Daily Health Policy Report

Wednesday, June 18, 2014

Last updated: Wed, Jun 18

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Health Care Fraud & Abuse

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

FAQ: Hospital Observation Care Can Be Costly For Medicare Patients

Writing for Kaiser Health News, Susan Jaffe reports: “Some seniors think Medicare made a mistake. Others are stunned when they find out that being in a hospital for days doesn't always mean they were actually admitted. Instead, they received observation care, considered by Medicare to be an outpatient service. The observation designation means they can have higher out-of-pocket expenses and fewer Medicare benefits. Yet, a government investigation found that observation patients often have the same health problems as those who are admitted” (Jaffe, updated 6/18). Check out this updated FAQ.

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Capsules: HHS Releases New Details About 2014 Marketplace Premiums, Subsidies; Enroll America Pushes Ahead To Second Enrollment Period; Insurer Begins Huge Palliative Care Program

Now on Kaiser Health News’ blog, Mary Agnes Carey reports on HHS details regarding marketplace premiums and subsidies: "The report was one in a series of ongoing updates from HHS about enrollment in the online exchanges or marketplaces. Federal officials have said more than 8 million people signed up for coverage under the health law. The document analyzed trends in the 36 states where the federal government is running the online marketplace, or exchange. It did not include similar data for the 14 states and the District of Columbia that are running their own exchanges because the data is not available, according to the report. The document did not include data on how many people who enrolled in coverage have actually paid their premiums, which they must do before coverage begins. Some critics of the program have suggested that many people signing up for coverage have not paid for it and shouldn’t be considered part of the 8 million touted by the government" (Carey, 6/18).

In addition, Lisa Gillespie reports on Enroll America’s meeting: “Enroll America convened a national conference this week in Washington to review the strategies that proved successful during the inaugural Affordable Care Act open enrollment period and to gear up for the next one, which will start Nov. 15. Organizers also want to ensure that the navigators and organizations working toward enrollment maintain their energy — despite reports of backlogged Medicaid applications and continuing struggles in some state-run exchanges” (Gillespie, 6/18).

Also on Capsules, Marissa Evans reports on a new palliative care program: “Cambia Health Solutions, which includes Regence Blue Cross Blue Shield, will offer training to providers and additional benefits for policyholders: more than 2.2 million members in Cambia’s family of health plan companies in Oregon, Washington, Idaho and Utah. Palliative care improves the quality of life by managing pain and other problems for people who have serious life-threatening medical conditions, such as cancer, heart and kidney failure. It differs from hospice care, especially because patients do not necessarily have less than six months to live” (Evans, 6/17). Check out what else is on the blog.

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Boeing, Health Care Providers Join Forces In Bid To Curb Costs

The Seattle Times' Lisa Stiffler, working in partnership with Kaiser Health News, reports: "Boeing and some of the Northwest’s largest health care providers are teaming up to provide what they say will be higher-quality, more-affordable care for some of the aerospace giant’s employees. To accomplish this, the company will work with accountable care organizations, or ACOs, an increasingly popular strategy for health-care delivery that puts more responsibility on providers for improving patients’ health and reining in costs" (Stiffler, 6/17). Read the story.

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Political Cartoon: 'Wrong Side Of The Bed?'

Kaiser Health News provides a fresh take on health policy developments "Wrong Side Of The Bed?" by Gary Varvel.

Meanwhile, here's today's haiku:


One thousand dollars 
that's the price for every pill
a nice round figure

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

HHS Report Details Premium Subsidy Use And Cost

Nearly 9 of 10 people who bought coverage on the health law marketplaces got government assistance to pay for the premium, and the average out-of-pocket premium cost was $69.

Los Angeles Times: Obamacare Subsidies Push Cost Of Health Law Above Projections
The large subsidies for health insurance that helped fuel the successful drive to sign up some 8 million Americans for coverage under the Affordable Care Act may push the cost of the law considerably above current projections, a new federal report indicates. Nearly 9 in 10 Americans who bought health coverage on the federal government’s healthcare marketplaces received government assistance to offset their premiums (Levey, 6/17).

McClatchy: New HHS Report Touts Federal Marketplace Premiums And Plan Availability
A new report by the Obama administration suggests that most people who purchased government subsidized health insurance on HealthCare.gov found affordable coverage and a wide selection of health plans on the federal insurance marketplace. Those who used tax credits to purchase "silver" coverage on HealthCare.gov -- which covers 70 percent of health care costs -- paid an average premium of $69 per month, according to the report by the U.S. Department of Health and Human Services. And 69 percent who used the tax credits to buy federal marketplace coverage had premiums of less than $100 per month, while nearly half -- 46 percent -- paid less than $50 per month (Pugh, 6/18).

