Daily Health Policy Report

Friday, June 21, 2013

Last updated: Fri, Jun 21

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Women's Health

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Firm Relies On Medicare Experience As It Prepares To Open Federal Health Exchange Calls Centers

Reporting for Kaiser Health News, in collaboration with The Washington Post, Susan Jaffe writes: "Within days, the company that handles an average of more than 60,000 calls daily about Medicare will be deluged by new inquiries about health insurance under the Affordable Care Act. The six Medicare call centers run by Vangent, a company based in Arlington, Va., will answer questions about the health care law from the 34 states that opted out of running their own online health insurance marketplaces or decided to operate them jointly with the federal government" (Jaffe, 6/21). Read the story.

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Capsules: Rate Shock? Let's Talk About It Later, Says Colorado Insurance Commish

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with KHN and NPR, reports: "Colorado is among the states getting their first glimpse of how much health insurance will cost under Obamacare in 2014. Colorado’s insurance commissioner Jim Riesberg says he’s pleased with what he’s seen so far, but, 'talking about rates at this point in time could lead to a lot problems in the future'" (Whitney 6/21). Check out what else is on the blog.

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Political Cartoon: 'The Origin Of Species?'

Kaiser Health News provides a fresh take on health policy developments with "The Origin Of Species?" by Gary Varvel.

Meanwhile, here is today's health policy haiku:


We all want to know
What Obamacare will cost
But we have to wait.

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

Health Law Rebates Paid By Insurers Tally $500 Million

About 8.5 million Americans will receive rebates. The Obama administration says that means insurers are getting more efficient.

The Wall Street Journal: Insurers Issue Rebates Under New Health Law
Insurers will rebate $500 million to consumers who purchased health insurance under a provision in the new health-care law that requires companies to spend a certain portion on premiums on consumers or refund the money. About 8.5 million Americans will receive the rebates with an average rebate of about $100 per family, the Department of Health and Human Services said Thursday. That is about $50 less per family than last year, when the new provision took effect (Schatz, 6/20).

Bloomberg: Health Law Rule Saves Consumers $3.9 Billion In Premiums
Consumers avoided $3.9 billion in health insurance premium increases in 2012 partly because of the U.S. Affordable Care Act’s limits on what UnitedHealth Group Inc., Aetna Inc. and other coverage plans can charge, the government said. ... The 2010 health law, an attempt by President Barack Obama to make medical coverage more widely available and affordable, forbids most insurance plans from keeping more than 20 percent of premiums charged for profit and overhead (Wayne, 6/20).

The Associated Press: Health Insurance Rebates Decline This Year
Health and Human Services' Gary Cohen says the lower rebates mean insurance companies have learned to be more efficient, and consumers are saving up front (6/20).

Politico: Insurers Will Pay Consumers $500M Over Obamacare Rules
A state-by-state breakdown of where rebates are headed suggests recipients in Washington state will see the biggest checks, with 3,000 consumers due to receive rebates of more than $500 each. Rhode Islanders will see the least per person, with an average of $43 in rebates slated for 1,265 plan holders (Cheney, 6/21).

Reuters: U.S. Health Insurers To Pay $500 Million In Rebates This Summer
Aetna Inc, the third-largest U.S. insurer, said that MLR rebates represent 0.2 percent of the premiums it collected in 2012. "We are delivering savings to our customers through competitive pricing, rather than waiting for a rebate check," Aetna spokeswoman Cynthia Michener said in statement (Humer, 6/20).

Modern Healthcare: Medical-Loss Ratio Rules Have Saved Consumers Billions, But Will It Last?
The health reform law's provision requiring insurers to spend at least 80% of their premium dollars on medical expenses was a major factor in helping consumers save $3.9 billion in premiums last year, according to an analysis released today from the CMS (PDF). But whether that will translate into lower premiums for 2014 is up for debate (Block, 6/20).

The Hill: HHS: ObamaCare Policy Has Saved Consumers Nearly $5 Billion
The Obama administration has consistently and aggressively promoted elements of the law that have had an immediate impact, as it tries to reverse negative public opinion and sell a skeptical public on the law as its major provisions are about to take effect (Baker, 6/20).

