prompted the departure of Center for Consumer Information and Insurance Oversight Director Steve Larsen (Feder, 6/17).

Bloomberg: U.S. Health Insurance Regulator to Leave Oversight Job
Steve Larsen, the government administrator directing enactment of U.S. insurance regulations created by the 2010 health care overhaul, said he is leaving to take a job with UnitedHealth Group Inc. (UNH) Larsen will resign as head of the Center for Consumer Information and Insurance Oversight in July to become an executive vice president at UnitedHealth’s Optum unit, he said in an e-mail. Larsen worked for Amerigroup Corp. (AGP), a Virginia Beach, Virginia-based insurer specializing in Medicaid plans, before joining the Department of Health and Human Services in 2010 and had served as Maryland’s insurance commissioner (Wayne, 6/15).

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Campaign 2012

Romney Lining Up With Ryan's Medicare Plan As His Health Law Assertions Are Tested

Presumptive GOP presidential nominee Mitt Romney is aligning himself with Rep. Paul Ryan's plan to slow the grow of Medicare. In the meantime, The Washington Post assesses Romney's assertions on Democrats' health care law.

The Wall Street Journal: Romney Embraces Hill GOP
The moves by Mr. Romney defy fears among some conservatives that he would tack to the center after clinching enough delegates for the Republican presidential nomination. Instead, Mr. Romney is identifying himself with Mr. Ryan's plans to rein in the size and scope of government -- and he appears to be shrugging off the political risks of embracing its measures to curb the growth of Medicare and other safety-net programs (Hook, 6/17).

The Washington Post’s Fact Checker: Does Romney's Assessment Of The Economic Impact Of Obama's Health Care Law Hold Up?
FactCheck.org then weighed in when Romney had tweaked the language somewhat, but it also found it wanting, saying it was "a pure partisan fantasy" and "patently false and misleading." With such harsh reviews, one would think that Romney might drop the assertion from his speeches. But now, a new iteration has appeared, so we will examine it (Kessler, 6/16).

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Medicare

MedPAC Urges Changes In Medicare Beneficiaries' Co-Pays, But Would Cap Other Costs

The MedPAC recommendations to restructure what they call an outdated system, will be the subject of a congressional hearing Tuesday.

Reuters: U.S. Agency Urges New Charge For Medicare Patients
A congressional agency on Friday recommended making traditional Medicare beneficiaries pay more money upfront for medical services as a way to insulate the popular government program from ever-rising healthcare costs. A report by the nonpartisan Medicare Payment Advisory Commission, or Medpac, recommended a new 20 percent charge for the 90 percent of Medicare beneficiaries who buy supplemental insurance to cover medical costs that Medicare Part A and Part B do not cover (Morgan, 6/15).

Politico Pro: MedPAC: Medicare Benefits Are Out Of Date
The Medicare Payment Advisory Commission wants Congress to give federal health officials a freer hand to overhaul parts of the Medicare benefit. Some of those changes, outlined in its June report, include caps on out-of-pocket expenses, changes to the deductibles for hospital and physician services, additional charges for supplemental Medigap coverage and replacing coinsurance with co-payments. The suggestions will get a deeper airing at a Tuesday hearing of the House Ways and Means health subcommittee (DoBias, 6/15).

CQ HealthBeat: MedPAC Sketches Out Plan To Discourage Medigap Plan Use
Medicare beneficiaries would get a cap on out-of-pocket spending and supplemental insurance plans would face an additional charge under recommendations included in the June report to Congress by the Medicare Payment Advisory Commission. About 90 percent of seniors currently buy supplemental plans such as Medigap but would be less likely to do so if Congress adopted the proposal. The recommendation also suggests that Congress should replace the current coinsurance — which is a percentage of a beneficiary's medical costs — with fixed-dollar copayments (Adams, 6/15).

Modern Healthcare: MedPAC Urges Changes For Beneficiaries
Centered primarily on the role of the beneficiary, the Medicare Payment Advisory Commission's latest report to Congress recommends the HHS secretary develop a Medicare fee-for-service benefit design that includes a host of changes including an out-of-pocket maximum, deductibles for Parts A and B and an additional charge on supplemental insurance (Zigmond, 6/15).

Medpage Today: MedPAC Proposes Payment Change
Congress should pass a bill that would restructure the "outdated" fee-for-service payment mechanism, the nonpartisan MedPAC recommended. MedPAC's plan would charge an additional fee for the 90% of Medicare beneficiaries who have fee-for-service supplemental insurance. Under the plan, beneficiaries would have to pay 20% of the supplemental policy's premium to Medicare. In its report released Friday, MedPAC offered a number of other recommendations aimed at improving Medicare's fee-for-service model, which has remained essentially unchanged since the creation of the program in 1965 (Walker, 6/16).

