Daily Health Policy Report

Friday, June 20, 2014

Last updated: Fri, Jun 20

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Public Health & Education

Health Care Marketplace

Medicare

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Review Finds Flawed Management Of Nursing Home Inspections In Los Angeles County

Kaiser Health News' staff writer Anna Gorman, working in collaboration with the Los Angeles Daily News, reports: "Los Angeles County public health staff repeatedly failed to follow state policies on nursing home inspections, leading to improper closure of cases and incomplete and delayed investigations, according to a report issued by the California Department of Public Health. After reviewing a sampling of 136 cases received since 2009, the state health department found that LA. County officials did not properly prioritize or track investigations. The county faces a backlog of hundreds of nursing home safety complaints" (Gorman, 6/20). Read the story.

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Survey: Most People Buying On Insurance Exchanges Weren’t Previously Covered

Kaiser Health News' staff writer Julie Appleby reports: "Nearly six in 10 Americans who bought insurance for this year through the health law’s online marketplaces were previously uninsured—most for at least two years, according to a new survey that looks at the experiences of those most affected by the law. That finding is higher than some earlier estimates, and counters arguments made by critics of the law that most of those who purchased the new policies were previously insured" (Appleby, 6/19). Read the story.

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A Reader Asks: Can Our Plan Kick Off Our Daughter Because Her Job Offers Coverage?

Kaiser Health News’ consumer columnist Michelle Andrews answers a reader question about coverage for adult children and what rules apply to grandfathered plans (Andrews, 6/20). Read the story.

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Capsules: Senators Offer Bill To Ease Readmission Penalties On Some Hospitals; Consumer Group Urges Hospitals To Stop Promoting Questionable Screenings

Now on Kaiser Health News' blog, Jordan Rau reports on new congressional legislation: "A bipartisan group of senators introduced legislation on Thursday to make Medicare take the financial status of hospital patients into account when deciding whether to punish a hospital for too many readmissions. The bill attempts to address one of the main complaints about the readmissions program: that hospitals serving large numbers of low-income patients are more likely be penalized" (Rau, 6/19). 

Also on Capsules, Julie Appleby reports about new criticism of a screening program offered by some hospitals: "Consumer advocacy group Public Citizen on Thursday called on 20 hospital systems to stop partnering with companies that offer low-cost screenings for heart disease and stroke risk, saying the promotions are "unethical" and the exams are more likely to do harm than good" (Appleby, 6/19). Check out what else is on the blog



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Political Cartoon: 'Are You Toying With Me?'

Kaiser Health News provides a fresh take on health policy developments with 'Are You Toying With Me?' By Graham Harrop.

Meanwhile, here's today's haiku:

Survey data show
Most of the newly insured
Are newly insured
-Anonymous

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

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Health Reform

Most People Buying On Exchanges Were Uninsured, Survey Finds

Nearly six in 10 people buying their own health insurance through health law exchanges were previously uninsured -- most for at least two years, according to a new survey by the Kaiser Family Foundation that looks at the experiences of those most affected by the law. (Kaiser Health News is an editorial independent project of the foundation.)

The Wall Street Journal: Poll: Nearly 60% Of Exchange Enrollees Were Uninsured
Almost six in 10 people who bought health insurance through the Affordable Care Act’s online exchanges had been uninsured just before they went shopping for a health plan, according to a new survey by the Kaiser Family Foundation. The finding offers another glimpse at whether the 2010 law achieved its main goal: to reduce the number of uninsured people in the U.S., which was around 45 million before the law’s passage (Radnofsky, 6/19). 

The New York Times: Health Exchange Enrollees Had Mostly Been Uninsured
Four in 10 people enrolling in health plans through the new insurance exchanges already had insurance, but six in 10 were previously uninsured, according to a Kaiser Family Foundation survey released Thursday. Most of the uninsured had been without coverage for two years or more, and 45 percent said they had been without coverage for at least five years, the foundation said in a report about people in the individual insurance market (Pear, 6/19). 

Los Angeles Times: Most With Obamacare Were Previously Uninsured, New Survey Finds
About 4.5 million of the 8 million Americans who signed up for health insurance on marketplaces created by the new federal healthcare law did not previously have insurance, according to a national survey that provides the most detailed look to date at who enrolled for coverage under the Affordable Care Act this year (Levey, 6/19). 

Kaiser Health News: Survey: Most People Buying On Insurance Exchanges Were Uninsured
Nearly six in 10 Americans who bought insurance for this year through the health law’s online marketplaces were previously uninsured—most for at least two years, according to a new survey that looks at the experiences of those most affected by the law. That finding is higher than some earlier estimates, and counters arguments made by critics of the law that most of those who purchased the new policies were previously insured (Appleby, 6/19).

The Washington Post: Most Obamacare Exchange Enrollees Were Previously Uninsured, Survey Finds
About six in 10 people who bought their own health insurance through Affordable Care Act exchanges were previously uninsured, according to a new survey providing one of the first comprehensive looks at the insurance landscape after the health care law's first open enrollment period (Millman, 6/19). 

The Fiscal Times: New Poll Shows More Uninsured Get Coverage
The main goal of the president’s health care law is to expand access to coverage to the millions of uninsured Americans—and according to a new survey of Obamacare enrollees—it may be achieving that goal. Nearly six in 10 people-or 4.5 million—who signed up for Obamacare were previously uninsured, a new Kaiser Family Foundation survey found. The majority of these people said they had gone without coverage for at least two years and nearly 70 percent said they decided to buy insurance because of the law, while a little over a quarter said they would have gotten it anyway (Ehley, 6/19).