Kaiser Health News: Capsules: HHS Releases New Details About 2014 Marketplace Premiums, Subsidies
The report was one in a series of ongoing updates from HHS about enrollment in the online exchanges or marketplaces. Federal officials have said more than 8 million people signed up for coverage under the health law. The document analyzed trends in the 36 states where the federal government is running the online marketplace, or exchange. It did not include similar data for the 14 states and the District of Columbia that are running their own exchanges because the data is not available, according to the report. The document did not include data on how many people who enrolled in coverage have actually paid their premiums, which they must do before coverage begins. Some critics of the program have suggested that many people signing up for coverage have not paid for it and shouldn’t be considered part of the 8 million touted by the government (Carey, 6/18).

Politico Pro: HHS Reports Shows ACA Premiums Varied Greatly By State
Premiums for people getting subsidized coverage on Obamacare exchanges swung wildly from state to state, according to data released Wednesday morning by the Obama administration. Average monthly payments ranged from $23 in Mississippi to $148 in New Jersey after tax credits were factored in. The average monthly premium for subsidized coverage in the 36 states relying on the federal exchange, HealthCare.gov, for enrollment was $82 — and it was $69 for "silver" plans, the mid-level plans that most people chose. But the report makes clear that the health law is more about each state's experience rather than the country as a whole (Cheney, 6/18).

The Fiscal Times: Average Obamacare Subsidy--$3,312
Nearly two months after Obamacare’s first open enrollment closed, we finally have a clearer picture of what people are paying for the policies they bought on the federal health insurance exchange.  Monthly premiums for silver plans – the standard insurance policy sold on the exchanges – cost an average of $345 a month this year for people who did not qualify for subsidies, a new analysis from the administration shows. However, for the overwhelming majority of Obamacare enrollees (87 percent) who did qualify for financial assistance, the average monthly premium on the silver plan costs about $69. That's an average tax credit of about $276 a month, or $3,312 a year (Ehley, 6/18).

Georgia Health News: Many Georgians Pay Bargain ACA Rates, Report Says
Georgia’s average premium for insurance through the Affordable Care Act exchange is the second-lowest among the 36 states using the federally run marketplace, according to a report released Wednesday. Georgians who qualified for subsidies or discounts for coverage are paying an average of $54 per month, the report said. Their average premium is $341, but they also get the immediate subsidy or tax credit of $287. Only Mississippi, with an average premium of $23 a month, is lower (Miller, 6/18).

Texas Tribune: Subsidized ACA Enrollees In Texas Paying Lower-Than-Average Premiums
Texans who received financial assistance to purchase health coverage through the federal insurance exchange are paying less in monthly premiums than individuals in most other states using that online marketplace, according to a new report by the U.S. Department of Health and Human Services. Texas, like dozens of other states with Republican leadership, declined to create its own state-based insurance exchange under the Affordable Care Act, relying on a federally managed marketplace instead (Ura,6/17).

Meanwhile, regarding politics and fact checking -

The Washington Post's The Fact Checker: Old Obamacare Claims Don't Age Well In New Crossroads GPS Ad
This advertisement from the pro-GOP group Crossroads GPS is almost like an oldies record of top tunes lambasting the Affordable Care Act—and it has the same dated feel as well. Just about everything in this ad has been called into question before, with the exception of its opening scenes—which highlight that our colleagues at PolitiFact had deemed President Obama’s promise that you could keep your health-care plan the "Lie of the Year." No argument about that – Obama’s statement was also one of the Biggest Pinocchios of 2013—but even the Lie of the Year reference seems dated. (We have seen it in what feels like a gadzillion ads.) Let’s look at the other elements of this ad (Kessler, 6/17).

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Insurers Continue To Eye State Health Exchanges

In a pair of stories, the Associated Press reports on how insurers in New Hampshire and Kentucky that did not participate in the health law's online insurance marketplaces during the first enrollment period are now indicating their interest for the next open season. In addition, news outlets in Oregon and Minnesota report on developments related to state exchanges.   

The Associated Press:  New Hampshire Outlines Proposed Insurance Networks
Each New Hampshire hospital will be included in at least three of the provider networks available under President Barack Obama's health care overhaul law next year, state insurance officials said Tuesday. This year, Anthem Blue Cross and Blue Shield was the only company selling plans through the new marketplace, and it was criticized for excluding 10 of the state's 26 acute-care hospitals. Next year, two other private insurance companies -- Harvard Pilgrim and Assurant -- and two cooperatives -- Maine Community Health and Minuteman -- are expected to begin offering plans (Ramer, 6/17).