Baltimore Sun: Health Insurers To Pay Rebates
Tens of thousands of Marylanders will get rebates from their health insurance companies this summer ... The U.S. Department of Health and Human Services said Tuesday that 149,961 Maryland residents would get rebates. The rebates, which average $143 per family, will go out by Aug. 1. The rebates will be given out as a check in the mail, a lump-sum reimbursement to the credit or debit card account the customer used to pay premiums, a reduction in premiums or an employer using the rebates to improve health coverage (Walker, 6/20).

MPR News: Health Insurance Rebate Coming To Some Minnesotans
A health insurance rebate could be coming to 9,161 Minnesotans. ... If insurers spend too little on health care, they must provide rebates to consumers. The rule was championed by Democratic U.S. Sen. Al Franken. Minnesota consumers will receive about $1.4 million for an average rebate of about $303 each (Stawicki, 6/20).

CT Mirror: Connecticut Insurers To Rebate $5.6 Million To Customers Under Obamacare Rule
More than 47,000 Connecticut residents will get rebates from their health insurance companies ... The rebates will average $168 per family and will go to people who get their insurance through the state’s individual and small-group markets. Overall, Connecticut insurers will pay $5.6 million in rebates (Levin Becker, 6/20).

In other news -

MedPage Today: Health Insurers Improve Claims Processing
The percentage of claims incorrectly processed by health plans fell for the third straight year to 7.1 percent in 2013, according to the American Medical Association (AMA). The error rate of commercial health plans in the National Health Insurer Report Card has dropped significantly since the 2011; that year, the report found that more than 19 percent of all medical claims were incorrectly processed. Last year, the AMA found about 9.5 percent of claims were incorrectly processed. The AMA released the report Monday at its annual meeting (Pittman, 6/20).

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Nonprofit Group Launches PR Push About Health Exchanges

It's nearly 100 days now until the new online insurance marketplaces created by the health law should be up and running. As the countdown to Oct. 1 picks up steam, the effort to educate the public and find people who are eligible for new coverage becomes increasingly important. Meanwhile, news outlets examine the actual development of exchanges at the federal and state level.

NPR: With Health Exchanges Poised To Open, PR Push Draws Scrutiny
This weekend marks 100 days until people can begin signing up for new health insurance coverage under the federal health care law. It also marks another milestone: the launch of an enormous public relations effort to find people eligible for new coverage and urge them to sign up when the time comes. But like everything else about the health law, even this seemingly innocuous effort has been touched by controversy (Rovner, 6/21).

Reuters: Insight: It Take An Army – Tens Of Thousands Of Workers Roll Out Obamacare
From the chief actuary at the California health insurance exchange that President Barack Obama's healthcare reform law established to the legions of call center staffers who will help people trying to buy insurance through such state exchanges, the number of people working to implement "Obamacare" has reached the tens of thousands, a Reuters analysis has found. No one said that overhauling healthcare, which accounts for 17 percent of all national spending, was going to happen with a skeleton crew (Begley, 6/21).

CNN Money: The Marketing Of Obamacare Exchanges Begins
In a little more than 100 days, Obamacare health insurance exchanges in each state will open for enrollment. But a lot of Americans don't know that. That's why advocacy groups around the nation are stepping up their efforts to educate consumers about the options that could be available to them through Obamacare, formally known as the Affordable Care Act, come October 1. Enroll America, a coalition of community organizations, health groups and businesses, is working with partners to hold more than 75 events in 27 states this weekend (Luhby, 6/21).

National Journal: Time Is Running Short For Big Obamacare Push
In what turned out to be unfortunate timing for the White House, President Obama traveled to San Jose, California, this month to tout his health care law and kick off a summer push to get Americans ready to sign up for insurance under new online marketplaces, scheduled to open on October 1. But the health care law wasn't the news of the day. A massive government surveillance program had just been revealed in the press and provoked a loud public outcry (Hollander, 6/21).