The report also drew criticism from some groups.

Modern Healthcare: MedPAC Report Riles Rural Health Groups
The National Rural Health Association and the Medicare Dependent Rural Hospital Coalition, an informal collaboration of hospitals with Medicare-dependent hospital status, strongly dispute a new report from the Medicare Payment Advisory Commission, which suggests that certain Medicare rural hospital special payments may be too high or unnecessary. MedPAC found little difference in healthcare use between rural and urban beneficiaries, similar access and quality for the most part and questioned the need for extra payments (Barr, 6/15).

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AMA Committee Fails To Find Consensus On Proposed Changes To Medicare

At the annual AMA House of Delegates meeting in Chicago, there was no agreement on whether the doctors' group should endorse a premium-support apporach to Medicare.

Modern Healthcare: At AMA Meeting, No Consensus On Premium-Support Issue
After an hour of debate on the subject of whether the American Medical Association should endorse transitioning Medicare to a premium-support system, there were plenty of witty lines, heartfelt pleadings, historical points of reference and dueling points of view from two former AMA presidents—but no consensus on the issue.  ... The issue will be brought up again for a vote by the entire house sometime before the meeting concludes on Wednesday (Robeznieks, 6/15).

Chicago Tribune: AMA Wants Higher Medicare Payments
Days before the U.S. Supreme Court is expected to rule on the constitutionality of the biggest overhaul of federal health care law in five decades, the nation's most powerful group of physicians said Saturday it may push for major changes — should the reforms land again in the hands of Congress (Frost, 6/17).

MedPage Today: AMA Makes Small Gain In Membership
[The AMA] added 1,636 new members to its ranks in 2011, ending a 2 year hemorrhage of members following the group's support of President Obama's healthcare reform. Unknown, however, is how many of those new members are practicing physicians, who pay $420 to join the AMA, and how many are students, who pay just $20. ... The gain in members, a growth of less than 1%, brings the AMA's membership to 217,490, a number that supports the group's claim to be medicine's "big tent" (Walker, 6/17).

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Health Care Marketplace

Health Care Spending Slowdown May Not Last As Economy Heats Back Up

The Associated Press reports that, although health care spending may have slowed, the trend may not last long. In the meantime, The Arizona Republic reports on a website that allows consumers to shop for discounted medical services.

The Associated Press: A Welcome Let-Up In Health Costs That May Not Last
Health care spending has eased up recently, a welcome respite for government and corporate budgets. But why has it? And will relief last or are medical costs on a roller coaster, like gas prices? One explanation for the slowdown says it's a temporary consequence of the recession and an economy that can't seem to hit its stride. A more hopeful view says American medicine is moving from disjointed solo practice to teamwork models aimed at keeping patients healthier, and that's a permanent change (Alonso-Zaldivar, 6/18).

Arizona Republic: Auction Website Lets Patients Suggest Prices
[BidOnHealth.com] allows consumers to shop for discounted rates for routine blood tests or medical-imaging services such as MRIs and CT scans. The site is geared toward people who do not have health insurance or have high-deductible insurance plans that require they spend $1,000 to $10,000 before substantial coverage kicks in. BidOnHealth allows consumers either to accept its discounted price or name their own price for a lab test or a diagnostic image (Alltucker, 6/16).

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State Watch

States Grappling With Medicaid Uncertainty, Costs, Decisions

Some states are preparing for the health law's 2014 Medicaid expansion.

Stateline:  States Push To Contain Health Costs
States spent a nervous spring this year wondering how the Supreme Court would rule on the Affordable Care Act. They are still wondering. But despite the uncertainty, they managed to write a good deal of health legislation, especially when it came to Medicaid. ... Some continued the pattern of Medicaid spending reductions that marked the past few years, while others were in a mood to restore earlier cuts they had made. Some even expanded coverage. Overall, the health care budget picture in the states is brighter than it has been in a while (Vestal, 6/15).

Market Watch: Aetna Calls For Ohio Medicaid Contract Renewal
Aetna Inc. is protesting an Ohio agency for the cancellation of its Medicaid health plan contract, saying undisclosed communication with other bidders swayed the state's decision to drop the insurer. Aetna argues that the Ohio Department of Job and Family Service retrospectively changed its initial requirements, resulting in its decision to drop the insurer from its list of five Medicaid health plans that will serve the state starting Jan. 1 (Stilwell, 6/15).