CQ Healthbeat:  Most Exchange Plan Buyers Had Been Uninsured, Study Shows
The majority of people who bought insurance through health law exchanges were previously uninsured, according to a study that honed in on the experiences of people who purchased plans in the individual market. The study is the first of series planned by the Kaiser Family Foundation designed to answer some common questions about who was enrolling through the exchanges. These state and federal web-based programs are a defining feature of the implementation of the 2010 health law (Young, 6/19).

Meanwhile, another analysis looks at the cost of the new plans -

CBS News: For Some, Obamacare Delivers ​"Sticker Shock"
Is health insurance bought through Obamacare really as affordable as it could be, or are prices higher than what was available before the federal program took effect in January? At least for some Americans, new research suggests, Obamacare is delivering a hefty dose of sticker shock. According to a working paper published by the National Bureau of Economic Research, insurance premiums rose from about 14 percent before the Affordable Care Act was implemented to as high as 28 percent post-Obamacare for plans bought in California and states using federally run insurance marketplaces. Those figures are before tax credits, it's worth noting (Picchi, 6/19).  

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Montana Medicaid Ballot Initiative Falls Short

Supporters announced that they didn't have enough signatures by the filing deadline. Meanwhile, in other state news on Medicaid expansion, Virginia Gov. Terry McAuliffe is facing a deadline on how to respond to the General Assembly's budget, which did not include his request.

Helena (Mont.) Independent Record: Medicaid Expansion Initiative Fails To Make November Ballot
An initiative to expand Medicaid coverage to 70,000 low-income Montanans won’t be on the November ballot this year, as supporters Thursday said don’t have enough signatures to qualify Initiative 170 for the ballot. With today’s deadline looming for turning in the signatures, Kim Abbott, president of Healthy Montana Initiative, the organization behind I-170, said the group is several thousand signatures short (Dennison, 6/19).

The Richmond Times-Dispatch: Deeds Urges McAuliffe To Veto Medicaid Amendment
State Sen. R. Creigh Deeds, D-Bath, is urging Gov. Terry McAuliffe to use his line-item veto to strip from the budget an amendment that seeks to tie his hands on Medicaid expansion. Lawmakers approved a two-year budget late Thursday night, breaking a three-month logjam. Republican senators included an amendment that bars Medicaid expansion or a private alternative without approval of both houses of the General Assembly. In an email newsletter to constituents Tuesday, Deeds called the line-item veto "the best option" for the governor (Cain, 6/19).

The Washington Post: Va. Officials Skeptical Of U.S. Interest In Phillip Puckett's Resignation From State Senate
Federal investigators this week interviewed officials and sought documents in connection with [Sen. Phillip] Puckett’s exit, which handed Republicans control of the Virginia Senate at a critical time and was connected to job prospects for Puckett and his daughter. The resignation enraged Democrats, who accused Republicans of bribing Puckett to leave the Senate as a way to break a deadlock over the state budget and Medicaid expansion. Puckett said there was no quid pro quo but withdrew his name from consideration for a top job with the state tobacco commission (Vozzella, Zapotosky and Portnoy, 6/19). 

North Carolina Health News: NC House And Senate Still At Odds Over Medicaid Reform, Funding
Members of the North Carolina House and Senate are a few steps closer to finding a way forward on Medicaid after a key committee meeting late Thursday afternoon. In a meeting of the House Health and Human Services Committee, co-chair Rep. Nelson Dollar (R-Cary) presented an update to an earlier Medicaid reform plan that moves the federal- and state-funded program closer to the managed care model favored by Senate leaders (Hoban, 6/20).

The Associated Press: 300,000 In Michigan Enroll For Medicaid Expansion
More than 300,000 Michigan residents have enrolled in the state’s expanded Medicaid program since it launched 11 weeks ago. The Healthy Michigan Plan began enrollment April 1. Medicaid expansion is anticipated to cover 320,000 low-income adults in the first year, though it could be much more given the rapid race of enrollment so far (6/19).

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Calif. Marketplace Officials Raise Concerns About Initiative's Effects

Backers of the ballot measure say it will not disrupt how the exchange works in the state but allow the insurance commissioner more authority over premium increases.

Los Angeles Times: Ballot Measure Won't Disrupt Obamacare In California, Backers Say
In response to concerns raised by California's health exchange, backers of a statewide ballot measure on health insurance rate regulation insisted Thursday that the measure would not disrupt how Obamacare works in the state. Consumer groups and California Insurance Commissioner Dave Jones are pushing for more authority over health premiums for consumers and small businesses. In November, voters will decide whether to give the insurance commissioner veto power over rate increases (Terhune, 6/19).

The Sacramento Bee: California Health Exchange Wants To Analyze Rate Initiative
California's health insurance exchange pressed for answers Thursday to how an initiative slated for the November ballot would affect its operations. Covered California board members said they want an expedited analysis of the measure, including its influence on the exchange and its consumers. The as-yet-unnumbered initiative, advanced by Consumer Watchdog and Democratic Insurance Commissioner Dave Jones, would allow the insurance commissioner to reject excessive health insurance rate hikes. The measure and a separate initiative to raise the $250,000 cap on pain and suffering damages in malpractice cases are expected to produce two of the most contentious and expensive ballot-box fights this fall (Cadelago, 6/19).

And in local news reports about insurance coverage under the law -

The San Jose Mercury News: Contra Costa Health Plan Must Withdraw From State Health Insurance Exchange
An East Bay health insurance plan offered under Covered California elected to withdraw from the exchange in 2015 because it could not meet a federal regulation. The Contra Costa Health Plan, which says its 1,100 new enrollees will remain covered through the end of the year, ran afoul of a recently clarified rule that insurers must offer the same plan inside or outside the exchange. "We are deeply disappointed that we are going to have to exit for the next year under the exchange," Patricia Tanquary, CEO of the health plan, told the Covered California board of directors at its monthly meeting Thursday in Sacramento (Seipel, 6/19).