Kaiser Health News: Firm Relies On Medicare Experience As It Prepares To Open Federal Health Exchange Calls Centers
Within days, the company that handles an average of more than 60,000 calls daily about Medicare will be deluged by new inquiries about health insurance under the Affordable Care Act. The six Medicare call centers run by Vangent, a company based in Arlington, Va., will answer questions about the health care law from the 34 states that opted out of running their own online health insurance marketplaces or decided to operate them jointly with the federal government (Jaffe, 6/21).

Kaiser Health News: Capsules: Rate Shock? Let's Talk About It Later, Says Colorado Insurance Commish
Colorado is among the states getting their first glimpse of how much health insurance will cost under Obamacare in 2014. Colorado’s insurance commissioner Jim Riesberg says he’s pleased with what he’s seen so far, but, 'talking about rates at this point in time could lead to a lot problems in the future'" (Whitney 6/21).

The Associated Press: N.H. Lawmakers Close On Health Care Overhaul
House and Senate lawmakers moved close to agreement yesterday on a severely scaled-back version of a bill intended to align state insurance rules with President Obama’s health care overhaul law. The state insurance commissioner had argued that a wide range of changes were necessary to preserve the state’s traditional role in regulating insurance plans (Ramer, 6/20).

Meanwhile, in other news about implementation --

The Wall Street Journal's Washington Wire: Paper Compares Obama Law With Medicare Part D, Mass.
In the debate around the readiness of the federal government to roll out the big provisions of the health-care law on time this fall, there are a couple of particularly popular comparisons: the launch of the Medicare part D prescription drug benefit in 2006, and the implementation of the Massachusetts health-care overhaul  in 2007 (Radnofsky, 6/20).

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After Months Of Debate, Iowa Gov. Signs Health Care Expansion Into Law

Media outlets offer coverage of developments In Iowa, Missouri, Michigan and Pennsylvania regarding the Medicaid expansion.

The Associated Press: Governor Signs Health Care Expansion Into Law
Gov. Terry Branstad signed a bill into law Thursday that will expand health care access for Iowa's poorest residents, though officials acknowledge they have significant work ahead to both establish the program and enroll eligible citizens. Branstad signed the legislation in Mason City, a location selected to acknowledge two lawmakers from the region — Republican House Majority Leader Linda Upmeyer and Democratic Sen. Amanda Ragan — who helped broker the final compromise deal in May after months of contentious debate in the Legislature (Lucey, 6/20).

The Associated Press: Pa. GOP Senators Eye Vote On Medicaid Expansion
Legislation to expand Medicaid eligibility in the state under the 2010 federal health care law will come up for a floor vote in the state Senate next week with conditions that will make it more amenable to the chamber's Republican majority, the Senate's top senator said Thursday. Senate President Pro Tempore Joe Scarnati, R-Jefferson, said a Medicaid expansion will help the state's hospitals stay afloat (Levy, 6/21).

Pittsburgh Post-Gazette: Corbett, Feds Jockey Over Efforts To Expand Medicaid In Pa.
For months, Gov. Tom Corbett has said that without concessions he will not expand Medicaid eligibility in Pennsylvania under the federal health care law. Now the Obama and Corbett administrations are increasingly taking their closed-door discussions into public view, as officials from both camps pitch reporters on the reasonableness of their positions (Langley, 6/21).

The Associated Press: Mo. House Creates 2 More Medicaid Student Panels
Having repeatedly rejected a Medicaid expansion, Missouri's Republican-led Legislature now plans to study _ and study, and study — whether to revamp the health care program for the poor before it convenes again in 2014. House Speaker Tim Jones created two new panels Thursday to examine a potential "Medicaid transformation” (6/20).

Detroit Free Press: Snyder Lashes Out At Senate For Failing To Vote On Medicaid Expansion
A frustrated Gov. Rick Snyder lashed out at fellow Republicans who failed to take a vote on expanding Medicaid on Thursday, the last day before breaking for the summer, calling on them to “take a vote, not a vacation.” In a late afternoon news conference, a short time after it was clear that the Senate was making plans to adjourn, Snyder was uncharacteristically indignant in criticizing fellow Republicans for failing to vote, despite what he said was a majority of support for Medicaid expansion by Michiganders; the House, which passed the expansion last week, and even by other members of the Republican caucus (Erb, 6/20).

