Daily Health Policy Report

Monday, June 2, 2014

Last updated: Mon, Jun 2

KHN Original Reporting & Guest Opinion

Administration News

Capitol Hill Watch

Health Reform


Public Health & Education

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

When Doctors Need Advice, It Might Not Come From A Fellow Human

Kaiser Health News staff writer Daniela Hernandez, working in collaboration with Wired, reports: "Tech titans like Google, Facebook, Microsoft and Apple already have made huge investments in artificial intelligence to deliver tailored search results and build virtual personal assistants. That approach is starting to trickle down into health care too, thanks in part to the push under the health reform law to leverage new technologies to improve outcomes and reduce costs, and to the availability of cheaper and more powerful computers. Computers can’t replace doctors at the bedside, but they are capable of crunching vast amounts of data and identifying patterns humans can’t. Artificial intelligence can be a tool to take full advantage of electronic medical records, transforming them from mere e-filing cabinets into full-fledged doctors’ aides that can deliver clinically relevant, high-quality data in real time" (Hernandez, 6/2). Read the story.

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Political Cartoon: 'Rearranging The Wheelchairs?'

Kaiser Health News provides a fresh take on health policy developments with "Rearranging The Wheelchairs?" by Lisa Benson.

Meanwhile, here's today's haiku:


Senator Sanders
has plans for vets' care. Will he
correct the problems?

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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Administration News

After Shinseki Resigns, A Scramble To Fix VA

Warnings about long wait times go back at least to 2005, raising questions about how to overhaul a sprawling system that has been chronically understaffed.

The Wall Street Journal's Washington Wire: Is The VA In Need Of A Major Overhaul?
The widening scandal at the U.S. Department of Veterans Affairs, which led to the ouster of Secretary Eric Shinseki last week and could fell a number of other officials, is sparking a broader debate about whether the agency should be overhauled after a decade of rapid expansion. The VA operates 150 hospitals, more than 1,000 health clinics and 131 cemeteries. It buries, houses, educates, hospitalizes, loans money to, and insures the lives of millions of veterans each year. And the veterans who intersect with the agency span decades of government service, from World War II survivors to those recently returning home from Iraq and Afghanistan (Paletta, 6/2).

Politico: VA Audit Find 'Systemic Lack Of Integrity'
Appointments’ wait times were manipulated at more than 60 percent of the Department of Veterans Affairs health facilities investigated as part of a new internal audit. The White House-ordered audit found that schedulers faced pressure to manipulate the system and concluded there was a "systemic lack of integrity within some Veterans Health Administration facilities." ... The audit, issued as VA Secretary Eric Shinseki resigned Friday, found that 64 percent of the 216 VA facilities reviewed had at least one instance where a veterans' desired appointment date had been changed (Herb, 5/30).

The Washington Post: Some Of The Internal Problems That Led To VA Health System Scandal
Here is a primer on the agency and some of the internal problems that fed the scandal. ... According to the American Federation of Government Employees, some VA doctors are carrying workloads of more than 2,000 patients — far more than the 1,200 goal set forth in the Veterans Health Administration handbook. The agency is struggling to hire 400 primary-care physicians, positions that are notoriously hard to fill because of a nationwide shortage of these types of doctors. This is not just a VA problem but an issue plaguing the U.S. medical system. ... The Government Accountability Office and the VA inspector general have for years been churning out reports about the long wait times experienced by veterans seeking medical care (Somashekhar, 5/30).

The New York Times: Many Veterans Praise Care, But All Hate The Wait
Marc Schenker, an Air Force veteran in Fort Lauderdale, Fla., is having surgery this month to remove a golf-ball-size hernia — but not at a veterans hospital. Mr. Schenker, 67, said he had given up on the Veterans Affairs hospital in Miami after waiting months to get the procedure scheduled and had turned to a private surgeon instead, using Medicare. ... In interviews and in hundreds of responses to a questionnaire posted on The New York Times website, veterans around the country expressed frustration with delayed access to care and what many described as an impenetrable and unresponsive bureaucracy at department hospitals and clinics, even as many praised the quality of care they received once they saw doctors (Goodnough, 5/31).

The Associated Press:  Warnings On VA Hospital Waits Go Back Years
The report last week confirming that 1,700 veterans were "at risk of being lost or forgotten" at a Phoenix hospital was hardly the first independent review that documented long wait times for some patients seeking health care from the Department of Veterans Affairs and inaccurate records that understated the depth of the problem. Eleven years ago, a task force established by President George W. Bush determined that at least 236,000 veterans were waiting six months or more for a first appointment or an initial follow-up. The task force warned that more veterans were expected to enter the system and that the delays threatened the quality of care the VA provided (Freking, 6/1).  

Los Angeles Times: VA Chief And White House Spokesman Resign, Fueling Unease
The next VA secretary will face enormous challenges to repair a system that has been plagued with service delays since at least 2005 and that now is struggling with a flood of claims from veterans of the wars in Iraq and Afghanistan. A White House official acknowledged Friday that the staff was in scramble mode to get to the "ground truth" of what happened at the VA and to develop a fix-it plan (Simon, Parsons and Memoli, 5/30).