Los Angeles Times: Number Of Uninsured In Los Angeles Could Drop 57% By 2016, Study Finds
The number of uninsured residents in Los Angeles could drop 57% by 2016 as a result of the federal health law's expansion of coverage, according to a new report. The study released Thursday by the Robert Wood Johnson Foundation predicts that the number of city residents without health coverage could decline from 1.2 million people to 524,000 in 2016. Researchers examined changes in health insurance in 14 big cities, half of which are in states that didn't expand Medicaid as part of the Affordable Care Act (Terhune, 6/19).

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Preliminary Report Examines Immigrants' Issues Getting Coverage

A study to be released in the next several weeks by an Illinois advocacy group examines issues that prevented the enrollment of many legal immigrants, The Associated Press reports. Meanwhile, The Washington Post examines a coal mining community's hostility to the health overhaul despite its residents' needs.

Associated Press:  Poorly Designed Federal System Impacted Immigrant Health Signups
A poorly designed federal system prevented perhaps thousands of immigrants from enrolling in coverage under President Barack Obama's health care overhaul, according to a preliminary report from an Illinois advocacy group. The Associated Press was given the report by the Illinois Coalition for Immigrant and Refugee Rights on Wednesday, a day before its planned release was abruptly postponed. The report says federal phone operators were misinformed about immigrant eligibility, a credit agency verifying identities couldn't handle languages other than English and Spanish and some immigrants were incorrectly referred to Medicaid, causing their applications to be frozen (Johnson, 6/19).

The Washington Post: In Southwest Va., Health Needs And Poverty Collide With Antipathy To Affordable Care Act
Carolyn Underwood remembers her dad coming home covered in black coal dust from the mines. ... In old age, he suffered from black-lung disease and wore an oxygen supply constantly. But unlike his daughter, he never worried about how he would pay his medical bills. The union took care of it. That doesn' make Carolyn Underwood, 63, a supporter of expanded government health coverage, even though she would benefit from it. In a region where the decline of the coal industry has sent poverty and health-care needs soaring, another force has grown at least by equal measures: antipathy to President Obama and the Affordable Care Act (Portnoy, 6/19). 

Also, former White House press secretary Jay Carney calls the troubled exchange rollout one of his greatest challenges -

The Wall Street Journal: Carney: Obamacare Rollout Was Toughest Period As Spokesman
As White House press secretary Jay Carney prepares to head for the exits, he's reflecting on the highs and the lows of the job …. Mr. Carney' time at the White House has included plenty of political victories and setbacks for the president, but he said the most difficult period was dealing with the "pretty awful rollout" of the HealthCare.gov website. The technical problems that thwarted enrollment efforts for several weeks last fall created a sustained bad news story, he said, noting that this was a problem of the administration’s own making (McCain Nelson, 6/19). 

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Capitol Hill Watch

In Letter To Hill, HHS Asserts Authority To Redistribute Money To Insurers

Elsewhere, more subpoenas are issued in the investigation of whether some Hill staffers may have leaked Medicare policy news to stock brokers.

The Hill:  Republicans Spar With HHS Over Insurer 'Bailout'
Congressional Republicans are clashing with the Obama administration over whether it has the authority to distribute money to health insurance companies in what they are calling a "taxpayer bailout" under Obamacare. Health and Human Services Secretary Sylvia Mathews Burwell sent a letter this week to Rep. Fred Upton (R-Mich) and Sen. Jeff Sessions (R-Ala.) asserting that she has the legal authority to redistribute the money in the "risk corridors" program, which was created by the health care law (Al-Faruque, 6/19).

The New York Times: House Ways And Means Committee Subpoenaed In Insider Trading Case
Federal prosecutors and financial regulators have subpoenaed Congress in an investigation that could test the limits of federal insider trading laws. The investigation focuses on a Washington research company, Height Securities. Last year, it correctly predicted a change in government health care policy, prompting a surge in the stock prices of health insurance companies. … The authorities want to know if someone in the government improperly revealed the forthcoming policy change (Apuzzo, 6/19). 

The Hill:  Ways And Means Subpoenaed In Medicare Leak Probe 
Federal prosecutors have issued subpoenas for the House Ways and Means Committee and a top health care aide as part of an investigation into an alleged leak of sensitive Medicare policy news. The Justice Department and the Securities and Exchange Commission are probing whether government officials illegally passed on information that led to a surge in insurance stocks before a major Medicare policy announcement last spring (Viebeck, 6/19).

And senators introduced a bill to lessen the Medicare penalties on some hospitals that have high rates of patient readmissions --

Kaiser Health News: Senators Offer Bill To Ease Readmission Penalties On Some Hospitals
A bipartisan group of senators introduced legislation on Thursday to make Medicare take the financial status of hospital patients into account when deciding whether to punish a hospital for too many readmissions. The bill attempts to address one of the main complaints about the readmissions program: that hospitals serving large numbers of low-income patients are more likely be penalized (Rau, 6/19).

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Coverage & Access

Obama To Extend Full Marriage Benefits To Gay Couples

Same-sex married couples will be eligible for emergency family leave and the full panoply of spousal benefits provided under federal law, regardless of whether the state in which they live recognizes their marriages. In addition, the government plans to extend those benefits to federal employees.

The New York Times: Obama To Extend Array Of Marriage Benefits To Gay Couples
The federal government on Friday will extend a wide range of marriage benefits to same-sex couples, making good on a promise by President Obama after the Supreme Court struck down the Defense of Marriage Act last year. ... The spouses of gay federal employees will get health insurance, life insurance and flexible spending accounts. In addition, federal employees will be able to take leave to care for a same-sex spouse, something that has long been limited to heterosexual married couples (Shear, 6/20). 