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Capitol Hill Watch

Republicans Question Privacy Protections In Health Law's Navigator Program

Nine GOP senators said that a proposed rule on navigators, who are supposed to help consumers buy coverage through online health insurance marketplaces, does not include enough safeguards. 

The Hill: GOP: Felons Could Be 'Navigators' Under ObamaCare
A program designed to help people enroll in ObamaCare could accept convicted felons as "navigators" and give them access to confidential health information, GOP lawmakers charged Thursday. Republican senators redoubled their attacks on the "navigator" program in a letter to Health and Human Services Secretary Kathleen Sebelius, arguing the effort is dangerous to consumers and a waste of taxpayer money (Viebeck, 6/20).

CQ HealthBeat: Republicans Question Privacy Protection In Health Care Law's Navigator Program
Nine GOP senators on Thursday questioned how the Obama administration plans to protect consumers' privacy in programs meant to help individuals enroll in the new health insurance exchanges. The Republicans said that a proposed Department of Health and Human Services rule on the programs does not include adequate safeguards and could put consumers at risk for identity theft or other crimes (Ethridge, 6/20).

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Health Coverage A Divisive Issue In Immigration Debate

As Congress considers an immigration law overhaul, health care for newly legalized residents is a sticking point. The proposed deal would bar such residents from receiving Medicaid or buying coverage in new health exchanges for more than a decade after they qualify for legal status. Meanwhile, budget issues and sequestration cuts are also hot topics. 

The Associated Press/Washington Post: As Congress Tackles Immigration Reform, Obama's Health Care Overhaul Looms Over The Debate
President Barack Obama has championed two sweeping policy changes that could transform how people live in the United States: affordable health care for all and a path to citizenship for the 11 million immigrants illegally in the country. But many immigrants will have to wait more than a decade to qualify for health care benefits under the proposed immigration overhaul being debated by Congress, ensuring a huge swath of people will remain uninsured as the centerpiece of Obama’s health care law launches next year (6/21).

The Associated Press/Washington Post: Senate Democrats Press Ahead On Spending Bills Restoring Sequestration-Mandated Budget Cuts
At issue is the congressional appropriations process in which 12 individual bills set the day-to-day operating budgets of 15 Cabinet departments and other federal agencies. The bills make up a little more than one-third of the budget, with expensive benefit programs like Medicare and Social Security making up most of the rest. The 12 bills represent Congress' most basic job but the appropriations process has broken down over the years and is showing signs of grinding to a complete halt this year. Congress is likely to resort yet again to a stopgap spending measure in September that keeps the government running but President Barack Obama has issued a blanket veto threat against the House GOP's spending measures, which reflect not just the sequestration-mandated cuts but transfers $28 billion from domestic programs in order to patch up the Pentagon’s budget (6/20).

Modern Healthcare: Providers Hang Back On Pushing For Sequester Fix
Despite two months of pain induced by Medicare cuts under the deficit-reduction law triggered this year, advocates for hospitals and physicians are waiting until fall to push a legislative fix. The dire warnings before the 2% cuts in Medicare payments hit April 1 have given way to watchful waiting. “In terms of mainstream policymaking, we're in a quagmire right now until we get to event-making policies that have to be dealt with, like the debt ceiling and government spending for 2014,” said Chip Kahn, president and CEO of the Federal of American Hospitals (Daly, 6/20).

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Coverage & Access

More Caring For Sick Or Elderly Family As Long-Term Care Costs Increase

Long-term care is an increasingly expensive necessity, Marketplace reports. In the meantime, a new study says four in 10 adults in the U.S. are caring for a sick or elderly family member.