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Capitol Hill Watch

Sanders Details Plan To Overhaul Veterans Health Care

On Sunday, Senate Veterans Affairs Committee Chairman Bernie Sanders, I-Vt., unveiled legislation, called the Restoring Veterans’ Trust Act, which is designed to smooth out the troubled Department of Veterans Affairs by -- among other changes --  making it easier for veterans to see outside providers if care isn’t available within 30 days. 

USA Today: Senator Unveils Proposal To Revamp VA Health Care
Senate Veterans Affairs Committee Chairman Bernie Sanders unveiled a broad proposal Sunday to revamp health care for 6.5 million veterans as the department faces an expanding investigation into the way care is provided at VA medical facilities. "The truth is that when people get into the VA, the quality of care is good. The problem that we have to address is access to the system and waiting lines," Sanders, an independent senator from Vermont who caucuses with Democrats, said on CBS's Face the Nation. ... The proposal would authorize the VA to lease 27 new health facilities across 18 states and Puerto Rico. It includes additional funding to hire health care providers (Davis, 6/1).

The Washington Post: Senate Veterans’ Affairs Committee Chairman Introduces Proposal To Overhaul VA
Senate Veterans’ Affairs Committee Chairman Bernard Sanders (I-Vt.) introduced a far-reaching proposal Sunday to overhaul health care for the nation’s veterans that would make it easier for the beleaguered Department of Veterans Affairs to hire and fire employees, lease new space for clinics and hospitals, and send veterans to outside providers if care isn’t available within 30 days. Sanders’s bill, the Restoring Veterans’ Trust Act, would give the VA secretary the authority to remove senior officials based on poor job performance, grant VA expedited hiring authority for nurses and doctors, authorize the department to lease 27 new facilities in 18 states and Puerto Rico, mandate a software upgrade for the department’s patient scheduling system by March 2016 and expand opportunities for eligible veterans to seek outside care if VA facilities are unavailable (O’Keefe, 6/1).

The Associated Press:  Senate To Consider New VA Bill After Scandal
Details of a refashioned bill to address the problems plaguing the federally run veterans' health care system were released Sunday by its sponsor, the chairman of the Senate Veterans Affairs Committee. Sen. Bernie Sanders, a Vermont independent, said the bill would be introduced this week. The bill includes several new provisions aimed at fixing the long delays for veterans' care. The long-simmering issue erupted into a scandal in April and led to last week's resignation of VA Secretary Eric Shinseki, after a federal investigation into the troubled Phoenix VA Health Care System found that about 1,700 veterans in need of care were "at risk of being lost or forgotten" after being kept off an official waiting list (Cappiello, 6/2).

The Wall Street Journal: Senate To Address Veterans’ Short-Term Health-Care Needs 
[Sanders] said the system was “gamed” in many parts of the country where the VA lacked the doctors or other staff to ensure the delivery of timely patient care. ... Resolving longer-term problems will require ensuring veterans have primary-care physicians and other staff they need to get timely quality care, said Mr. Sanders, who carefully avoided blaming Mr. Shinseki and said–when asked whether he or Congress is responsible–that “everybody” can bear some responsibility for the problems (Trottman, 6/1).

Politico: VA Moves Bernie Sanders From Stage Left To Center Stage
He’s a combative, self-described “democratic socialist” more prone to hand-to-hand combat with Republicans than cutting deals with them. But Bernie Sanders now is tasked with leading Democrats through a sensitive political dilemma that’s putting their party on the defensive. With Eric Shinseki out at the Department of Veterans Affairs, the focus now shifts to Capitol Hill, placing the two-term Vermont independent and Senate Veterans’ Affairs Committee chairman at the center of the growing VA health care controversy. Sanders, who caucuses with Democrats, is assembling a legislative package to help address the issue in the hopes that he can consolidate support within the veterans community and assuage concerns of vulnerable Democrats (Raju and Everett, 6/1).

In related news on Capitol Hill -

Fox News: Hill Leaders Vow Shinseki’s Resignation Won't Dim Spotlight On Veterans Affairs' Woes
Top Capitol Hill lawmakers said Sunday that the resignation of Veterans Affairs Secretary Eric Shinseki will not take the spotlight off the agency’s widespread patient-care problems and suggested a criminal probe into the situation. Florida GOP Rep. Jeff Miller, chairman of the House Committee on Veterans Affairs, told “Fox News Sunday” the intensity in Congress will not wane. “I can promise you that,” he said. “The American people are so disgusted it's not going to fade out” (6/2).

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Health Reform

With Healthcare.gov The Go-To For 36 States, National Exchange Becoming A Likely Possibility

Politico reports that a national enrollment system is what liberals wanted all along, and now, because some GOP governors took a pass on state-run marketplaces while some Democratic states bungled theirs, it's picking up steam. News outlets also report on the latest exchange news from Maryland, Illinois, Minnesota and Washington.

Politico: GOP’s Obamacare Fears Come True 
Liberals wanted a national enrollment system under Obamacare. They might just get it. Right now, 36 states rely on healthcare.gov, the federal exchange, to enroll people in health coverage. At least two more states are opting in next year, with a few others likely to follow. ... The federal option was supposed to be a limited and temporary fallback. But a shift to a bigger, more permanent Washington-controlled system is instead underway -- without preparation, funding or even public discussion about what a national exchange covering millions of Americans means for the future of U.S. health care. It’s coming about because intransigent Republicans shunned state exchanges, and ambitious Democrats bungled them (Cheney and Haberkorn, 6/1). 