The Wall Street Journal: Same-Sex Couples To Get More Benefits
The Obama administration will announce Friday the extension of more benefits and obligations to same-sex married couples, including plans to allow workers nationwide to take leave from their jobs to care for same-sex spouses. The White House also is expected to press Congress to pass legislation needed to change some provisions, such as Social Security benefits, to apply to same-sex married couples (McCain Nelson and Bravin, 6/20).

Los Angeles Times: Same-Sex Couples Eligible For Family Leave, Administration Says
The Obama administration will announce Friday that it plans to make same-sex spouses eligible for emergency family leave to care for their partners regardless of whether the state in which they live recognizes their marriages. The Department of Labor will issue a proposed rule making clear that the right to time off under the Family and Medical Leave Act is valid for all legally married couples, according to a White House official who asked for anonymity because the news was not yet official (Phelps, 6/19).

The Washington Post: New Proposal Would Make Same-Sex Partners Eligible Under Family And Medical Leave Act
The Labor Department will issue a proposed rule Friday stating that any employee is eligible for leave to care for a same-sex spouse under the Family and Medical Leave Act, according to White House officials, regardless of whether they live in a state that recognizes their marital status. ... Due to FMLA’s scope, the Labor Department rule would apply only to private-sector employees, but administration officials said the Office of Personal Management would issue its own proposal Friday extending the same benefits to federal employees (Eilperin, 6/20).

Associated Press:  Obama Moves To Ensure Sick Leave For Gay Couples
The Obama administration will work to ensure that gay and lesbian Americans are eligible to take leave from their jobs to care for a same-sex spouse, regardless of whether they live in a state that recognizes gay marriage, the White House said Friday. President Barack Obama is directing the Labor Department to start drafting rules making clear that the Family and Medical Leave Act applies to same-sex couples, allowing gay and lesbian employees to take unpaid leave to care for a sick spouse regardless of where they live. The move comes three years after the Obama administration stopped defending the Defense of Marriage Act, which lets states refuse to recognize gay marriages performed in other states (Lederman, 6/20).

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Public Health & Education

CDC Says Scientists May Have Been Exposed To Anthrax

As many as 75 researchers in Atlanta may have come in contact with the live virus after workers failed to follow proper safety procedures. CDC says the risk of infection, however, is low.

The New York Times: C.D.C. Details Anthrax Scare For Scientists At Facilities
As many as 75 scientists from the Centers for Disease Control and Prevention may have been exposed to live anthrax bacteria after potentially infectious samples were sent to laboratories unequipped to handle dangerous pathogens, a spokesman for the federal health agency said Thursday. The agency was testing a new way to kill anthrax, which it discovered did not work as well as expected (Tavernise and McNeil, 6/19). 

Los Angeles Times: Anthrax: 75 CDC Workers Might Have Been Exposed To Pathogen
About 75 staff members at the Centers for Disease Control and Prevention in Atlanta are being monitored or given antibiotics after they were potentially exposed to anthrax, the CDC announced. A failure to follow established safety practices caused the possible exposure, the agency said Thursday in a statement, adding that it believed the risk of infection was very low and that nobody else was at risk of exposure (Raab, 6/19). 

The Wall Street Journal: CDC Lab Scientists May Have Been Exposed To Live Anthrax
Potentially exposed staff are being given antibiotics and monitored for symptoms of infection, the CDC said in a statement. "Based on most of the potential exposure scenarios, the risk of infection is very low," it said. It said there is no risk to other CDC staff or the general public (McKay, 6/19). 

The Washington Post: CDC Says About 75 Scientists May Have Been Exposed To Anthrax
The potential exposure took place after researchers failed to follow adequate protection procedures to inactivate anthrax samples at one CDC lab in Atlanta before transferring them to three other CDC labs not equipped to handle live anthrax bacteria, the statement said. Workers at those three labs, believing the samples were inactivated, were not wearing adequate personal protective equipment while handling the material (Sun, 6/19). 

Politico: CDC Reports Anthrax Exposure At Lab, No Known Illness
Dozens of scientists at Centers for Disease Control and Prevention laboratories in Atlanta may have been exposed this month to live anthrax bacteria, the agency announced Thursday. As many as seven researchers in a high-level biosecurity lab at the CDC campus may have been put at risk after failing to follow procedures to inactivate the bacteria. Their error was compounded when the samples were sent to three lower-security labs not equipped to handle live anthrax, where unknowing workers didn’t wear adequate protective gear while handling the material (Levine, 6/19). 

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Health Care Marketplace

Consumer Group Presses Hospitals To Stop 'Unethical' Screenings

Public Citizen called on 20 hospitals to stop partnering with companies that promote low-cost medical screenings, which it says can lead to unneeded, expensive and even risky follow-up exams.

Kaiser Health News: Consumer Group Urges Hospitals To Stop Questionable Screenings
Consumer advocacy group Public Citizen on Thursday called on 20 hospital systems to stop partnering with companies that offer low-cost screenings for heart disease and stroke risk, saying the promotions are 'unethical' and the exams are more likely to do harm than good (Appleby, 6/19).

Los Angeles Times: Consumer Group Urges Hospitals To Stop 'Unethical' Health Screenings
A prominent consumer group is calling on 20 hospitals, including three in Southern California, to stop marketing medical tests to patients that the group considers unnecessary and unethical. Public Citizen said it sent letters to hospitals in eight states Thursday asking the institutions to cut ties with HealthFair Health Screening of Winter Park, Fla., because its heavily advertised testing program is likely to do more harm than good for consumers (Terhune, 6/19).