The Associated Press: 2 New Insurers Interested In Joining Kynect
At least two new insurance companies say they want to sell policies on Kentucky's state-run health exchange after more than 421,000 people signed up for health insurance during the first round of open enrollment. Residents can go to the website, known as kynect, to sign up for the state's Medicaid program or purchase discounted private health insurance plans, depending on their income. It is part of the federal Affordable Care Act, the health care legislation championed by President Barack Obama that has been fiercely opposed by others, including conservative Republicans, since the day it was passed (Beam, 6/17).

Reuters:  Oregon Takes Steps Toward Lawsuit Over Defunct Health Exchange Website
Oregon is taking the next step toward a possible lawsuit against the company that developed the embattled Cover Oregon website as part of the implementation of the federal health care program known as Obamacare, state officials said on Tuesday. The state issued what are known as civil investigative demands (CIDs) for information on Monday in the potential case against Oracle Corps, which the state paid about $134 million to create technology for the site (Sebens, 6/17).

The Oregonian: New Cover Oregon Health Exchange Chief, Aaron Patnode, Likes A Challenge
Aaron N. Patnode is in the final stages of negotiating a contract to become the new executive director of Cover Oregon. And one of the questions he's getting practiced at answering is: Why? Patnode knows the health insurance exchange is battling poor morale and appears on the brink of being enveloped in massive litigation in addition to being under investigation by Congress and the Federal Bureau of Investigation. He knows it has become a symbol for many of government waste, and could well be abolished as the federal government takes over Cover Oregon's main responsibility of enrolling Oregonians in health coverage (Budnick, 6/17).

The Star Tribune: Another Logjam: MNsure Slow To Process Insurance Coverage Changes
Thousands of Minnesotans whose insurance needs have changed because of a lost job or other life event are waiting weeks and sometimes more than a month to get coverage through the MNsure exchange. Since open enrollment ended in March, about 6,000 Minnesotans have contacted MNsure because of events such as a new baby or change in marital status. But systems are still not in place to quickly handle their insurance needs (Crosby, 6/18).

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Federal Officials, Software Specialists Working To Simplify Healthcare.gov Enrollment Application

Their goal is to make the process easier during the next enrollment season. Meanwhile, Enroll America held a meeting to rally its troops as the organization also looks ahead to the next sign-up period.

CQ Healthbeat: Simpler Enrollment Application Planned for Fall Health Law Sign-Up
Federal officials and software engineers are working on a simplified application to install on the federal insurance website healthcare.gov during the upcoming enrollment period. The goal is to make things easier both for consumers and the website, which collapsed under the pressure of high volume during the first days of last fall’s sign-up window. Application 2.0 will be “for people who don’t have complicated financial assistance needs, so we think it could be a high percentage of people who are signing up,” said Paul Smith, a software engineer who was part of the technical rescue team that helped Obama administration officials patch healthcare.gov in the months after its disastrous launch on Oct. 1 (Adams, 6/17).

Kaiser Health News: Capsules: Enroll America Pushes Ahead To Second Enrollment Period
Enroll America convened a national conference this week in Washington to review the strategies that proved successful during the inaugural Affordable Care Act open enrollment period and to gear up for the next one, which will start Nov. 15. Organizers also want to ensure that the navigators and organizations working toward enrollment maintain their energy -- despite reports of backlogged Medicaid applications and continuing struggles in some state-run exchanges (Gillespie, 6/18).

Politico Pro: Sebelius: Obamacare Prevailed Despite ‘Very Daunting Odds’
In her first public appearance since stepping down from HHS, Kathleen Sebelius praised advocates of the Affordable Care Act on Tuesday for overcoming major challenges and exceeding enrollment expectations despite “relentless” political misinformation and obstruction. “We were facing very daunting odds,” Sebelius said, speaking to hundreds of enrollment assisters, health care leaders and government officials at Enroll America’s first conference in Washington. “You absolutely stepped up to the plate,” she said. The question is whether such opposition will persist as more Americans gain coverage under the law (Villacorta, 6/17).

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Expanding Coverage To Under-26-Year-Olds Made Them Healthier, Saved Money

Researchers found that one of the keystone provisions of the health law had a significant impact.

Los Angeles Times: Young Adults Healthier After Passage Of Obamacare, Study Finds
Expanding the number of young adults with health insurance appears to have improved their health and saved them money, ... Starting in 2010, the Affordable Care Act allowed adults under age 26 to remain on their parents’ health plans, the first coverage expansion to take effect under the law. ... The new study, published in the Journal of the American Medical Assn., suggests the coverage expansion also measurably increased the number of young adults who reported that they are in excellent physical and mental health. Researchers also found a significant drop in how much young people were paying out of pocket for their medical care (Levey, 6/17).