The Washington Post: Maryland Looks To Connecticut For Health Exchange Answers
The Access Health CT Web site is everything that the Maryland Health Connection site had hoped to be. The format is simple and easy to navigate, allowing Connecticut residents to browse health insurance plans before creating an account. More importantly, the system properly relays enrollment information to insurance companies and the federal government, making real the Affordable Care Act’s vision of quickly insuring tens of thousands of previously uninsured people (Johnson, 5/31).

The Associated Press: Board OKs $43.5M In Contacts On Health Exchange
The Maryland Health Benefit Exchange Board voted Friday for a five-year contract with Xerox totaling $29.3 million to host new technology used in the more successful health exchange website used in Connecticut. The board also voted for a three-year contract with Deloitte totaling $14.2 million. That contract is for software licenses, both for development and production (5/30).

The Baltimore Sun:  State Won’t Tap Federal Grants For New Exchange
Maryland will not need to ask the federal government for additional grant money to build a new health exchange that will replace the faulty one the state was forced to scrap. Health Secretary Joshua M. Sharfstein, also chair of the board that oversees Maryland's exchange, said late Friday that there is enough money left over from building the first exchange plus funding through Medicaid to cover the $40 million to $50 million it will cost to create a new site where the uninsured can buy private health plans and enroll in Medicaid under the Affordable Care Act (Walker, 5/31).

The Associated Press: Ill. Insurance Marketplace To Open For Gay Couples
Illinois' health insurance marketplace is now allowing gay and lesbian couples to enroll for private coverage. Now that same-sex marriage is legal in the state, Get Covered Illinois announced it will open up special enrollment periods for gay couples. Married same-sex couples and their children can enroll as a family and may qualify for financial help (5/1).

Minnesota Public Radio: MNsure's COO To Step Down In July
Erik Larson, MNsure's chief operating officer is stepping down in mid-July. In a letter to staff of the state's online insurance marketplace, MNsure CEO Scott Leitz announced that Larson would leave July 11. Leitz lauded Larson for providing valuable leadership from the troubled launch of the website through open enrollment and beyond. Leitz said Larson made MNsure work for Minnesotans (Stawicki, 5/30).

The Seattle Times:  Payment Problems Continue To Vex State’s Online Health Exchange
Two months after open enrollment closed, Washington’s online health-insurance exchange still faces complaints from consumers and organizations about how it is performing in its first year. Many of the complaints involve the enrollment process and, in particular, the system under which enrollees make payments to insurers, payments that are handled by the exchange.  One group, the Association of Washington Healthcare Plans (AWHP), complained recently that an estimated 15 percent of enrollees -- up to 25,000 people -- may have had problems resulting in service or claims payment delays. Cristina Rancourt, 55, and her family are among that 15 percent. The Rancourts, who live in Kirkland, thought they had insurance since they finished the application procedure in December. But about three weeks ago, when they were denied coverage for a prescription, they called their insurer, Premera (Marshall, 6/1).

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Virginia's Medicaid Expansion Standoff Moves State Toward Budget Shortfall, Government Shutdown

Also in the news, after Louisiana's Medicaid expansion efforts failed in the legislature, the state is poised to try out Gov. Bobby Jindal's alternative to the federal health law.    

The Washington Post: Va. Attorney General Hires Law Expert As Possible Shutdown Looms
At issue is whether to expand health coverage for the poor as allowed under President Obama’s Affordable Care Act; McAuliffe and the state Senate support doing so, while the Republican-dominated House of Delegates does not. Supporters forced the standoff by attaching the proposal to the state spending plan, leading resolute lawmakers on both sides of the debate to adjourn their regular session in March with no budget in place. Also in the spotlight are several constitutional questions, notably whether McAuliffe has the authority to keep certain appropriations flowing after July 1 if no budget deal is reached. Under the constitution, only the legislature has the power to appropriate funds (Portnoy, 5/30).

The Richmond Times-Dispatch: ‘Sense Of Urgency’ As Budget Shortfall Looms
After almost three months of political theatrics, Virginia is about to get a stiff dose of budget reality. The General Assembly money committees are preparing for deep spending cuts in a two-year budget that has been stalled by a bitter political fight over using federal money to expand health coverage for uninsured Virginians. If the legislature doesn’t break the impasse and adopt a budget by July 1, the cuts will be twice as deep and the state’s financial reputation could be imperiled (Martz, 6/1).

The Associated Press Lawmakers Agree To Try Out Jindal Health Plan
Louisiana could become a testing ground for Gov. Bobby Jindal's alternative to the federal health care overhaul, under a bill that received final backing from lawmakers Friday. Democratic Sen. Ben Nevers, of Bogalusa, proposed trying to use Jindal's "America Next" health care plan in Louisiana, after lawmakers rejected Nevers' push to expand Medicaid as allowed under President Barack Obama's health law (5/31).

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States Focus on Network Adequacy, Other Issues

States are updating rules to better reflect how the health system has changed as a result of the Affordable Care Act, and the Los Angeles Times takes a look at confusion by doctors, as well as consumers, about who's in the new networks.