USA Today: Consumer Group Urges Hospitals To End Mass Screenings
A consumer group called on hospitals across the USA to stop "fear mongering" by marketing health screenings directly to patients. Public Citizen says the low-cost tests -- advertised for what appear to be "bargain basement" prices -- often lead to expensive and even risky follow-up exams (Szabo, 6/19).

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Medicare

Fla. Cancer Docs Bill Often For Controversial Drug

And former Health and Human Services Secretary Tommy Thompson is urging Medicare to cover some obesity medicines.

The Wall Street Journal: Cancer Doctors Ring Up Big Medicare Bills For Tarnished Drug Procrit
Many cancer doctors now use a drug called Procrit sparingly. It was approved in 1989 for anemia and became a popular treatment for that side effect of chemotherapy. But regulators later learned Procrit can speed tumor growth and hasten death in cancer patients. … Medicare paid U.S. oncologists $128 million in 2012 to administer Procrit, federal data show. One-sixth of that money went to oncologists in the group, Florida Cancer Specialists. Of the 20 oncologists whom Medicare paid most for Procrit, 11 belonged to the Florida group (Weaver, Wilde Mathews and McGinty, 6/20). 

Associated Press:  Officials Want Medicare To Cover Obesity Medicine 
Former U.S. Health and Human Services Secretary Tommy Thompson is urging Congress to pass year-old legislation requiring Medicare to cover obesity medicines for seniors. The ex-Wisconsin governor was in Lansing Wednesday drawing attention to the obesity problem. Thompson says fitness and diet are important, but some overweight people also need medications because of genetics and metabolism. He says if Medicare covers obesity treatments, long-term costs associated with chronic diseases will drop (6/19). 

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State Watch

Audit Questions Female Inmate Sterilizations In California

At least 39 female inmates in California prisons underwent sterilizations in which the women's informed consent was in question, according to a state audit released Thursday.

Los Angeles Times: Audit Questions Whether 39 Female Inmates Consented To Sterilization
At least 39 female inmates at California prisons underwent sterilizations in which the women's informed consent was in question, according to a state audit released Thursday. The inquiry by the California state auditor found no evidence that doctors documented that the women had consented to the procedure in 27 cases. In 18 cases there were "potential violations" of the required waiting period between consent and the sterilization procedure, the report stated. Both violations may have occurred in some of the cases (Willon, 6/19). 

The Associated Press: Audit Seeks Investigation Of Inmate Sterilizations
State auditors found 39 cases where female state prison inmates may not have understood they were submitting to medical procedures that would leave them sterile, according to a report released Thursday that recommended authorities investigate the doctors and hospitals involved. State law prohibits inmates from elective sterilizations as methods of birth control. However, prison officials allow sterilizations in cases deemed medically necessary (Thompson, 6/19).

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N.Y. Lawmakers Reach Medical Marijuana Deal

The agreement would allow doctors to prescribe it for a half-dozen medical conditions, but some lawmakers say the deal was more limited than they had hoped.

The New York Times: New York Leaders Reach Deal On Medical Marijuana
Gov. Andrew M. Cuomo and legislative leaders announced an agreement on Thursday for a pilot program to provide access to marijuana to sick New Yorkers, making the state one of the largest to embrace the drug’s use as medicine (McKinley, 6/19). 

The Wall Street Journal: New York State Reaches Multiple Last-Minute Deals
After days of intense negotiations, the medical pot bill was more limited than many lawmakers wanted, after the governor warned he would sign it only with strict requirements. It would permit only doctors to prescribe marijuana, in forms including oil-based and vapor, to individuals with any of about a half-dozen conditions, including cancer, AIDS, epilepsy and multiple sclerosis (Orden, 6/19). 

Meanwhile, mothers of epileptic children push the federal government to change its 'no accepted medical use' classification of marijuana -

The Washington Post: Fairfax, Frederick Moms Lobby Feds For Medical Marijuana For Kids With Epilepsy 
Beth Collins of Fairfax, one of two Northern Virginia mothers who have moved to Colorado to obtain medical marijuana oil for her daughter with epilepsy, is continuing the effort by mothers across the country to make the oil available for the thousands of families with children who have multiple seizures every day. ... Collins reached out to the Office of National Drug Control Policy to lobby for a shift in the federal scheduling of marijuana from its current classification of “no accepted medical use.” On Monday she, her husband Patrick Collins and Shannon Moore of Frederick, who successfully advocated for medical marijuana in Maryland, had a conference call with high-level officials with the Food and Drug Administration, the National Institute on Drug Abuse, and the ONDCP (Jackman, 6/19).

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State Highlights: Suit Over Transgender Medicaid Coverage In N.Y.; Calif. Nursing Home Inspections

The Associated Press: New York Sued Over Transgender Medicaid Coverage 
A lawsuit filed Thursday against New York state seeks Medicaid coverage for transgender people seeking what they consider to be life-saving health treatments, including gender change procedures. The lawsuit, filed in federal court in Manhattan against the state health commissioner, seeks class-action status on behalf of people seeking hormone therapy and sex reassignment surgery (Neumeister, 6/19).

Kaiser Health News: Review Finds Flawed Management Of Nursing Home Inspections In Los Angeles County
Los Angeles County public health staff repeatedly failed to follow state policies on nursing home inspections, leading to improper closure of cases and incomplete and delayed investigations, according to a report issued by the California Department of Public Health. After reviewing a sampling of 136 cases received since 2009, the state health department found that LA. County officials did not properly prioritize or track investigations. The county faces a backlog of hundreds of nursing home safety complaints (Gorman, 6/20).