The Boston Globe: Young Adults Allowed To Stay On Parents’ Health Plan Report Being In Better Health
The researchers from Boston Children’s Hospital and the Harvard School of Public Health surveyed more than 26,000 young adults ages 19 to 25 both before and after the health care law was implemented and found that 6 percent more reported being in excellent physical health and 4 percent more in excellent mental health in 2011 compared to a decade earlier. Those in the control group, who were ages 26 to 34, reported no significant change in their health (Kotz, 6/17). 

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Capitol Hill Watch

Bill To Give Veterans Private Medical Care Advances In House

The Rules Committee approved the measure Tuesday. In other news on veterans' care, a Kansas senator pushes the administration to keep a pilot project offering some of that same flexibility in rural areas and the White House is turning to experts for help in picking a new leader for the VA.

Politico: House VA Bill Advances
The House moved closer on Tuesday to giving veterans stuck on federal wait lists for medical care the freedom to visit private providers. The Rules Committee approved legislation that would allow veterans who live far from a Department of Veterans Affairs’ medical facility or who have been delayed longer than the VA's "standard" wait time for treatment to seek care from a private doctor (French, 6/17).

Kansas Public Radio: Future Uncertain For VA Rural Health Care Pilot Program
U.S. Sen. Jerry Moran, R-Kan., said a U.S. Department of Veterans Affairs pilot program offering timely, quality health care to rural veterans is being allowed to expire in a few months, even though VA officials tell members of Congress no decision has been made. The pilot program is called Access Received Closer to Home, or ARCH. It's offered through five sites across the country, including a Kansas site in Pratt. The program allows veterans to get health care services from community providers if they live at least one hour from a VA health facility (Thompson, 6/17).

Reuters: White House Asks Health Care Experts For Help In Picking VA Head
The White House has turned to healthcare experts and industry leaders in its effort to pick a new head for the troubled Department of Veterans Affairs, the agency's interim leader said on Tuesday. "This is one of the most important jobs in government today," Gibson said in remarks at the Baltimore VA Center. "This is one position that has a greater opportunity to have an impact and make a lasting difference than any other opportunity in health care” (Clarke, 6/17).

Baltimore Sun: VA’s Acting Chief Tours Baltimore Medical Center
The acting secretary of veterans affairs said Tuesday that the agency would add more primary care physicians to the Maryland VA Health Care System to help reduce the long waits for veterans seeking appointments with doctors. Acting Secretary Sloan Gibson said the agency would also add $500,000 — a 40 percent increase — to help veterans facing delays seek private care (Wenger, 6/17).

The Associated Press: New Jersey Hospital To Offer Veterans Priority
Veterans will go to the front of the line at a private New Jersey health care system under a new program being started in response to problems with the federal Veterans Administration’s health system. Under the initiative announced Tuesday, veterans living in the seven southern New Jersey counties are being promised same-day primary care appointments and help from health care navigators at Cooper University Health Care. Veterans would be served at the hospital in Camden and at system clinics in southern New Jersey (6/17).

The Associated Press: Millions In Bonuses Paid In Phoenix VA System
Workers at the Phoenix VA Health Care System — where investigators say veterans' health was jeopardized when employees covered up long wait times for patients — received about $10 million in bonuses, newly released records show. Department of Veterans Affairs documents indicate than 2,100 employees got bonuses over the course of a three-year period, the Arizona Republic reported (6/18).

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Medicare Faces Cost Tension With Lawmakers, Advocates

CMS must decide how it will handle certain tests and medicines.

The Associated Press: Lawmakers Urge Medicare Cover Cancer Test
More than 130 lawmakers are urging the Obama administration to expand coverage for a lung-cancer test under Medicare that could cost the program billons, calling the screening important for vulnerable seniors. In a letter to the Centers for Medicare and Medicaid Services, the lawmakers called for a timely decision on coverage for low-dose CT scans for older patients at higher risk of developing lung cancer. ... A CMS spokesman said the agency’s decision will be based on whether the test is “reasonable and necessary,” without regard to its cost to Medicare (Yen, 6/17).

The Hill: Advocates Blast 'Prior Authorization' For Hospice Drugs
Hospice programs and workers are urging the Obama administration to suspend rules they say are limiting patients' access to necessary medications at the end of life.  During a lobby day on Capitol Hill, more than 240 advocates called on Medicare to withdraw a new "prior authorization" process for drugs used for hospice patients. ... The agency reasoned that "prior authorization" would help to ensure the correct division of Medicare was paying for each prescription. Hospice care and related medications are covered under Part A, while other drugs fall under Part D (Viebeck, 6/17).