The Associated Press: US Law Prods States To Revisit Health Care Rules
Prompted by the health care overhaul law, several states are updating their rules for insurance networks to better reflect who is covered and how people shop for and use their benefits. ... For example, nurse practitioners and physician's assistants now provide a significant share of primary care, and many consumers head to urgent care clinics instead of scheduling office visits, he said. And the current focus on hospitals ignores the reality that virtually every service provided during a short-term hospital stay is now available in other settings, including ambulatory surgical centers (Ramer, 5/31).

Los Angeles Times: Thrown A Curve By Health Networks
The problem involves not just consumers who are discovering their doctors are not covered by their plans. Some doctors have themselves been confused about whether they participate in various networks, making it difficult for them to instruct their patients. Other providers are dropping out of networks, leaving patients in the lurch (Zamosky, 5/30).

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GOP Candidates Expand Campaign-Trail Message Beyond The Health Law

Increasingly, it appears that Republican candidates are focusing their assaults on more than just the Affordable Care Act. News outlets examine how the overhaul is playing on the campaign trail.  

The Washington Post: GOP Candidates Show Signs Of Retreat On Full Obamacare Repeal As Midterms Approach
Republican candidates have begun to retreat in recent weeks from their all-out assault on the Affordable Care Act in favor of a more piecemeal approach, suggesting they would preserve some aspects of the law while jettisoning others. The changing tactics signal that the health-care law -- while still unpopular with voters overall -- may no longer be the lone rallying cry for Republicans seeking to defeat Democrats in this year’s midterm elections. The moves also come as senior House Republicans have decided to postpone a floor vote on their own health-reform proposal (Eilperin and Robert Costa, 5/30).

CNN: Wait -- Obamacare Isn't An Issue?
The Affordable Care Act, aka Obamacare, might not be the Republican Party's key to electoral victory as once thought. Patterns are emerging that Republicans and like-minded groups are broadening their scope and not homing in on a singular anti-Obamacare message. In March, Reince Priebus, head of the Republican National Committee, told CNN's Candy Crowley that Obamacare is "complete poison" and advised Republican candidates they "have to hit your main target which is Obamacare" in order to win (Caldwell, 5/30).

The Washington Post: Can Republicans Expand Their Reach In Blue States? Oregon Senate Race Provides A Test.
To Republicans, the Senate race in this solidly Democratic state presents an alluring opportunity. Oregon’s health insurance exchange has been one of the country’s most troubled. President Obama’s approval rating has fallen below 50 percent. Sen. Jeff Merkley, a liberal Democrat first elected on Obama’s coattails in 2008, is not terribly well known. And in Monica Wehby, Republicans have a fresh-faced, female challenger who they believe matches the moment: a pediatric neurosurgeon and political outsider who rails against the Affordable Care Act but is relatively moderate on social issues (Rucker, 6/1).

The Baltimore Sun:  Hate The Health Exchange, Love The Insurance
Frustrated with her inability to get health insurance, Bonnita Spikes entered the political fray when she was featured in gubernatorial candidate Douglas F. Gansler's April radio ad lambasting Maryland's problem-fraught health exchange. But as irritated as she was with the implementation of the Affordable Care Act in Maryland, she's been much happier with the treatment she's received after she finally enrolled. Now Spikes has lent her voice to a publicity campaign praising the health reform effort. Shortly after she appeared in Gansler's ad, a navigator from the Area Agency on Aging in Prince George's County helped Spikes sign up for Medicaid coverage. And now the retired nurse, who suffers from a terminal illness, calls her new health coverage lifesaving. She is such a fan of Obamacare that when her old friend and health advocate Vincent DeMarco sent out an email in search of people who had successfully enrolled in insurance, she contacted him right away (Walker, 5/31).  

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Medicare To Cover Sex-Change Surgery

The ruling, handed down Friday by a Department of Health and Human Services appeals board, reverses a Medicare policy in place since 1981. It covers surgery, but not other treatments like hormones.

The Washington Post: Ban Lifted On Medicare Coverage For Sex Change Surgery
The ruling by a Department of Health and Human Services board was in response to a lawsuit filed last year on behalf of Denee Mallon, 74, a transgender woman and army veteran from Albuquerque. The blanket Medicare ban was put in place in 1981 when such surgeries were considered experimental. But now most medical groups, including the American Medical Association and the American Psychological Association, consider it a safe option for those suffering from gender dysphoria, a condition that is characterized by intense discomfort — or “incongruence,” according to the official definition — with one’s birth sex (Cha, 5/30).

The New York Times: Medicare To Now Cover Sex-Change Surgery
The decision, handed down Friday by a Department of Health and Human Services appeals board, reverses a Medicare policy in place since 1981. It comes as a small but growing number of university health plans and large companies — including some Fortune 500 companies like Shell Oil and Campbell Soup — have started covering gender transition services, and could signal further changes since many health plans follow Medicare’s lead on coverage. ... The Medicare decision, which applies to beneficiaries of the health plan for older Americans and people with disabilities, covers only surgery, not other treatments like hormones (Rabin, 5/31).