Los Angeles Times: L.A. County's Olive View Hospital Settles Patient Dumping Case 
A Los Angeles County hospital in Sylmar has agreed to pay $40,750 to settle federal allegations of patient dumping. Attorneys with the Office of Inspector General of the U.S. Department of Health and Human Services alleged that Olive View-UCLA Medical Center failed to properly screen a patient to determine if he had an emergency medical condition (Sewell, 6/19).

The Texas Tribune/New York Times: Questions On Treatment Of Mentally Ill By State 
The sheriff of the state's largest county is peeved with the Texas Department of State Health Services, the agency that runs the state's mental health hospitals. The agency is not offering the care that it is required to provide, the Harris County sheriff, Adrian Garcia, said. Given proper treatment, the sheriff argues, some patients would not be committing the crimes of which they are accused. Instead, they end up in Harris County’s jails, where they are a health care and financial burden to the county. Sheriff Garcia has allies, and might even get some help (Ramsey, 6/19).

Stateline: Right-to-Try for The Terminally Ill
Withholding experimental drugs from the most gravely ill has fueled several states to pass so-called “right-to-try” legislation that would make these drugs available without Food and Drug Administration approval to terminally ill patients with no other options. Some critics of the years-long FDA drug approval process, with its requirement for multiple clinical trials, contend that it is much longer than it should be, thereby keeping some promising drugs from those who might benefit, particularly those, like Austin, with time running out. The Tufts Center for the Study of Drug Development says it normally takes 5½ to 10½ years for a drug to receive FDA approval (Ollove, 6/19).

The CT Mirror: IRS, Hartford Police Conducting Criminal Investigation On Access Health Data Breach
The Internal Revenue Service and Hartford police are conducting a criminal investigation of the data breach involving information on clients of Connecticut’s health insurance exchange. But an exchange official said Thursday that the cause was most likely a mistake by a call center worker. The breach occurred two weeks ago after a worker at the exchange’s call center put notepads containing callers’ names, birth dates and Social Security numbers into a backpack and left the call center. The backpack was later discovered outside a Hartford deli, where the worker had been waiting for a ride. He told officials with Maximus, the company that runs the call center, that he’d accidentally left without the bag (Becker, 6/19).  

The Sacramento Bee: Sacramento Region Scrambles To Confront New 'Dental Care Crisis'
The last in a long line of Northern California hospitals abruptly announced last week it will discontinue dental surgery programs, igniting a scramble by community health leaders to solve what they termed yet another "dental care crisis" in Sacramento County. Sutter Medical Center is just the latest health system to shut down its dental surgery program over concern for the bottom line. Sutter’s decision leaves the region with no hospital willing to brave financial losses in order to serve such vulnerable patients as severely autistic adults who must undergo costly anesthesia to endure dental work (Craft, 6/19).

Texas Tribune: Report Shows Texas Lagging In Long-Term Care Quality 
Texas ranks third-worst in the nation on quality of long-term care for elderly and disabled people, according to a new AARP report released Thursday -- five days before a state commission convenes for a public hearing on the Department of Aging and Disability Services. The report scores states and the District of Columbia in five categories of services for elderly people and those with disabilities, and Texas' rankings are all over the board. The state ranks among the top 10 in the country for affordability and access. But it places 49th for quality of care and quality of life — a category including factors like staff turnover in nursing homes (Okun, 6/19).

Denver Post: Birth Control Issue Ignites In Colorado’s U.S. Senate Contest 
The battle over birth control in Colorado's U.S. Senate race exploded Thursday when Congressman Cory Gardner accused Democrats of not wanting to make contraceptives available over the counter. He unloaded on his opponent, U.S. Sen. Mark Udall, accusing him and Democratic leaders of using the issue as a "wedge to divide our state" rather then pushing to make the pill available at pharmacies. The left fired back, attacking Gardner's record as a state lawmaker and a two-term Republican congressman on women's issues (Bartels and Matthews, 6/20).

MinnPost: One Mother's Fraught Journey Through Minnesota’s Mental Health System 
Kathleen Bischel Beddow knew there was something wrong with her "beautiful boy" -- something that others would not or could not see. ... The Beddows’ son was 14 years old when he finally got a diagnosis of Asperger’s. (Now the family could understand his flat affect, his rigid behaviors, his agitation, his inexhaustible arguments, his seeming arrogance.) And he was 17 years old when he had brain surgery to remove all of his right temporal lobe, the focal point of his seizures and where a tumor was discovered postoperatively. After the surgery, though he no longer had seizures, his rage ramped up unabated (Williams, 6/19).

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Health Policy Research

Research Roundup: Improving Colon Cancer Screening; Disparities In Heart Care; Medicaid's Effect On Cities

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

Urban Institute and Robert Wood Johnson Foundation: The ACA And America's Cities: Fewer Uninsured And More Federal Dollars
This report estimated the effect of the Affordable Care Act (ACA) on 14 large and diverse cities: Los Angeles, Chicago, Houston, Philadelphia, Phoenix, Indianapolis, Columbus, Charlotte, Detroit, Memphis, Seattle, Denver, Atlanta, and Miami. Among the seven cities in states that have expanded Medicaid, the ACA will likely decrease the number of uninsured by an average of 57 percent. ... Among the seven cities in states not expanding Medicaid, the ACA will likely decrease the number of uninsured by an average of 30 percent. ... If Medicaid eligibility were expanded in these cities, the number of uninsured would fall by an average of 52 percent (Buettgens and Dev, 6/19). 