The CT Mirror: ‘Observation Status:’ The Term Hospital Patients Should Know
Patients, take note: Starting Oct. 1, those who spend more than 24 hours in the hospital could receive notice that they’ve been placed on something known as "observation status." It’s a technical term, but one that could mean the difference between having their recovery paid for -- or ending up with a hefty bill. The notice is required under a new state law Gov. Dannel P. Malloy signed last week. It takes effect Oct. 1 (Levin Becker, 6/18).

Related KHN coverage: FAQ: Hospital Observation Care Can Be Costly For Medicare Patients (Jaffe, updated 6/18). 

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Health Care Fraud & Abuse

Feds Join Whistleblower Suit

The Justice Department says in a lawsuit that IPC The Hospitalist Co., which assigns doctors to hospitals in 28 states, bilked Medicare and Medicaid by billing for more expensive care than was provided. Meanwhile, West Virginia could lose as much as $200 million in federal Medicaid funds because it contracts with providers facing "credible" fraud accusations, according to an audit.

Los Angeles Times: IPC The Hospitalist Defrauded Medicare And Medicaid, U.S. Lawsuit Says
In a lawsuit filed Monday in Chicago, federal lawyers said IPC The Hospitalist Co. bilked Medicare and Medicaid by billing for more expensive care than was provided. The company assigns doctors to hospitals in 28 states, then bills insurers, including government programs, for treatment they provide. The company reported $610 million in revenue last year (Pfeifer, 6/17).

Modern Healthcare:  Feds Join Whistleblower Suit Against Evaluation/Management Firm For Upcoding
The U.S. Justice Department has filed a complaint against IPC the Hospitalist Co. alleging the company actively encouraged physicians to upcode claims for routine patient evaluations for the past decade.  The government, joining a whistle-blower lawsuit filed by one of its physicians, alleges that North Hollywood, Calif.-based IPC has overbilled federal health care programs by upcoding for evaluation and management services since 2003. For example, the government said hospital-based physicians with IPC were billing a high-severity E&M code, 99233, at an average rate of 70 percent, while the national average is around 20 percent. That code pays almost $90, compared with $36 for a less-intensive code (Herman, 6/17).

Charleston (W.Va.) Daily Mail: Report: WV Could Lose Millions In Medicaid Money
West Virginia could lose roughly $230 million in federal Medicaid funding if it doesn’t stop sending payments to health care providers facing “credible” accusations of fraud, according to a new report provided to lawmakers Tuesday.The state Bureau for Medical Services sent that much money between March 2011 and June 2013 to providers accused of several different types of fraud, in violation of the Affordable Care Act, said Brandon Burton, an analyst with the office of the West Virginia Legislative Auditor (Boucher, 6/17).

Charleston Gazette: Audit Finds Medicaid Not In Compliance
West Virginia’s Bureau of Medical Services is not following a 2011 federal directive to suspend Medicaid payments to health-care providers accused of fraud, putting it at risk of losing between $17.9 million to $211 million in federal matching funds, a legislative audit released Tuesday warns.The audit notes that a 2011 amendment to the Affordable Care Act requires states to suspend Medicaid payments to providers once it is determined that an allegation of fraud is credible and is referred to the Medicaid Fraud Control Unit for investigation (Kabler, 6/17).

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Health Care Marketplace

Generic Drug Delays Cost U.S. Payers Millions

Problems surrounding an Indian company's launch of generic versions of three blockbuster drugs have preserved millions in revenue for the brand-name makers, reports The Wall Street Journal. Meanwhile, Swiss pharmaceutical giant Novartis projects its overhaul will boost profits, and the impact of a $1,000-a-pill drug to treat hepatitis C is examined.

The Wall Street Journal: Drug Delays Cost U.S. Health-Care Payers Millions Of Dollars
Delays to an Indian company's generic versions of three blockbuster drugs annually cost U.S. health-care payers millions of dollars—and preserve millions of dollars in revenue for the makers of the brand-name versions. AstraZeneca's heartburn drug Nexium is the most recent big drug to face delays to its generic version. Key patents on the U.K. company's "purple pill," which ranks among the world's best-selling prescription drugs, expired at the end of May, but manufacturing problems at India's Ranbaxy Laboratories have prevented the launch of an expected generic rival (Plumridge and McLain, 6/17).

The Associated Press: 1,000-A-Pill Sovaldi Jolts U.S. Health Care System
Leading medical societies recommend the drug as a first-line treatment, and patients are clamoring for it. But insurance companies and state Medicaid programs are gagging on the price. In Oregon, officials propose to limit how many low-income patients can get Sovaldi. Yet if Sovaldi didn’t exist, insurers would still be paying in the mid-to-high five figures to treat the most common kind of hepatitis C, a new pricing survey indicates. Some of the older alternatives involve more side effects, and are less likely to provide cures (6/17).