Richmond Times-Dispatch: Medicaid Decision Looms For Va. In Health Care Debate
With an estimated 1 million Virginians uninsured, the Patient Protection and Affordable Care Act would make up to 425,000 people in the state eligible for Medicaid health coverage beginning on Jan. 1, 2014. As the U.S. Supreme Court nears a decision, ... Virginia is preparing for an outcome that would leave most of the act intact, even if the "individual mandate," requiring that almost all Americans have insurance, is overturned (Martz, 6/17).

Minneapolis Star Tribune: On Trial: Minnesota Medicaid
It began with a $30 million "voluntary contribution" to Minnesota taxpayers from one of the state's nonprofit Medicaid contractors, an unprecedented act of corporate generosity that raised eyebrows from St. Paul to Washington. ... Whether any of that amounted to fraud is now the focus of at least three federal probes, two by congressional Republicans and one by the Justice Department. Officials in the Dayton and Pawlenty administrations say they have done nothing wrong. Industry executives likewise deny that the health plans are overpaid (Diaz, 6/16).

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In Calif. And Mass., Reforms Proceeding Even As Court Causes Uncertainty

News reports offer updates on California's health exchange as well as the important signal sent by Massachusetts' major health insurers.

Kaiser Health News: California Bullish On Health Exchange -- No Matter What
Many states have done nothing to implement the health overhaul law, saying they'll wait and see how the Supreme Court rules. Not California. The country's most populous state got out in front first on implementing the law, and it hasn't slowed down in recent weeks as the rest of the country waits to hear from the High Court (Bartolone, 6/15). 

California Healthline: Study Estimates High Enrollment For Exchange
As many as 2.1 million Californians will get subsidized health insurance coverage through the state's new Health Benefit Exchange by 2019, according to a study released yesterday by the UC-Berkeley Labor Center and UCLA Center for Health Policy Research. Another 1.1 million from the unsubsidized individual health insurance market are expected to join the exchange as well, said UCLA researcher Dylan Roby. That would bring the estimated total to about 3.2 million. Yesterday's study concluded that the high enrollment rate is dependent, in part, on how effectively the exchange markets itself, Roby said (Gorn, 6/15).

San Jose Mercury: Medical Community Focused On Fate Of Health Reform
If the Supreme Court strikes down health care reform Monday, "there is no contingency plan," said the top U.S. Department of Health and Human Services administrator for California, as the San Bernardino County health care community awaits a decision on whether the law is constitutional. The Obama Administration has not spent "a minute of the day" thinking about what would happen if the U.S. Supreme Court strikes down healthcare reform when it issues a ruling, which is expected this month, said Herb K. Schultz, San Francisco-based HHS administrator for the states of California, Arizona, Nevada and Hawaii. As it stands, 4 million California residents will get health insurance when the act becomes fully operational in 2014, he said. But in many respects, that future has already arrived. "Health care reform is not the future," he said. "It is already here" (Steinberg, 6/17).

San Francisco Chronicle: State Uncertain As Top Court Steps In
When President Obama's health care overhaul became law two years ago, California lawmakers jumped into action. … The difference this year is that the fate of those state laws, and the impact they will have on Californians, hang under what state Sen. Ed Hernandez , D-West Covina (Los Angeles County), called a "cloud of uncertainty." Before the end of the month, the U.S. Supreme Court is expected to rule on the constitutionality of the federal health law, called the Affordable Care Act (Bazar, 6/17).

Boston Globe: Insurers To Stay With Key Benefits Of U.S. Health Law
The largest insurers in Massachusetts have pledged to extend two popular provisions of the Affordable Care Act even if the US Supreme Court decides to overturn the federal health law in a ruling expected before the end of the month. Blue Cross Blue Shield of Massachusetts, Harvard Pilgrim Health Care, and Tufts Health Plan said in statements to the Globe that they would continue to allow young adults to remain on their parents’ insurance plans up to age 26. ... The insurers also said they would cover a broad array of preventive services with no copayments, as outlined by the federal law. Among them are certain immunizations and screening for diabetes, depression, and colorectal and breast cancer (Conaboy, 6/18).

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Calif. Programs Reach Out To Give Care To Undocumented, Uninsured

In California and North Carolina, local programs that help undocumented workers and the uninsured get care -- often without using federal funds -- are detailed.

California Health Report/HealthyCal.org:  Reaching Out To The Undocumented And Uninsured
Since Maria Alfaro and her family came to California from El Salvador eight years ago, getting sick has not been an option. … That might soon change. Alfaro last month connected with Lucy Moreno, a community health outreach worker, or promotora, who travels the countryside helping people apply for medical assistance.  Moreno told Alfaro about Riverside County's medically indigent services program, which provides basic preventive and emergency care for the poor, regardless of their immigration status. Excluded from the subsidized insurance that will come if the federal health overhaul takes effect, undocumented immigrants will be eligible for limited services provided by the counties, which will remain the health care providers of last resort (Potter, 6/17).