The Wall Street Journal: Medicare Ban On Sex-Reassignment Surgery Lifted
Transgender people who receive Medicare benefits will no longer be automatically denied coverage for sex-reassignment surgery, a federal review board ruled Friday. The decision means that Medicare, the federal health insurance program for seniors and those with disabilities, will now cover sex-reassignment surgery on a case-by-case basis rather than routinely denying the surgery under guidance adopted during the 1980s (Armour, 5/30).

The Associated Press: Ruling Means Medicare Can Cover Transgender Surgical Procedures
Medicare can no longer automatically deny coverage requests for sex reassignment surgeries, a federal board ruled Friday in a groundbreaking decision that recognizes the procedures are medically necessary for people who don't identify with their biological sex. The Departmental Appeals Board ruled in favor of a 74-year-old transgender Army veteran whose request to have Medicare pay for her genital reconstruction was denied two years ago. The board said there was no justification for a 3-decade-old Health and Human Services rule excluding such surgeries from procedures covered by the national health program for the elderly and disabled (Leff, 5/31).

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After Controversies, Medicare Reimbursement For End-Of-Life Planning Again Getting Consideration

Stateline: Feds To Consider Paying Doctors For End-Of-Life Planning
The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate. A similar provision was in an early draft of the federal health care law, but in 2009, former Republican vice-presidential candidate Sarah Palin took to Facebook to accuse President Barack Obama of proposing “death panels” to determine who deserved life-sustaining medical care. Amid an outcry on the right, the provision was stripped from the legislation. Now, quietly, the proposal is headed toward reconsideration — this time through a regulatory procedure rather than legislation (Ollove, 6/2).

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Public Health & Education

Oncologists Urged To Consider Financial Impact Of Treatments

The American Society of Clinical Oncology is developing a system to rate drugs for advanced cancer based on their likely benefits and side effects, as well as on their price. Meanwhile, better long-term care is urged for the millions who survive the disease, and a report details how drugmakers are tailoring treatments to individuals' genetic makeups even though that may affect only small numbers of people.

Reuters:  Cancer Docs Urged To Consider Value When Treating Patients
Cancer doctors should consider the financial as well as the medical impact of treatment for patients as healthcare costs continue to grow faster than the overall economy, according to experts in Chicago at the annual meeting of the world's largest organization of oncologists. The American Society of Clinical Oncology is developing a system to rate drugs for advanced cancer based on a combination of benefit, side effects and price. The cost of such drugs can easily run into tens of thousands of dollars a year, even though many have been shown to extend the lives of later-stage cancer patients by just a few months (Beasley and Steenhuysen, 5/31).

Los Angeles Times: Cancer Survivors In The U.S. -- 14.5 Million Strong And Growing
The authors of the report – from the ACS and the National Cancer Institute – define a cancer "survivor" as anyone who has been diagnosed with cancer and is still alive. That includes patients who are undergoing treatment as well as those who have finished treatment and are considered cancer-free. ... "The growing number of cancer survivors in the U.S. makes it increasingly important to understand the unique medical and psychosocial needs of survivors," ACS epidemiologist Carol DeSantis, the lead author of the report, said in a statement. "Cancer survivors face numerous, important hurdles created by a fractured healthcare system, poor integration of survivorship care, and financial and other barriers to quality care, particularly among the medically underserved" (Kaplan, 6/1).

The Washington Post: Drugmakers Find Breakthroughs In Medicine Tailored To Individuals' Genetic Makeups
When the Food and Drug Administration recently [approved] a promising new lung cancer drug named Zykadia four months ahead of schedule, it heralded the medication as a "breakthrough" therapy. The drug isn't meant for everyone with the devastating disease, which kills an estimated 160,000 Americans each year. Or even for the majority of patients with its most common form, non-small-cell lung cancer. Rather, Zykadia is designed for a sliver of patients — about 5 percent — who have advanced non-small-cell lung cancer and have a specific gene mutation that causes tumors to become resistant to existing treatment (Dennis, 6/1).

Meanwhile, in Kentucky, a pilot program allowing some infirm inmates to go to nursing homes is approved -

The Associated Press: Kentucky Studies Private Nursing Homes For Inmates
The state legislature has approved a pilot program that requires Kentucky to parole some infirm inmates — excluding sex offenders and death row inmates — to private nursing homes where the federal government, through Medicaid, would pay most of the medical bills. For the plan to work, inmates cannot be in prison. The federal government will not pay for inmates' medical expenses. But if the inmates are paroled to a private facility, they become eligible for Medicaid. Inmates who leave the nursing home would be returned to prison for violating parole (6/1).

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Health Care Marketplace

New Editor Takes Reins At Health Affairs

Politico: Health Affairs’ New Editor Brings Legal Background
Key elements of the Affordable Care Act were first previewed in the journal Health Affairs. It’s where policy wonks kick the tires on big ideas for reforming Medicare, Medicaid and most every aspect of health care in the United States — before those proposals find their way into legislation on the Hill. On Monday, a new editor-in-chief takes charge of the publication, considered unique among peer-reviewed journals for channeling new research into health policy debates with political immediacy (Norman, 6/2).

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State Watch

State Highlights: NYC Plan For Treating Mentally Ill

A selection of health policy stories from New York, Kansas, Iowa, Massachusetts, Missouri, North Carolina and California.