JAMA Internal Medicine: Comparative Effectiveness Of A Multifaceted Intervention To Improve Adherence To Annual Colorectal Cancer Screening In Community Health Centers
Colorectal cancer (CRC) screening rates are lower among Latinos and people living in poverty. ... However, the ability of [fecal occult blood testing] to reduce CRC mortality depends on high rates of adherence to annual screening. ... our multifaceted intervention [including computerized reminders, standing orders for medical assistants to give patients home fecal immunochemical tests (FIT), and clinician feedback on CRC screening rates] ... greatly increased adherence to annual CRC screening; most screenings were achieved without personal calls. It is possible to improve annual CRC screening for vulnerable populations with relatively low-cost strategies that are facilitated by health information technologies (Baker et al., 6/16).

Circulation: Early Results Of Massachusetts Healthcare Reform On Racial, Ethnic, And Socioeconomic Disparities In Cardiovascular Care
Insured adults receive invasive cardiovascular procedures more frequently than uninsured adults. We examined the impact of healthcare reform in Massachusetts on use of coronary revascularization procedures and in-hospital and 1-year mortality by race/ethnicity, education, and sex. ... Using hospital claims data, we compared differences in coronary revascularization rates (coronary artery bypass grafting or percutaneous coronary intervention) and in-hospital mortality .... Reducing insurance barriers to receipt of coronary revascularization procedures has not yet eliminated preexisting demographic and educational disparities in access to these procedures (Albert et al., 6/17).

Employee Benefit Research Institute: Consumer Engagement Among HSA And HRA Enrollees
HRAs [health reimbursement arrangements] and HSAs [health savings accounts] are very similar, though there are some key differences that may provide different incentives related to using health care services, and thus, different consumer engagement experiences. An HSA is owned by the individual with the high-deductible health plan and is completely portable. There is no annual use-it-or-lose-it rule associated with an HSA .... In contrast, an HRA is an employer-funded health plan that reimburses employees for qualified medical expenses. ... Leftover funds at the end of each year can be carried over for future use (at the employer's discretion) .... Adults with an HSA were more likely than those with an HRA to exhibit a number of cost-conscious behaviors related to use of health care services (Fronstin, 6/19).

The Kaiser Family Foundation: Potential Supreme Court Decision: Who Will Bear The Coverage "Burdens?"
The Supreme Court is expected to issue its decision [in the Hobby Lobby and Conestoga Wood Specialties cases] by the end of June 2014. ... If the Court decides that Hobby Lobby must comply with the [health law] contraceptive coverage requirement, Hobby Lobby will likely choose to stop providing health insurance .... If, however, the Supreme Court exempts Hobby Lobby from the requirement that they include all prescribed FDA approved contraceptives as the ACA requires, some female employees and dependents ... may either have to go without their preferred contraceptive method, pay out of pocket, or seek subsidized services at a government funded clinic. ... it would be easy to envision that other corporations with religious objections to the full range of contraceptives would eliminate coverage (Sobel, Salganicoff and Nisha Kurani, 6/18).

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

AARP Blog: Diabetes, Alzheimer's Top 2 Areas For Drug Research
Diabetes, Alzheimer’s, arthritis and heart disease top the list for the most new drugs in development to treat the common chronic diseases of older Americans, according to a new drug- industry report. The report, by the Pharmaceutical Research and Manufacturers of America (PhRMA), an industry trade association, says 435 medicines that primarily target seniors are currently either in clinical trials or under review by the Food and Drug Administration (FDA) (Sagon, 6/16).

Reuters:  Needle Biopsies May Be Underused For Breast Cancer Patients
Most women should undergo a needle biopsy for breast cancer diagnosis, but some surgeons opt for a more invasive procedure instead, according to a new study [in the Journal of Clinical Oncology]. The difference may be a matter of surgeon experience, researchers say, so many women could benefit if surgeons were trained and encouraged to opt for the needle method more often (Doyle, 6/15).

Journal of the American Medical Association: Researchers Focus On Recovery In Schizophrenia
The outlook for people diagnosed with schizophrenia, once considered a devastating illness that only worsens over time, has improved in the past several decades. Antipsychotic medications and psychosocial treatments have allowed many with the illness to achieve some degree of recovery, manage residual symptoms, and lead productive lives. Yet additional efforts are needed to consolidate these improvements and help more patients reach these goals. ... These approaches are outlined in a new report, “Schizophrenia: Time to Commit to Policy Change,” drafted by [Stephen Marder, MD, professor of psychiatry at the University of California, Los Angeles] and others (Friedrich, 6/18). 

NewsWorks: Study: One In Five Inmates In Pa. Prisons Has Hepatitis C
Nearly one in five inmates entering Pennsylvania prisons has hepatitis C, according to a study published in the June issue of the American Journal of Public health. Since 2003, Pennsylvania has screened everyone entering prison for hepatitis C unless an inmate chooses to opt out of the test. Of the more than 100,000 people who were tested upon entry between 2004 and 2012, about 18 percent tested positive for the virus. "It's an incredibly high rate," said lead author, Sarah Larney, who's a fellow at the National Drug and Alcohol Research Center at the University of New South Wales and a research associate at Brown University (Gordon, 6/16). 

MinnPost:  Few Doctors Discuss End-of-life Planning With Heart-Failure Patients, Mayo Study Finds
About 5 million Americans have heart failure, a chronic condition in which the pumping action of the heart slowly weakens. There is no cure. Treatment — medications and lifestyle changes — can help people with the condition live longer and lead more active lives, but half of heart-failure patients die within five years of receiving their diagnosis. Yet, despite that prognosis, few doctors discuss end-of-life planning with heart-failure patients and their families, according to a recent study from researchers at the Mayo Clinic in Rochester (Perry, 6/18).

Reuters: Shared Decision Making Still Lacking For Cancer Screening
When it comes to cancer screening, doctors often do not adequately discuss the balance of pros and cons with their patients, a new study suggests. ... Depending on the screening test in question, between 69 and 93 percent of study participants chose to get screened, and most said they would make the same decision again, the authors write in the American Journal of Preventive Medicine (Pittman, 6/19). 