North Carolina Health News:  Program Helps Uninsured Get Free Medications
North Carolina's Medication Assistance Program allowed uninsured patients access close to $100 million in prescription drugs last year by helping them apply to pharmaceutical companies for assistance. A $1.7 million state allocation for the program is not included in the Senate budget passed last week (Hoban, 6/18).

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Mental Health Hospitals Scrutinized In Calif., Mass.

The Los Angeles Times looks at former consultant who helped overhaul California's psychiatric hospitals. In Massachusetts, the future of Taunton State Hospital -- one of two remaining publicly run mental health hospitals there -- is uncertain.

Los Angeles Times: Ex-Consultant To California Mental Hospitals Criticized Elsewhere
A consultant who led the troubled effort to overhaul California's public psychiatric hospitals has played a lead role in federal reforms in at least five other states, where critics have raised similar concerns about cronyism and the quality of his work. Nirbhay Singh, a psychologist from Virginia, abruptly resigned from his California post last year after The Times asked state officials about rising violence in the hospitals and the state's hiring of Singh's family members (Romney and Hoeffel, 6/17).

Boston Globe: State Mental Hospital In Taunton Has Uncertain Future
As residents this year debated a proposal to build a $500 million casino resort at an industrial park here, the future of another massive property six miles north seemed a near certainty: the 154-acre site of Taunton State Hospital, one of the state's two remaining publicly run hospitals exclusively for the mentally ill, was marked for closure by the governor in January. The Patrick administration's closure, planned for the end of the year, would empty 18 historic buildings in this cash-strapped city (Wen, 6/17).

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Mass. Nursing Homes Miss Out On Federal Grant To Curb Inappropriate Sedative Use

Nursing Homes In Massachusetts will not get a federal grant to help them drive down use of antipsychotic drugs. In Kansas, officials launched a campaign to encourage reporting of elder abuse.

Boston Globe: Nursing Homes Miss Out On Aid Targeting Antipsychotic Drugs
Massachusetts nursing homes, which recently pledged to lower their rate of antipsychotic use by 15 percent this year, found out Friday that they will not be receiving a coveted federal grant that would have helped fund the initiative to drive down inappropriate use of the powerful sedatives. Under the proposal, developed by researchers at the University of Massaschusetts Medical School, nursing home staff would be trained on alternative methods of managing difficult behaviors by residents, particularly those with dementia, instead of relying on antipsychotic drugs to calm them (Lazar, 6/16).

Kansas Health Policy Institute: SRS Urges Public To Report Elder Abuse, Exploitation
Department of Social and Rehabilitation Services officials today rolled out an informational campaign aimed at encouraging the public to report elder abuse and exploitation. "It is not widely known that our elderly or disabled adults can be targets of physical or financial abuse or neglect by their caregivers," said Jim Kallinger, deputy secretary in charge of integrated services at SRS. Kallenger, a former Florida legislator and chief child advocate for the Florida governor’s office, spoke during a mid-morning rally outside the Statehouse (Ranney, 6/15).

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Abortion, Contraception Controversies Create Political Divisions

In some states, even some Republican legislators are not endorsing anti-abortion rules as a group of Catholic hospitals, which had supported the Obama administration's contraception compromise, revoked that approval.

Reuters: Catholic Group Seeks Change In Birth Control Policy
The biggest U.S. network of nonprofit health facilities formally asked the Obama administration on Friday not to require Roman Catholic-affiliated institutions including hospitals to provide employees with health coverage for contraceptives. The Catholic Health Association of the United States, which initially welcomed White House efforts to find compromise with Catholic authorities on the contraceptives issue, said administration proposals have not satisfied its concerns about emergency contraceptives that could interfere with a fertilized egg (Morgan, 6/15).

St. Louis Beacon:  Catholic Health Association Backs Away From Limited Support For Contraception Coverage Mandate
Long a backer of universal health care, the CHA sent the White House and the Department of Health and Human Services a letter that called current provisions to exempt only churches from providing sterilization and contraceptive coverage “unacceptable.” In the letter CHA president, Sister Carol Keehan, asked for the federal department to expand its exemptions on religious grounds to "not only churches, but also Catholic hospitals, health care organizations and other ministries of the church (Rice, 6/16).

Chicago Tribune: Contraceptive Mandate Stirs Local Catholics
The Archdiocese of Chicago has not yet joined 43 other Roman Catholic institutions in suing the federal government over a mandate to pay for birth control, but local Catholic leaders are urging parishioners to speak out against what they view as a threat to religious freedom (Brachear, 6/17).