The New York Times: Panel To Create Plan To Reduce Number Of Mentally Ill People In New York City Jails
Mayor Bill de Blasio has asked several of his commissioners and aides to provide him with a plan by September to reduce the rate of incarceration among New Yorkers with mental illness. The effort, which City Hall will announce on Monday, is the administration’s first major criminal justice initiative. Named the Task Force on Behavioral Health and the Criminal Justice System, it will include recommendations from the police and correction commissioners, the Manhattan district attorney, hospital administrators and judges (Goldstein, 6/1). 

NPR: Abortion Services Return To Town Where George Tiller Was Murdered
Five years ago, Dr. George Tiller was shot and killed at the Wichita, Kans., church where he was an usher. Tiller was widely known for performing abortions in late pregnancy and had become a target for protests. ... But in April of last year, South Wind Women's Center opened in the very same building where Tiller's clinic was. Executive Director Julie Burkhart worked for Tiller for seven years. Her clinic now offers abortion care for pregnancies less than 22 weeks along. "About 1 in 3 women are going to have abortions in their lifetimes -- so we all know somebody. If you think about women who are having abortions, nationally about 60 percent of women who are having abortions are already mothers," Burkhart says (Leblanc, 5/31).

The Des Moines Register: Branstad Signs Limited Medical-Marijuana Bill
A few months after their hopes seemed dashed, parents of Iowa children with severe epilepsy cheered Friday as Gov. Terry Branstad signed a bill allowing them to purchase a cannabis oil extract to lessen the effects of their kids' seizures. Branstad and many Republican legislators were steadfast opponents of previous medical-marijuana proposals. Even the bill's main sponsor declared on the day of its introduction that it had no chance of passing. But the parents were undeterred. They cornered lawmakers, talked to reporters and met with the governor. They calmly recounted their children's plight and explained that the extract has very little of the chemical in most marijuana that makes people high (Leys, 5/30).

The Boston Globe: Support To Keep A Loved One At Home
There’s plenty of structure at Great Days for Seniors, which occupies several rooms on the ground floor of a building at Hebrew Rehabilitation Center’s campus. In a typical day, 30 or so participants might play games or solve puzzles, sing in a group, join a current events discussion group, practice Tai Chi, and participate in crafts or baking classes. Nurses monitor their health conditions, and they have access to physical and speech therapists and a gym. Adult day health centers -- informally called adult day care -- have been around for more than 30 years. But demand for them has risen, driven by a growing population of older adults and a desire for people to live with family members, not in institutions (Humphries, 6/2).

St. Louis Post-Dispatch: Jury’s Out On Programs Intended To Reduce Medicaid Costs 
In 2008, Centene Corp. took on a contract to manage health care for 30,000 foster children in Texas -- a tough new challenge for the Clayton-based Medicaid contractor. Texas state caregivers had been prescribing a lot of psychotropic drugs to these children and adolescents. As these youngsters were shuttled from one house to another, Centene executives said, state authorities often lost track of which medications the children were taking. But in Texas and other states, managed care of Medicaid continues to spark debate (Doyle and Young, 6/1).

The Associated Press: New York Medical Database Aids Doctors, Patients 
New York is quietly building one of the nation's largest computer databases of medical records, a system that when finished will allow patients and doctors alike to see complete health histories in one place and promises to save millions in costs by avoiding redundant tests and unneeded hospital admissions. People who visit emergency rooms are less likely to be admitted when they're enrolled in the program, and repeat radiological scans and hospital readmissions are also less likely, according to initial limited studies done around Rochester, New York's third-largest city (Virtanen, 6/1).

Pioneer Press:  The Doc Will See You Know, And So Will The Scribe
When Ron Meyer visits his doctor, there's always a third person in the room. Last week, it was Allyson Untiedt, 24, of Minneapolis, who is one of the small but growing number of "scribes" working in medical clinics and hospitals across the Twin Cities. Scribes accompany physicians in exam rooms and help document what happens during a patient's visit. They tend to a patient's chart before the exam -- so doctors can quickly find the lab and test results they need -- and help physicians complete documentation chores afterward (Snowbeck, 6/1).

North Carolina Health News: Parallel Epidemics: Living With HIV And A Criminal Record 
People who are HIV positive who have been in prison face challenges accessing services. Once released, former prisoners are provided with a 30-day supply of antiretroviral drugs and are linked up with HIV care coordinators who help them make appointments on the outside. But the sudden transition from prison to the outside can be a jarring experience for some, especially people who have little social support. Tasks such as getting transportation for doctor’s appointments, paying for health care and achieving some semblance of financial security can be difficult for people who are both formerly incarcerated and HIV positive (Hoban, 6/2).

Modern Healthcare: Hospitals Offering Patients No-Interest Payment Plans 
Novant Health long has had a financial assistance program for patients with incomes under 300 percent of the federal poverty level. But in recent years, more patients who are eligible for assistance still have gotten overwhelmed by thousands of dollars they owe for deductibles and coinsurance. Novant wanted a way to give patients more time to pay their bills without facing high interest costs. At Novant's 12 hospitals, patients previously had the option of a payment plan carrying a 12 percent interest rate. But early last year, the Winston-Salem, N.C.-based system, working with vendor ClearBalance, started offering a no-interest plan with a flexible repayment time frame. It combined that with an online cost estimator so patients can get a good idea of how much they will owe before receiving health care services. (5/31).