The Wall Street Journal: Novartis Business Overhaul To Lift Profitability
Swiss pharmaceutical giant Novartis on Wednesday offered details of how its sweeping business overhaul would boost its performance, saying its core operating profit margin would have been more than two percentage points higher if the changes had been implemented last year. Basel-based Novartis is in the midst of a series of transactions worth roughly $25 billion that includes the sale of its vaccines business to GlaxoSmithKline and its animal health business to Eli Lilly. Novartis is also buying Glaxo's oncology business as part of the deals (Revill, 6/18).

Meanwhile, the cost of inpatient hospital care grew faster than outpatient care -

Modern Healthcare: Inpatient Prices Rise Faster Than Outpatient Prices
U.S. consumer prices for inpatient hospital care grew faster than outpatient hospital prices last month as overall hospital prices increased 0.3%, the latest seasonally adjusted federal data show.  The Consumer Price Index, a measure of inflation produced by the U.S. Bureau of Labor Statistics, tracks the changes in prices paid by commercial insurance companies. Last month's 0.3% increase for hospital prices was slower than the 0.5% price bump in April and the 0.8% price growth in March. It was faster, however, than the 0.1% in May 2013 (Evans, 6/17).

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State Watch

State Highlights: Illinois Medicaid Digital Shift Delayed; N.C. Hospitals Fight Cuts; Heroin In New England

A selection of health policy stories from Illinois, North Carolina, New York, California, Oregon, Washington state, Idaho, Utah, Texas, Florida, Michigan, Connecticut and Massachusetts.

Modern Healthcare: Digital Woes Hamper Illinois System’s Shift To New Medicaid Program
Alexian Brothers Health System is suspending its effort to launch a new Medicaid program, blaming the difficulty of connecting physicians using different electronic records systems. The Arlington Heights, Ill.-based health system was spearheading a so-called accountable care entity (ACE) to coordinate the care of about 46,000 patients on Medicaid, the state-federal health insurance program for the poor and disabled. The ACEs are a form of managed care, one of Gov. Pat Quinn's initiatives to focus on preventative treatment to keep patients healthy and reduce health care costs (Schorsch, 6/17).

North Carolina Health News: Hospital Executives Fight For No Health Care Cuts, Come Away Pessimistic
Executives from Carteret General Hospital said they worried about the future of rural hospitals if the Senate budget becomes law. The budgets presented by the House and the Senate are far apart on how the state will reimburse for services provided to Medicaid recipients. Senate budget writers raise the assessment on hospitals to 28.5 percent of what they get reimbursed for providing Medicaid services. The Senate also imposes a single base rate statewide for inpatient services, which hospital officials say would be a cut for many of them (Hoban, 6/18).

The New York Times: Governors Unite To Fight Heroin In New England
Facing a heroin crisis that they say has reached epidemic proportions, the governors of five New England states met here on Tuesday to devise a regional strategy to combat the rise in overdoses and deaths from opioid abuse (Seelye, 6/17).

Los Angeles Times: Bill Requiring Health Labels On Sugary Drinks Fails In Assembly Panel 
A proposal to affix health warning labels to sugary drinks, including sodas and sports drinks, failed to win sufficient support in a key Assembly panel Tuesday. The measure would have required sugary drinks sold in California to be labeled with a warning that sugar contributes to obesity, diabetes and tooth decay (Mason, 6/17).

Kaiser Health News: Capsules: Insurer Begins Huge Palliative Care Program
Cambia Health Solutions, which includes Regence Blue Cross Blue Shield, will offer training to providers and additional benefits for policyholders: more than 2.2 million members in Cambia’s family of health plan companies in Oregon, Washington, Idaho and Utah. Palliative care improves the quality of life by managing pain and other problems for people who have serious life-threatening medical conditions, such as cancer, heart and kidney failure. It differs from hospice care, especially because patients do not necessarily have less than six months to live (Evans, 6/17).

Houston Chronicle: Coalition Wants To 'Recapture The Energy' Of Abortion Law Protests
Nearly a year after thousands of abortion-rights activists brought the Texas Legislature to a standstill, a coalition of liberal groups announced a campaign Tuesday to “recapture the energy” of the movement. #FightBackTX, unveiled in a morning conference call by the Texas Research Institute, Texas Freedom Network, NARAL Pro-Choice Texas, Whole Women’s Health and the ACLU of Texas, is centered on a documentary-style website (fightbacktx.com) about last summer’s protests, which aimed to stop the anti-abortion House Bill 2 from making it through the state Senate (Rosenthal, 6/17).

The Chicago Sun-Times: Alexian, Adventist: Partnership Means Lower Patient Costs Are Possible
Alexian Brothers Health System and Adventist Midwest Health have signed a letter of intent to form a partnership with their nine total hospitals. But the CEOs stressed that it is not a merger. The two systems would maintain separate ownership of their assets and finances. Yet, they are looking to create an umbrella company to handle long-term planning and strategy for the nine hospitals in suburban Chicago, said Mark A. Frey, president and CEO of Alexian Brothers Health System (Thomas, 6/17).