Los Angeles Times: Idaho Woman's Case Marks A Key Abortion Challenge
The plaintiff aborted her fetus at home after about 20 weeks, using pills purchased over the Internet from an out-of-state doctor. She represents a discomfiting situation for both sides of the debate as her civil suit takes on the state's strict laws. ... The case also marks the most significant constitutional legal challenge so far to so-called "fetal pain" statutes, adopted by Idaho and at least five other states. Such laws significantly shorten the window of time in which a woman can legally abort a fetus — in the case of Idaho, to 19 weeks (Murphy, 6/16).

Kansas City Star: Thousands Email Governor About Missouri Contraception Bill
Gov. Jay Nixon has been inundated with nearly 5,000 online messages, emails and letters as he mulls what to do with a politically thorny bill injecting Missouri into the national debate over insurance coverage for contraception. The Republican-led Legislature sent the Democratic governor a bill saying no employer or health plan provider can be compelled to provide coverage for contraception, sterilization or abortion if those items run contrary to their religious or moral convictions (Blank, 6/16).

Richmond Times-Dispatch: Abortion Rights Advocates Score A Victory Before The State Board Of Health
The Virginia Board of Health on Friday rejected a controversial proposed regulation that would have required abortion clinics to meet new hospital construction standards. After hearing from dozens of opponents, including physicians, some of whom called the proposed regulations politically motivated and a thinly veiled attempt to make it more difficult for women to get abortions in Virginia, the board approved an amendment that exempts existing abortion providers from the building guidelines. New clinics still will have to meet hospital construction standards (Green, 6/16).

The Dallas Morning News: Arlington Rep. Bill Zedler Tries A New Path For Rejected Abortion Rules
Rep. Bill Zedler of Arlington has worked for years to get women to provide the state with more information about why they're getting abortions. ... The price of collecting the information, the invasiveness of the questions and the polarizing nature of abortion legislation meant Zedler's bills failed, even in a Legislature dominated by Republicans and anti-abortion sentiments. Now, at Zedler's urging, the state health department has copied some of his legislation into proposed state regulations (Hoppe, 6/15).

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State Roundup: Calif. Budget Cuts; Texas Hospitals Cry Foul Over Funding Plan

A selection of health policy stories from California, Texas, Colorado, Oregon and Rhode Island.

Los Angeles Times: Specifics Of California's Budget Cuts
Spending on welfare, child care and home care for the elderly and disabled would be reduced but not by as much as Brown wanted. CalWORKs, the state welfare program, is facing the biggest hit at $428 million. … In-Home Supportive Services, which allow some elderly residents to avoid being moved into nursing homes, would be reduced by about $90 million. The cut means 3.6 percent fewer hours of care for beneficiaries (Megerian and York, 6/16).

Texas Tribune: Private Hospitals Angry Over Funding Plan
Three days before Health and Human Services Commissioner Tom Suehs announced his upcoming retirement, the chief executives of Texas’ five biggest private hospital systems asked Gov. Rick Perry for a sit-down meeting ... In the letter, the presidents and chief executives ... suggested that state deliberations over how to reimburse private hospitals for caring for the indigent -- including the details of a federal Medicaid waiver -- favored public hospitals in a way unfair to private hospitals. ... It's the latest salvo in a running back-and-forth between public and private hospitals (Ramshaw, 6/15).

Texas Tribune: Texas-Based Projects Win Health Care Innovation Awards
Texas-based health care projects have been selected to receive about $38.8 million in federal money through an initiative that aims to support projects designed to deliver quality medical care and save money. Winners of the U.S. Health and Human Services Department's Health Care Innovation Awards were announced Friday by the federal Centers for Medicaid and Medicare Services. In addition to the direct awards, about $61.6 million will go to other projects that affect Texas (Luthra, 6/15).

Denver Post: Denver Health Wins $19.8 Million To Manage High-Risk Cases
Denver Health won $19.8 million from a highly competitive federal grant to hire "navigators" and information specialists who can sort high risk cases to cut costs and improve care. Denver Health believes it can extend the complex services to 15,000 new patients, saving $40 million over three years by reducing ER visits and expensive procedures through better primary medicine and mental health coordination (Booth, 6/16).

The Oregonian: Health Reform: Portland Collaborative Lands $17.3 Million Health Innovation Award
Portland-area health providers have landed a $17.3 million federal innovation award to build a more coordinated system for taking care of low-income people with complex health problems. The goal is to step-up support services and preventive care for people to reduce their need for emergency room visits and hospital admissions. Planners hope to save about $32.5 million over three years (Rojas-Burke, 6/15).