Marketplace: How Much Should You Save For Long-Term Care? (Audio)
Long-term care. It's an economic consequence of an aging America that doesn't get nearly as much attention as Social Security. Nursing homes can run around $100,000 a year, and many aging boomers will not have the money. Marketplace Economics Correspondent Chris Farrell joins Morning Report's Mark Garrison to discuss (Farrell, 6/20). 

Reuters: Two-Fifths Of U.S. Adults Care For Sick, Elderly Relatives
Four in 10 U.S. adults are now caring for a sick or elderly family member as more people develop chronic illnesses and the population ages, a new study has found (Abutaleb, 6/20).

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Women's Health

FDA Approves Plan B Pill, Ends Long Fight

The FDA on Thursday approved over-the-counter sales without age restriction for the Plan B emergency contraceptive pill, ending a decade-long fight over the pill.

Los Angeles Times: With FDA Approval, Fight Ends Over Morning-After Pill
The Food and Drug Administration on Thursday approved the emergency contraceptive Plan B One-Step for use without a prescription or age restrictions, effectively ending more than a decade of legal and regulatory wrangling over the controversial morning-after pill. In a statement, the FDA said its action complied with an order by U.S. District Judge Edward Korman of New York, who had openly criticized the George W. Bush and Obama administrations for imposing restrictions on the sale of the pill for political reasons (Morin, 6/20).

Politico: FDA Approves Morning-After Pill for Over-The-Counter Sale
The Obama administration had been fighting in court to preserve restricted access for younger teens, but recently dropped the case after legal setbacks. The FDA then told the court it would quickly approve an application for over-the-counter sale by Teva, the manufacturer of Plan B One-Step (Norman, 6/20).

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State Watch

Miss. Health Law Fight Could Shutter Medicaid Program

The state's attorney general says Gov. Phil Bryant cannot single-handedly reauthorize the state's Medicaid program, setting up a showdown with Democrats who have blocked the program's reauthorization to force the governor's hand on expanding Medicaid.

Stateline: Is Mississippi Headed For Medicaid Shutdown?
The pressure on Mississippi Gov. Phil Bryant to call a special session on Medicaid expansion has increased after the state attorney general ruled that Medicaid cannot continue without legislative authorization. Bryant, a Republican, had pledged to keep the program running on his own authority when Democrats in the legislature blocked a measure that would have reauthorized the Medicaid program but without the expansion of the Affordable Care Act. Bryant said he didn't need legislative approval (Ollove, 6/20). 

Politico: Mississippi Governor May Lose Medicaid Authority
Mississippi Gov. Phil Bryant lacks the legal authority to single-handedly run Medicaid in his state should lawmakers fail to renew it amid partisan squabbling over Medicaid expansion, the state's attorney general has determined. The nonbinding opinion by Democratic Attorney General Jim Hood ratchets up the pressure on the Republican governor and state lawmakers to reach a deal to reauthorize the Medicaid program, which is due to expire on June 30 without legislative action (Cheney, 6/21).

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WellPoint To Pay L.A. $6M To Settle Rescission Lawsuit

WellPoint has agreed to settle a lawsuit brought by the city of Los Angeles that alleged the insurer improperly dropped people from coverage when they got sick.

Los Angeles Times: Insurance Giant WellPoint Agrees To Pay $6 Million In L.A. Case
Insurance giant WellPoint Inc. has agreed to pay $6 million to resolve allegations that the company improperly dropped policyholders after they got sick and needed treatment. The settlement announced Thursday by Los Angeles City Atty. Carmen Trutanich caps a long-running investigation into so-called rescissions by several insurers in the state (Terhune, 6/20).

The Associated Press: LA Settles Health Insurance Lawsuit For $6 Million
The settlement is far less than the $1 billion in fines and restitution former Los Angeles City Attorney Rocky Delgadillo threatened when the lawsuit was filed in 2008. At the time, Delgadillo said some of the dropped policies affected elderly patients and patients with health costs that topped $100,000. Anthem denied the allegations then, and is admitting no fault in the settlement now.The settlement took into account Anthem's steps to enhance policyholder safeguards (6/20).