North Carolina Health News: Charlotte Will Get One Nurse In Every School
After two years of emails, speeches and bake sales, a group of Charlotte-Mecklenburg Schools parents will finally get their wish: one nurse in every school. In a vote Tuesday evening, the Mecklenburg Board of County Commissioners approved a $1.5 billion budget, which included $1.8 million in funding for 33 new CMS public-health school nurses, bringing the total number up to 161 for the 2014-15 academic year. The money will also cover another three school-nurse supervisors.Teri Saurer, founder of N. C. Parents Advocating for School Health, the group that pushed for the increased school-nurse presence, said she couldn’t be happier (Porter-Rockwell, 6/18).

Miami Herald:  Project Boosts Chances For Black Babies 
Across the country, black infants are more than twice as likely than white infants to die before their first birthday -- a gap at least half a century old that maternal and infant health experts say no quick fix can close. Enter the Jasmine Project, a joint University of Miami Department of Pediatrics perinatal care program and Healthy Start Coalition of Miami-Dade initiative. The Jasmine Project works with Florida Healthy Start to serve some of the most high-risk black women in the county, providing case management, childbirth and parenting education, breastfeeding support and risk-reduction counseling services for women during their pregnancy up until their child’s second birthday (Duffort, 6/17).

Detroit Free Press:  Michigan Pays Convicted Felons As Caregivers, Audit Shows 
The State of Michigan improperly paid $160 million in a 29-month period for services provided to vulnerable, low-income adults in a program designed to keep them out of more expensive, long-term care, according to a report released earlier today by the state’s Auditor General. Among those on the payroll: convicted criminals -- including those convicted of crimes ranging from financial fraud to homicide, auditors found (Erb, 6/17).

The Sacramento Bee: CalPERS Health Premiums For 2015 A Mix Of Hikes, Cuts
CalPERS’ health care premiums are going up again for hundreds of thousands of public employees and their families, although 40 percent of CalPERS members will see their rates decline. The 2015 CalPERS premiums, closely watched in the health care industry because of the pension fund’s size and clout, will be a decidedly mixed bag. Blue Shield of California HMO subscribers will be hit with rate hikes of 9.6 percent to 16.4 percent, depending on the specific plan. But Kaiser HMO members’ rates will fall 4.3 percent (Kasler, 6/17).

The CT Mirror: Panel Recommends Mental Health Changes For CT’s Young Adults
The task force established after the Newtown shootings to examine mental health issues among young adults released 47 recommendations Tuesday in what a key legislative leader described as a “blueprint” for future legislative action on behavioral health. The task force concluded that the state’s overall system of providing mental health and substance abuse treatment for young people does not function well in meeting the needs of individuals and their families, although it cited some pockets of excellence (Becker, 6/17).

The California Health Report: Innovation Programs Aim To Improve Care For Seniors And The Poor, But Are The Results Reliable?
Donald Vidal has had both of his knees replaced, but the 85-year-old Novato resident experienced different levels of care with each procedure. Although the same surgeon performed both operations, during the second one Vidal was part of a federal pilot program that aims to improve care and save money. More patients across California are finding themselves involved in similar pilot projects, which began in 2011 and are funded by the Center for Medicare and Medicaid Innovation, based in Washington, D.C. The Innovation Center was created as part of the Affordable Care Act in 2010 to test new and creative ways of providing better, cheaper care for patients who are poor, elderly or have disabilities (Bookwalter, 6/17).

WBUR: A New Way To Shop For A Primary Care Doctor In Mass.
Massachusetts Health Quality Partners is launching what it hopes will be a more user friendly way for the public to use information it has gathered on primary care doctors’ offices for years. MHQP has been publishing reports for almost a decade that compare physician groups based on the experience of their patients as well as how well they treat depression, asthma, diabetes, heart disease and screen for cancer. But the reports, which gather information from 65,000 patients and commercial insurance records, did not get a lot of attention from patients. On Healthcare Compass, MHQP’s new website, patients can search for a primary care doctor by zip code or a physician’s name (Bebinger, 6/18).

WBUR: No Court Filing Yet In Partners Deal To Expand
WBUR’s Martha Bebinger reports that a negotiated agreement that would have let Partners HealthCare expand to include South Shore and three other hospitals is on hold. Partners and Attorney General Martha Coakley had planned to file a deal in court Monday that the AG said would curb Partners’ market clout. But a spokesman for the AG says “both sides are continuing to negotiate based on the agreement in principle announced last month” (Bebinger, 6/17). 