Modern Healthcare: R.I. Governor To Let Legislation On Hospital Deals Become Law
Rhode Island Gov. Lincoln Chafee said that he will allow legislation to amend the state's Hospital Conversions Act become law without his signature. The bill will amend the state law to allow for-profit companies to acquire more than one hospital in Rhode Island every three years. The Rhode Island House and Senate passed the legislation this week (Lee, 6/15).

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Editorials and Opinions

Upcoming Supreme Court Ruling: GOP As 'Dog That Caught The Car'; Growing Concerns About Mandate

The Wall Street Journal: GOPCare 
[T]he GOP may be positioning itself to become the dog that caught the car. Political and policy uncertainty is perhaps inevitable given the range of what the Court could do. But the Republicans need a more coherent strategy. ... An orderly unwinding of ObamaCare was always going to be difficult. But based on its disarray and confusion so far, the GOP may be making it harder (6/16).

The New York Times' Opinionator: Life After The Health Care Ruling
Within the next two weeks, the Supreme Court is expected to hand down its decision on the Affordable Care Act. If they accepted jurisdiction, the justices could uphold the law entirely or strike it all down, or they could zero in to reject the most controversial aspect, the mandate that individuals must have health insurance. What would the future hold if the individual mandate were struck down? (6/17).

The Wall Street Journal: Why I No Longer Support The Health Insurance Mandate
Soon the U.S. Supreme Court will rule on the constitutionality of the Affordable Care Act. I am not a lawyer, or an expert on the Constitution. But as the chairman and CEO of a major health plan, I had a ringside seat to the entire health-care reform process. After much reflection, I have concluded that the federal individual mandate, which requires all Americans to purchase health insurance starting in 2014, will not be upheld. I don't say this lightly, as I have long been a vocal advocate of getting and keeping every American covered (Ron Williams, 6/17).

The Washington Post: The Folly Of Obamacare
We pay our presidents for judgment, and President Obama committed a colossal error of judgment in making health-care "reform" a centerpiece of his first term. Ahead of the Supreme Court’s decision on the Affordable Care Act (ACA) — and regardless of how the court decides — it’s clear that Obama overreached. His attempt to achieve universal health insurance coverage is a massive feat of social engineering that, by its sweeping nature, weakens the economic recovery and antagonizes millions of Americans (Robert J. Samuelson, 6/17).

Politico: Health Insurance Isn't Like Broccoli
If we require people to purchase health insurance, the reasoning goes, with that nose under the tent, why not broccoli next? That logic comes as close to insulting one’s intelligence as anything I can imagine. … Do those who suggest the possibility of a broccoli mandate really believe that there is no difference between broccoli and health insurance? Do they not recognize that an insurance mandate goes to the heart of creating actuarial insurance models that allow for universal coverage for health insurance for everyone living within our borders? (Tom Daschle, 6/17).

Kansas City Star: Health Care Law Is Already Improving The System
Much of the nation is on high alert in anticipation of a U.S. Supreme Court ruling on the constitutionality of part, or all, of the sweeping health care reform law that President Barack Obama signed two years ago. The decision, which could be announced as soon as Monday, will have a profound impact on political fortunes, the insurance market and on people’s lives. A ruling to invalidate the law, or even to strike down its most controversial provision, the individual insurance mandate, would be destructive. Among other things, it would increase the chances of more Americans being forced to go without health insurance (6/16).

Minneapolis Star-Tribune: Supreme Court Won't Have Last Word On Health Reform
[T]he two of us don't see eye-to-eye on the legislation. ... However, despite our differences on ACA, both of us do agree that with or without ACA the soaring cost of health care will undermine the private health care marketplace and crowd out other important public priorities. ... We also agree that, whatever the Supreme Court decides, the delivery and financing of health care need to change in fundamental ways (Tom Horner and Tim Penny, 6/16).

Houston Chronicle: Court Will Examine Legality, Not Merits, Of Health Care Reform
Whatever the Supreme Court decides about the constitutionality of the Affordable Care Act (ACA), one thing is certain: it will not be based on an assessment of the merits of a national health care system. Rather, it will be a ruling about whether there is explicit constitutional authority for the way Congress chose to fund a system to make health insurance affordable and accessible to all Americans (Jennifer S. Bard, 6/15).

The Hill: Defeat Of Health Care Law Would Erode Voters' Trust In Supreme Court
The hardball political fact is that attacking the court will help the president's campaign and it will damage the court for years to come. A CBS News/New York Times poll released last week shows most Americans already believe the ruling on healthcare reform will be based on justices' personal and political views. According to the survey, 55 percent of Americans believe the justices' political ties will play a role in the healthcare decision. An earlier CBS/New York Times poll ... found that 60 percent of Americans now believe that lifetime appointments for Supreme Court justices are a "bad thing" (Juan Williams, 6/18).