WBUR: Poor Get Poorer But Babies Get Healthier, Thanks To Help For Moms
(Patricia) Wornum and over a hundred other home visitors in Massachusetts are trying to combat a known phenomenon: If you are born to a poor mother, that overwhelmingly raises the chances that you will grow up to be poor. The odds are stacked against you in several ways: Poverty can mean stress and anxiety, poor nutrition and environmental toxins, higher risks of obesity and heart disease. An entire issue of the journal Science on “The Science of Inequality” this month rounded up some of that bad news. But it also shared what Janet Currie, an economics professor at Princeton, calls a “bright spot” -- though inequality has been rising, the health of newborns born into the poorest families has been improving (Emanuel, 5/30).

The California Health Report: Sacramento Heroin Addiction On The Rise, Affordable Care Act Opens Doors For Recovery
Kurt Wagner was 12-years clean when his life began to unravel. He lost his job, his wife left and the money ran out. Homeless and alone, the uninsured Wagner had to pay $300 a month for methadone treatment. When he could no longer afford it, it was only a matter of time before he fell off the wagon… And this was how he lived for years after: on and off of methadone, then relapsing whenever money for treatment ran out. It wasn’t until three months ago, when he joined the millions of Californians who have signed up for Medi-Cal since last year, that Wagner was able to clean up for good. He is among 7,774 Californians taking advantage of addiction services newly available to them thanks to the expanded coverage and services mandated under the Affordable Care Act (Kempa, 6/1).

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Editorials and Opinions

Commentary On VA Shake-Up:Inadequate Performance Measures; Congress Must Do Its Part; Similarities To Medicare

Media outlets offer opinions on Gen. Eric Shinseki's departure from the Department of Veterans Affairs and efforts to fix problems in that system.

Los Angeles Times: The Problem At The VA: 'Performance Perversity'
The acting inspector general's investigation into delays at Veterans Health Administration facilities points to problems so systemic that they cannot be attributed to a few bad apples. But the report does not tell us why these problems occurred. The most likely answer is "performance perversity": Imperfect performance measures were tied to pay incentives. Such performance incentives have been portrayed as the best way to manage all kinds of public services, even as evidence of their problems mount (Donald Moynihan, 6/1).

The Washington Post: Will Congress Be As Brave As Shinseki?
If you want a prime example of what's wrong with our politics, study the response to the veterans' health-care scandal. You would think from the coverage that the only issue that mattered to politicians was whether Gen. Eric Shinseki should be fired. Shinseki is a true patriot, and his resignation as Veterans Affairs secretary on Friday calls Congress's bluff. He played his part in a Washington sacrificial ritual. Will the politicians now be honorable enough to account for their own mistakes? (E.J. Dionne Jr., 6/1). 

The Washington Post: VA Reforms Should Preserve The System's Quality Of Care
It is clear, though, from a reading of the report by the department’s Office of Inspector General — the 19th report issued since 2005 about delays and scheduling issues — that it will take more than a ritual resignation and the election-year posturing that accompanied it to resolve the systemic issues that have long plagued the VA (5/31). 

The Washington Post: Did Shinseki Fail His Underlings By Trusting Them Too Much? 
To many in the trenches of the vast and decentralized VA system, Shinseki was seen as "the good guy everybody knew was trying to help," [retired psych nurse Janet] Nickolaus said. But of course, that undercover drop-by she hoped for never happened. And so much bad news was covered up that Shinseki resigned Friday over a widespread conspiracy to hide long wait times for military veterans seeking care. It's often said that an organization's tone is set at the top — and that person sends employees a message of either fear or safety about speaking up to voice concerns (Melissa Henneberger, 5/31). 

USA Today: At VA, Now Comes The Hard Part: Our View
But the bad news about waiting times was in fact flagged repeatedly by VA watchdogs going back to 2005. In 2009, the Office of Inspector General said it listed the problem as one of the "hot issues" for the then-new Obama administration to handle. ... Other problems may require an overhaul of VA management and certainly of VA thinking. ... The administration will need to find new leaders who have experience in the private sector, who are proven managers, who know how to run hospitals or huge academic institutions. Their job will not only be fixing what's broken but to change the culture to ensure against a relapse (6/1).

USA Today: After Shinseki's Misrule, VA Needs Accountability: Column
The VA is more than one man, and it's important to remember that the secretary's departure is not the final word on the VA's woes. This should not be seen as an end, but a beginning. Now comes the hard work of turning around a deeply troubled agency. For the last several weeks, it looked as if the VA was hoping to "run out the clock" on this scandal. The thinking appeared to be that if Shinseki and the rest of the status quo leadership could simply hang on, the uproar over falsified records, secret wait lists, destroyed documents, preventable patient deaths and corrupt bonuses paid to VA executives would subside, and the media spotlight would shift elsewhere (Darin Selnick, 5/30). 