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State Highlights: Weiner Wants Single-Payer For NYC Workers

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

The Associated Press/Washington Post: States Increasingly Saying 'No Way' to Federal Laws Ranging From Guns To Drugs And Health Care
An Associated Press analysis found that about four-fifths of the states now have enacted local laws that directly reject or ignore federal laws on marijuana use, gun control, health insurance requirements and identification standards for driver’s licenses. The recent trend began in Democratic leaning California with a 1996 medical marijuana law and has proliferated lately in Republican strongholds like Kansas, where Gov. Sam Brownback this spring became the first to sign a measure threatening felony charges against federal agents who enforce certain firearms laws in his state (6/21).

The New York Times: Weiner Wants City To Test Single-Payer Health Care
Vowing to "make New York City the single-payer laboratory in the country" if he is elected mayor, Anthony D. Weiner on Thursday presented an ambitious plan to create a Medicare-like system for the coverage of municipal workers, retirees and uninsured immigrant residents left out of the Affordable Care Act (Bernstein, 6/20).

Los Angeles Times: Hoag Hospital's Abortion Ban Linked To New Catholic Partner
When Hoag Hospital announced this spring that it would no longer provide elective abortions, officials at the esteemed Orange County medical center said the decision was made because of low demand. But records and interviews show the decision was closely tied to the Newport Beach hospital's new partnership with a Catholic health care provider (Cowan and Gorman, 6/20).

Georgia Health News: Discount Plan May Draw Few HIV Patients (Video)
When Vincent McDaniel was diagnosed with AIDS in 1991, doctors gave him a year to live. But 22 years later, he was working as a volunteer bagging canned goods, cereals and other foods for himself and other clients in the food pantry at AIDS Athens, an HIV/AIDS outreach clinic. AIDS Athens, housed in a nondescript office building on the edge of the historic Georgia city, supports a few of the estimated 5,000 local residents who have no health insurance. When the Affordable Care Act is fully implemented in 2014, most Americans will be required to buy health insurance or pay a fine. But for those whose incomes are low enough, the requirement will be waived (Smith, 6/20). 

Reuters: Docs May Cherry-Pick Cases After Death Rate Reports
Doctors may avoid treating the sickest heart patients with a common procedure after their hospitals are marked as having high death rates, says a new study that points to a possible unintended consequence of transparency. Researchers found the severity of cases treated at four Massachusetts hospitals was lower after they were labeled "outliers" for having high death rates after stenting between 2003 and 2010, compared to their counterparts with lower death rates (Seaman, 6/20).

St. Louis Beacon: On Top Of Layoffs And Service Cuts, Add 'Bay State Boondoggle' To Problems Afflicting Hospitals
Pemiscot Memorial Hospital, in Hayti, Mo., is on the equivalent of life support, unsure how long it will survive without an infusion of more federal Medicare and Medicaid dollars. In most rural communities as well as in large and small cities, the challenges facing hospitals are not as dire as the case of Pemiscot, but all are being forced to cope in a new health care environment as a result of sequestration, failure of Medicaid expansion and other cost factors (Joiner, 6/20).

Kansas City Star: Lawsuit Challenges New Kansas Abortion Law
Kansas abortion providers sued state medical and legal authorities Thursday, alleging that a new law set to take effect July 1 would violate their freedom of speech rights. Comprehensive Health of Planned Parenthood of Kansas and Mid-Missouri Inc. and its medical director, physician Orrin Moore, contend in the federal lawsuit that disclosure requirements written into the new law compel abortion providers to approve of the government's view of abortion (Morris, 6/20). 

HealthyCal: Clinics Unite To Better Serve Low-Income Patients
It is 9 a.m. on a Tuesday and the St. John's Well Child & Family Wellness Center in South Los Angeles is busy. More than 40 adults and children sit in the clinic’s large waiting area while the sounds of friendly conversations in Spanish and English, ringing cell phones and fussing youngsters fill the air. In the middle of this, Olivia Mendez stands and begins to speak, first in Spanish, then in English, her voice rising above the buzz while her partner Evelia Castaneda hands out literature (Fulton, 6/20).