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Editorials and Opinions

Viewpoints: Working For Benefits; Fears For A Pill To Prevent HIV; Possible Medicaid Strategy For Virginia

The New York Times: Cutting The Poor Out Of Welfare
[Economist Robert] Moffitt noted in an email that "the work incentives in the government safety net have greatly increased over the last 20 years: less welfare payments if you don't work, and much greater government payments if you do." The 2010 enactment of the Affordable Care Act reinforced the pattern of rewarding those above the official poverty line. The A.C.A.'s major provisions make everyone earning from 100 to 138 percent of poverty level income eligible for Medicaid (in states that sign on to the program) and grant subsidies for the purchase of health insurance to those making from 138 percent to 400 percent of poverty level income (Thomas B. Edsall, 6/17).

The New York Times' Room For Debate: Is A Pill Enough To Fight H.I.V.?
New federal guidelines urge gay men and others who have unprotected sex to take a daily dose of the drug Truvada, a regimen called pre-exposure prophylaxis (PrEP), to curb H.I.V. infections and AIDS. Is promoting the use of the antiviral drug a good public health strategy, or will it encourage more to have unprotected sex? (6/17). 

Los Angeles Times: The U.S. Healthcare System: Worst In The Developed World
The U.S. healthcare system notched another dubious honor in a new comparison of its quality to the systems of 10 other developed countries: its rank was dead last. The new study by the Commonwealth Fund ranks the U.S. against seven wealthy European countries and Canada, Australia and New Zealand. It's a follow-up of previous surveys published in 2010, 2007, 2006 and 2004, in all of which the U.S. also ranked last (Michael Hiltzik, 6/17). 

Los Angeles Times: A Better Way To Cure What Ails Us
Annual spending on healthcare in America totals nearly $9,000 per person, accounting for more than 17% of the U.S. economy. Yet, on some of the most basic medical interventions, we're failing. Sometimes patients are overtreated, particularly with antibiotics and prescription opiates. But a problem that may be even bigger, from my vantage point, is undertreatment. Some highly effective medicines for potentially deadly conditions aren't being used nearly often enough (Tom Frieden, 6/17).

The Wall Street Journal: Medicare's Puzzling Refusal To Cover Lung-Cancer Screening
If you could save thousands of lives, would you do it? That's the question Medicare officials are now considering—whether to approve lung-cancer screening for Medicare beneficiaries, which we estimate could save 14,000 lives each year in that group alone. Most patients are discovered with lung cancer at a stage already too late for a cure, and cancer screening for early detection has been recommended for other common cancers for decades. The procedure has turned thousands of people into survivors rather than victims. It is not clear why Medicare does not cover lung-cancer screening like it does for breast, colon and prostate cancer—all far less lethal. But the issue is especially acute since nearly 70% of lung cancer occurs in the Medicare population (Douglas E. Wood and Ella A Kazerooni, 6/17). 

The Wall Street Journal’s Washington Wire: Who Would Pay for This Medicaid Expansion?
Even as states continue to debate the costs of expanding Medicaid under the Affordable Care Act, some in the medical field are proposing new commitments for the program. Last week Politico reported on a letter to Congress by several physician groups asking that increased reimbursements for primary-care physicians participating in Medicaid be extended. ... The proposal raises several questions, including whether states would cover any of the cost of extending the increased payments (Chris Jacobs, 6/17). 

The Richmond Times-Dispatch: Schapiro: McAuliffe Has Another Card To Play On Health Care
Gov. Terry McAuliffe has made no secret of his distaste for the manner in which his Republican predecessor, Bob McDonnell, went about financing a highway that would link Petersburg and Suffolk. The project is supposed to be a back door for trucks into the Port of Hampton Roads. McAuliffe depicts it as a frontal assault on the wallets of taxpayers, costing $1.4 billion, about a quarter of which has already been spent with nary an inch of asphalt poured. And it may never happen because the federal government is blocking the road as a threat to rapidly diminishing wetlands. That said, the Road to Nowhere, as detractors call the new U.S. 460, may provide McAuliffe a path out of his jam over health care (Jeff E. Schapiro, 6/17). 

Anchorage Daily News: Medicaid Gaps In Alaska Not As Big As Has Been Claimed
In November 2013, when [Gov. Sean Parnell] announced that he would not be seeking Medicaid expansion in 2014, he asked me to analyze Alaska's health care safety net. ... Through a combination of tribal health organizations, community health clinics and federally qualified health centers, public health centers and hospitals, Alaskans without health insurance can access comprehensive care in more than 200 Alaska communities. Gaps exist but they are more limited than what has been reported in the media or claimed by political advocacy groups (William J. Struer, 6/17).

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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.