The Fiscal Times:  Reform May Survive If Supreme Court Kills Mandate
If the high court follows the polls, it probably will rule the requirement that individuals purchase insurance – the mandate – is unconstitutional but leave the rest of "Obamacare" intact. A CBS/New York Times poll released earlier this month showed that 41 percent wanted the entire law overturned, 24 percent supported it fully and 27 percent supported it but wanted the mandate eliminated.  Pooling the latter two groups suggests there is majority support for the coverage expansion, insurance protections and delivery system reforms contained in the bill – as long as there is no mandate (Merrill Goozner, 6/18).

iWatch News:  Pledge To Honor ObamaCare Provisions Even If Court Strikes Down Law Left Much Unsaid
It was clear to me that UnitedHealth "declined" to make any company official available — at least "on the record" — Sunday night because "rude" questions would have been asked. So the stories that appeared Monday and over subsequent days did not have answers to critically important questions about whether the company would "honor" the many other provisions of the reform law that will benefit most Americans if the Court rules against it (Wendell Potter, 6/18).

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Viewpoints: Catholic Group Dismisses Compromise On Contraceptives; Funding Entitlements

USA Today: Catholic Health To Obama, HHS: No Contraception Compromise
President Obama's support for his signature health care act took a fresh hit Friday. The Catholic Health Association, the nation's largest private health care provider, has rebuffed the latest White House moves to make its contraception coverage mandate more acceptable to Catholics and conservative evangelicals, according to Religion News Service. The CHA was a critical voice in getting the Affordable Care Act passed in 2009. Sister Carol Keehan, head of CHA, drew standing ovations from progressive Catholics (Cathy Lynn Grossman, 6/15).

Modern Healthcare: Not Secular
Some commentators recently have advanced a novel perspective that because Roman Catholic healthcare institutions live in the secular world, they are not "churches" worthy of the constitutional protection of religion. They argue that all religious institutions serving in secular space should be treated as different from a house of worship or religious grammar school. ... Based on Catholic theology and my understanding of legal precedent gained from work I have done with the Chicago law firm of Unagretti & Harris, I would posit that this proposal runs counter to decades of legal precedent and centuries of Church teaching (Rev. Michael Place, 6/16).

Kaiser Health News: Different Takes: A Status Check On State-Based Exchanges
Kaiser Health News recently checked in with three states actively pursuing a state-based exchange. Commentaries follow from Rhode Island, Utah and Maryland. A common theme emerged: No matter how the court rules, change is not going to stop. Read commentaries from Christopher F. Koller, Rhode Island's health insurance commissioner; Patty Conner, Utah's exchange director; and Maryland Lt. Gov. Anthony G. Brown

The New York Times: Fiscal Cliff Notes
Controlling the rising costs of Medicare and Medicaid and ensuring the long-term viability of Social Security are essential to a healthy budget. Equally essential is for lawmakers to grasp that not all so-called entitlement spending is the same. Medicare and Medicaid do indeed present potentially explosive and crippling budget problems because of the aging population and the relentless rise in health care costs. Social Security costs, in contrast, are driven solely by the aging population. So its cost curve flattens out over time as the baby boom generation dies off (6/17).

Houston Chronicle: True Or False: Markets And Medicare Don't Mix?
The place where we can see if a market is possible is Medicare, the largest health care payer in the U.S. Recent national proposals have suggested that Medicare's current system of pay for everything (so-called "defined benefit") be replaced with a model where each Medicare enrollee would receive a subsidy to purchase private health insurance ("defined contribution"). ... This would make Medicare much more "market-like" because it would interject individual preferences and the ability to pay for a product, and, in our opinion, a perfectly fine first step. ... The market and Medicare can mix -- but only if the mixture contains important modifications known as regulations, a four-letter word in some places (Arthur Garson Jr. and Carolyn Long Engelhard, 6/15).

The Wall Street Journal: FDA Approvals Are A Matter Of Life And Death
In November, the U.S. Food and Drug Administration (FDA) approved an innovative product called the Sapien Transcatheter Heart Valve, for the treatment of severe aortic valve stenosis. The Sapien valve can be implanted endoscopically, making it a boon for patients who are too sick to endure open-heart surgery. ... This would be a great story for American patients, but for one frustrating detail: The Sapien valve has been available in Europe since 2007, saving lives there but not here (Andrew Von Eschenbach and Ralph Hall, 6/17).