California Healthline: Bill Would Exempt Some Skilled Nursing Facilities From Cut
The Senate Committee on Health yesterday approved a measure to reverse some of the Medi-Cal provider rate cuts passed by the Legislature two years ago. It's an urgency bill, which means it needs a two-thirds legislative vote to pass. AB 900 by Assembly member Luis Alejo (D-Salinas) would reverse cuts to one specific type of health care facility -- hospital-based, distinct-part skilled nursing facilities (Gorn, 6/20).

California Healthline: New Budget Makes 'Major Change' To Lanterman Act, Autism Policy
A small, obscure provision in the California budget bill passed last week is the culmination of a number of changes and limitations in autism treatment recently made by the state. The provision deals with regional centers, the private not-for-profit companies that operate 21 regional centers under contract with the state, to provide or coordinate services for Medicaid beneficiaries with developmental disabilities, including autism (Gorn, 6/20).

Des Moines Register: Insurance Program For Chronically Ill To End
The government is shuttering a health insurance program for Iowans with expensive chronic diseases. People who are in HIP Iowa-Fed are being offered the chance to enter a similar federal program, but some of them could wind up having to spend thousands of extra dollars. The decision, which takes effect June 30, will affect 371 Iowans (Leys, 6/21).

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Weekend Reading

Longer Looks: A Nurse's Hardening Approach To Death; Preventing Diabetes

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

Slate: Approaching Death
A child is dead. There is a terrifying, soul-piercing scream that a mother makes when she loses a child. This scream is so universal that everyone, in every corner of the emergency department, knows what has just happened when they hear it. … Was it really possible that my response to the intense anguish of two broken parents was to push them into a room and run off to finish my job? When had I become so callous? I remembered myself as a new nurse—one who made it a point to touch every patient, even when she wasn't examining them; who had a gift for sensing what a psychotic patient needed in order to de-escalate; who was known as the one to call when a battered woman needed to feel safe enough to talk—but this memory was distant and faded (Kimberly A. Condon, 6/19).

Los Angeles Times: Girl's Lung Transplant Leaves Thorny Ethical Questions
The emails arrived by the dozens. Then the hundreds. Then the thousands. Family and friends of Sarah Murnaghan had posted an online petition demanding that the 10-year-old, whose lungs were ravaged by cystic fibrosis, be given the same access as adults to organs from adult donors — and not be limited to organs from children. … Nobody wants to deny transplants to children. In fact, minors generally receive preferential status for organs. But allocation of lungs is particularly complicated (Alan Zarembo, 6/12).

National Journal: How To Lower Your Risk Of Diabetes
Wendy Wiernik was sitting in her car, just after a doctor's appointment when it hit her: She was not going to get diabetes. She started crying. Wiernik, a 42-year-old mother with two jobs and a family history of depression and diabetes, weighed more than she should and had been flagged as "prediabetic" half a year before. That's when her physician's assistant made a surprising suggestion. Instead of writing her a prescription or offering her medical treatment, the PA suggested that Wiernik sign up for a diabetes-prevention class at the YMCA (Margot Sanger-Katz, 6/13).

NPR: Why Men Die Younger Than Women: The 'Guys Are Fragile' Thesis
The 19th century just lost its last living man. Jiroemon Kimura, of Kyotango, Japan, was born in April 1897, lived right through the 20th century and died last Wednesday. He was 116. According to Guinness World Records (which searches for these things), he was the last surviving male born in the 1800s. All the other boys from that century, as best we know, are dead. … Once again, the ladies have outlasted the gentlemen. Not that that's a big surprise. Women, on average, seem to take a little longer to die. But here's what I didn't know: Women, it turns out, don't just win in the end. It seems that women consistently outlive men in every age cohort (Robert Krulwich, 6/17).