MedPage Today: Racial Disparity In Stroke Grows In South Carolina
In South Carolina, the rate of stroke hospitalization increased in recent years among young and middle-age blacks, but not other groups, resulting in a widening disparity, researchers found. In black individuals younger than 65, the rate per 100,000 rose from 121 in 2001 to 142 in 2010, a relative 17.3% increase, according to Wayne Feng, MD, of the Medical University of South Carolina Stroke Center in Charleston, and colleagues. In contrast, the stroke hospitalization rate declined in both black and white individuals 65 and older and remained stagnant in younger whites, they reported in the July issue of Stroke: Journal of the American Heart Association (Neale, 6/19). 

Modern Healthcare: Black, Hispanic Dialysis Patients Admitted More Often For Infections
Black and Hispanic patients on dialysis for end-stage renal disease had markedly higher rates of infection-related hospitalizations and were less likely to have visited a specialist for pre-treatment care, a new study finds. Infection-related hospitalizations were about 20% higher for blacks of all ages, and about 30% higher for older Hispanics, compared with white patients, said study co-author Dr. Keith Norris of the David Geffen School of Medicine at UCLA (Rice, 6/19).

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Editorials and Opinions

Viewpoints: Health Law's 'Risk' Question; Medicaid Options In Va.

The Wall Street Journal: An Obamacare 'Risk' Question For Insurers
As insurers submit bids for the 2015 open-enrollment season, media reports have trumpeted increased participation by carriers on several health exchanges. Depending on the legal and judicial interpretations of two important issues, those insurance companies may end up getting much more than they bargained for (Chris Jacobs, 6/19). 

The Wall Street Journal: Does The Affordable Care Act Cover The Uninsured?
One of the big criticisms of the Affordable Care Act has been that very few people covered in the new insurance marketplaces were previously uninsured. It's an important criticism, as expanding insurance coverage was a bedrock goal of the law. The Congressional Budget Office estimates that the number of uninsured will be reduced by about 26 million by 2017, cutting in half the number of uninsured in this country. A new Kaiser Family Foundation survey out Thursday gives us real data on this question. Among the facts: 57% of those who bought coverage from the new marketplaces during the first ACA open-enrollment period were previously uninsured, and seven out of 10 of them had been uninsured for two years or more (Drew Altman, 6/19).

The New York Times: Good Progress On Affordable Health Care
Americans are finding very affordable health insurance and a wide choice of plans on the exchanges operated by the federal government, according to a report issued Wednesday by the Department of Health and Human Services. The report was based on data from the 36 states in which the federal government is operating health insurance exchanges this year. Comparable data from states operating their own exchanges is not yet available. ... A separate survey of enrollees who bought policies on the exchanges or directly from insurers, issued by the Kaiser Family Foundation on Thursday, revealed that 34 percent felt they had benefited from the law. Of those, 49 percent said it had lowered their costs and 45 percent said it had increased their access to insurance or medical care (6/19).

The Washington Post: McAuliffe's Best Option On The Budget
Virginia Gov. Terry McAuliffe has until Sunday to figure out what to do about the troublesome budget the General Assembly has handed him that forbids the expansion of Medicaid health coverage to 400,000 lower-income state residents. Depending on what he chooses to do, McAuliffe risks blowing out the entire $96 billion, two-year budget and tossing state finances into turmoil on July 1. Since he has vowed to make expanded Medicaid a reality, he is sure to do something other than simply approve the budget. What are his options? (Peter Galuszka, 6/19). 

The Washington Post: Obamacare Sticker Shock
When last we left off in the late spring, the administration was goosing up the enrollment figures without ever telling us how many had paid and how many were newly insured Americans. But the "affordable" part of the Affordable Care Act has always been its Achilles heel. By heavily subsidizing health-care insurance and insisting on very expensive coverage plans, the administration is almost certainly encouraging demand (i.e. overuse) — thereby moving the price of health-care insurance in the wrong direction (Jennifer Rubin, 6/19).

The Boston Globe: Don Berwick And The Single-Payer Pitch
While (Bernie) Sanders came out of Vermont’s '60s-era socialist movement and started his career in local politics, (Don) Berwick is a doctor and former Medicare administrator who comes armed with one major issue: single-payer health care. When his rivals claimed he wasn't really offering anything new — just another health care commission — Berwick doubled down by calling it "Medicare for all," a description that pretty much suggests he'd eliminate private insurance. Now, with the Democratic race [for Massachusetts governor] down to three candidates — Berwick, and two party regulars with histories of failing to excite voters — single-payer will finally get the attention it merits as essentially the only markedly different policy proposal to emerge from either party (Peter Canellos, 6/19).

The Washington Post: Summit Addresses Mental Health Of Teens
When six Fairfax county youths who have wrestled with depression and flirted with suicide spoke their minds on a stage in front of 200 people last week , it was the right thing to do, they said, especially after closing out another school year with four suicides among their peers. One boy from Langley High School talked about that night — July 23 — when he decided to die (Petula Dvorak, 6/19).

Journal of the American Medical Association: Health Care At The VA
Legislative efforts to address the problems within the VA are important. However, feedback from employees is paramount, and VA clinicians and scientists should be empowered to help solve their local problems. What is effective in one community might not be equally effective in another. This is an ideal opportunity to analyze and redesign the VA system, to make it not only the largest integrated care system in the country, but a model in every measurable sphere. This will require the commitment, innovation, and resources necessary to provide the best care possible for veterans (Faisal G. Bakaeen, Alvin Blaustein and Melina R. Kibbe, 6/19).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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