The Wall Street Journal’s Washington Wire: What The VA Scandal And Medicare Cost Issues Have In Common
The federal government adjusts its payment policies, the health-care system tailors its practices to meet those new policies, and a variety of unexpected—and perverse—consequences result. This isn't just one aspect of the VA scandal. It also describes the effects of physician payment policies in Medicare. In the case of the Department of Veterans Affairs, decisions to tie performance bonuses to patient waiting times apparently resulted in attempts to manipulate the appointment system. Incidents reported in Pennsylvania, Wyoming and New Mexico illustrate how compensation and bonuses drove decisions about patient care (Chris Jacobs, 5/30). 

The Wall Street Journal: Real Accountability At The VA
If failure is an orphan, Eric Shinseki is now Oliver Twist. The Veterans Affairs Secretary did the honorable thing and resigned on Friday, and the White House is hoping this will plug its political leak. But the next President, and the ones after that, will endure more VA scandals without more reform than President Obama is offering. Mr. Obama said he only reluctantly accepted Mr. Shinseki's exit so he would not be "a distraction" from fixing the VA—and until this week the cable-TV carnival over his status was mostly that. But the Inspector General's preliminary findings reveal a systematic and perhaps criminal conspiracy to falsify wait-time records across dozens of hospitals and clinics (5/30). 

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Viewpoints: GOP Needs To Refine Its Message On Health Law; Battle Over School Lunches

The New York Times: The Vanishing Cry of 'Repeal It'
It was supposed to be so easy this election year for Republican congressional candidates. All they would have to do was shout "repeal Obamacare!" and make a crack about government doctors and broken websites, and they could coast into office on a wave of public fury. ... But it has not quite worked out that way. ... That sentiment conflicts with the Republican playbook, which party leaders are suddenly trying to rewrite. The result has been an incoherent mishmash of positions, as candidates try to straddle a widening gap between blind hatred of health reform and the public’s growing recognition that much of it is working (6/1).  

Politico: Running in 2016? Don't Like Obamacare? Better Offer An Alternative.
I am of the view that any candidates thinking about running for the Republican nomination in 2016 have to make clear that while they seek to repeal Obamacare, they also want to put in place a better health care system than the one we had before the law was passed in 2010. It is essential, therefore, that each candidate articulate a set of reforms that can plausibly replace Obamacare and, more importantly, address the challenge of rising health care costs (Lanhee Chen, 6/1). 

Bloomberg: Dr. Carson Will Find Politics Is Best Left to Politicians
[Dr. Ben] Carson, a retired physician at Johns Hopkins Medical Institutions, has become a favorite of the political right as he weighs a run for the Republican presidential nomination. ... In his calm, appealing manner, he unleashed a harsh critique of the Affordable Care Act at the National Prayer Breakfast last year, in front of President Barack Obama. He has gone on to call Obamacare "the worst thing that has happened in this nation since slavery," which, he said, it resembles. He later explained he was talking about any attempt to take away an individual's control of his or her life. He hasn't included Medicare in that critique yet (Albert R. Hunt, 6/1). 

Forbes: Five Alternative Futures For Obamacare
[T]here is more uncertainty about what will happen to our health care system over the next five years than at any other time during the more than four decades I have been studying health policy matters. The range of possibilities include full repeal, repeal and replacement post-2016, morphing into "zombie legislation," Medicare redux and H.J. Res. 263 redux ... We can do much better than Obamacare. Put another way: if Obamacare is the best this nation can do, our best days are behind us (Chris Conover, 6/1).

The New York Times: Bad Food In School Cafeterias
Republicans on a powerful House committee have balked at requiring all schools to serve healthy lunches in the coming school year. The action drew a well-deserved rebuke from the first lady, Michelle Obama, who has focused public attention on combating obesity among young people through exercise and better nutrition. Let's hope the Senate holds out against such inanity (6/1). 

The Washington Post: Michelle Obama's 'Let’s Move!' Goes Too Far
The first lady’s "Let’s Move!" program and her focus on whole foods (as opposed to fast) and water instead of sodas have been welcome developments. Who better to bring needed attention to such issues? Obama is merely expanding her maternal focus to include all those public school kids whose mothers apparently have forgotten how to make a sandwich. Or whose fathers have forgotten to say, "Get those plugs out of your ears and make friends with the lawn mower" -- or whatever its urban equivalent. But, as is often the case with mammoth federal programs, one size does not fit all (Kathleen Parker, 5/30).

The New York Times: A Vote On Medical Marijuana
The New York State Assembly easily approved a law legalizing medical marijuana last Tuesday, and there appear to be enough votes to pass similar legislation in the State Senate if that chamber's leaders agree to allow a vote. They ought to do so before the legislative session ends on June 19. The bills would make the drug available, under tight regulation, to patients who, in many cases, do not get relief from other medications (6/1). 

The Denver Post: Getting Serious On Rx-Drug Overdoses
Robert Valuck, professor of pharmacy at the University of Colorado, likens the prodigious task of reducing the country's non-medical use of prescription drugs to turning an aircraft carrier. "The forces are so large," he said. Deaths linked to prescription opioid use have doubled in 10 years in Colorado. For that matter, nonmedical use of painkillers is 19 percent higher here than the national average, according to the Centers for Disease Control and Prevention. ... One idea that could help became law last week when Gov. John Hickenlooper signed a bill to modify the state's prescription drug monitoring program to better identify abuse and prevent overdoses (5/30).

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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.