Des Moines Register: Democrats Must Fight Even Harder
Some of us were disappointed the law didn't go farther and include a public option. But partisan and big-money forces have unleashed efforts to maintain the status quo and block reforms these last four years, and will surely try to undo them if Romney wins. Obama needs to re-energize the people who put him in office, expand the base of voters and hope they can still see their own stakes through the fog of special-interest rhetoric (Rekha Basu, 6/16).

Des Moines Register: Parties Need A Moral Compass, Health Reform Emails Show
Republicans in the U.S. House of Representatives have released more documents showing how President Barack Obama's administration worked behind the scenes with the drug industry in 2009. Such collaboration in crafting the health reform law is no surprise. Also no surprise is the intention behind drawing attention to the emails: Embarrassing the president. And Obama deserves to be embarrassed on this one (6/17).

The New York Times: Michigan's Attack on Women's Rights
Even at a time when extreme attacks on women's reproductive rights and freedom are nothing unusual, a sweeping measure on a fast track in Michigan's Republican-led State Legislature stands out. ... One portion of the extreme legislation seeks to shrink access to abortion care by imposing costly and unnecessary space and other requirements on all clinics that provide six or more abortions a month. Under the bill's terms, clinics would need to be licensed as surgical centers even if they offer only medicine-based abortions that entail handing out pills and do not perform surgery (6/15).

The New York Times: Will The Reformers Come For Me, Too?
Last week, here in Illinois, the governor signed into law $1.6 billion worth of Medicaid "reform." The ax came down on disabled children and young adults who are M.F.T.D. — medically fragile, technology dependent — those who have tracheostomies, are ventilator-dependent or need central intravenous lines. New co-payments and income caps could mean that many of these young people will no longer be able to receive care at home and will have to be institutionalized. No more free lunch for them! (Mike Ervin, 6/17). 

Des Moines Register: Branstad Talk Of Leadership Has Its Irony
Gov. Terry Branstad is the former president of a medical school, and he has a lot of opinions on health care. During a meeting with Des Moines Register staff on Tuesday, we were reminded of some of them: "ObamaCare" should be repealed; Iowans can take more responsibility for staying well; and public employees must contribute to the cost of their health insurance. The governor talks a lot about making Iowa the healthiest state in the nation. But we wonder if he recognizes the importance of people actually having health insurance for the idea to become a reality (6/15).

Des Moines Register: U.S. Needs To Rework Rules On Patient Privacy
The time for corrective action has arrived. There is something wrong when medical professionals routinely cite federal privacy rules as the grounds for withholding information from a patient's family, but a university's hospital can provide the same information to a fundraiser. And the time for Congress to act is now (6/16).

Boston Globe: Mass. Has Too Many Hospitals For Its Own Good
Knowing that state-of-the-art medical help is always close at hand is probably a comforting feeling. But it shouldn't be. The presence of so many hospitals in Boston — along with high numbers of physicians, particularly specialists — contributes to the enormous amount of unnecessary medical care that gets delivered in the state. Unless Massachusetts finds a way to limit growth in the supply of both hospitals and specialists, the state's efforts to control health care spending are likely to be thwarted (Shannon Brownlee, 6/15).

McClatchy Newspapers: The Dollars And Sense Of Addressing Hearing Loss In The Workplace
Hearing loss doesn't win many headlines. Nor does it win much time in the doctor's office. But maybe it should. And perhaps America's employers should be the first to listen up. Consider this: Hearing loss is linked to a three-fold risk of falling among working-aged people (40 to 69) whose hearing loss is just mild. Falls and fall-related injuries cost billions in health care costs in the United States each year (Sergei Kochkin, 6/18).

Baltimore Sun: Stock Transaction Fee To Fund Dental Care
What’s this? Someone wants to make Wall Street traders put up billions of dollars for the millions of elderly and poor Americans and veterans who do not have sufficient insurance for dental care? Somebody wants to put a $2.50 fee on every $10,000 of Wall Street trading — on derivatives, credit default swaps, stocks and bonds — and put the money into a comprehensive dental program to improve the nation’s oral health? I just have one question: When do we start? (Dan Rodricks, 6/16).

Sacramento Bee: Is Nurses Union A Health Hazard?
The California Nurses Association can place its record of campaign wins against any of the other big-time players on the left. But watching its lobbyists work the Capitol halls, I'm left to wonder which side they're on. At a time when unions are on the decline, the California Nurses Association has had undeniable successes, doubling its size in a 10-year period to 86,000 members and doubling assets to $70 million in the past five years, its latest report to the U.S. Department of Labor shows. The growth came as the union made its name in politics by mau-mauing Gov. Arnold Schwarzenegger, after he sided with hospitals and tried to roll back a law signed by Gov. Gray Davis that guaranteed nurse staffing levels (Dan Morain, 6/17). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.