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Editorials and Opinions

Viewpoints: Health Law's 'Premium Joy;' John Kerry's Hidden Surprise; The Heartbreak Of Abortion

The New York Times: Economix: 'Premium Shock' and 'Premium Joy' Under the Affordable Care Act
Starting on Oct. 1, Americans can purchase individual health insurance in what is known as the nongroup market on the newly established electronic health-insurance exchanges that were called for in the Affordable Care Act of 2010. That coverage will take effect on Jan. 1. In the meantime, Americans will be bombarded with information on the premiums they will pay for coverage on the exchanges. Much of that information will be pure speculation, and a good part of it will be strategic misinformation (a topic that I will explore more fully in a future post). So let's review what the new arrangement seeks to accomplish (Uwe E. Reinhardt, 6/21). 

The Wall Street Journal's Potomac Watch: John Kerry's ObamaCare Boondoggle
A bipartisan backlash is growing against another section of President Obama's health-care law. ... The change has allowed Massachusetts to raise its Medicare payout by $257 million, forcing cuts to hospitals in 40 other states. The National Rural Health Association and 20 state hospital associations in January sent a panicked letter to President Obama, noting that the Massachusetts manipulation of the program would hand that state $3.5 billion over the next 10 years at the expense of Medicare beneficiaries everywhere. They quoted Mr. Obama's former head of the Centers for Medicare and Medicaid Services, Donald Berwick, admitting that "What Massachusetts gets comes from everybody else" (Kimberley Strassel, 6/20).

Bloomberg: Obamacare Is For Republicans, Too
Three months from now, Americans will get their first look at whether Obamacare works. The answer will depend a lot on Republican governors and legislatures -- and they should want the law’s exchanges to be successful as much as the president does (6/20).

The Wall Street Journal: Here Comes ObamaCare's 'Workplace Wellness'
During the congressional debate over ObamaCare, few provisions stirred less controversy than an amendment providing incentives for companies to encourage their workers to stay healthy. It's a turbocharged version of "workplace wellness" programs: If employees fall short of their targets—on blood pressure or weight, for example—employers are allowed to make them contribute more to their health insurance. The idea is to rein in medical costs by reducing worker illness (Al Lewis and Vik Khanna, 6/20).

Politico: Competition Is Rx To Slow Health Costs
Three years into the Affordable Care Act, America's employers are still looking for the affordable part. Despite a recent slowdown, health care inflation remains two to three times the rate of general inflation. Health insurance is expected to cost a family $16,000 this year, double what it cost a decade ago. ... Congress must focus on cost containment, the unfinished business of health reform, as it works to tame entitlement spending and the deficit. Congress can tackle the cost issue head-on by making both public and private-sector payment for care dependent on delivering the high-quality care every hardworking American deserves (David Lansky and Sally Welborn, 6/19).

Detroit Free Press: Snyder Shows Leadership; Senate Shows Partisanship
On Thursday, Snyder was in rare form. The normally genial Snyder laid into his fellow Republicans, lambasting the GOP-led state Senate for its refusal to vote on the expansion before its summer recess. "Take a vote, not a vacation," Snyder told legislators. ... There was determination in Snyder's eyes as he urged the Senate to vote. Not voting is saying no, he said. It was clear the governor was on a mission, as he encouraged residents to tell their state senators to vote to expand Medicaid. It’s the right thing to do, and we’re heartened by his leadership on this issue (6/21). 

Arizona Republic: Will Medicaid Referendum Make It?
Gov. Jan Brewer says that opponents to her Medicaid expansion won't get the signatures to refer it to the 2014 general election ballot. Her lawyers say that, even if they do, the courts will strike it down. Brewer has a much better chance of being right than her lawyers. The Arizona Constitution allows virtually any law passed by the Legislature, or any part of a law, to be referred. If enough signatures are gathered, the law doesn't go into effect until the electorate gets a chance to vote on it. Opponents are circulating petitions to refer both the expansion and the hospital assessment to pay for it and some of the state's existing Medicaid obligations (Robert Robb, 6/20). 

Health Policy Solutions (a Colo. news service): The Pot Calling The Kettle Black On Obamacare
During the past month several reports have been published on cost variations in the health care system. Among medical providers, there is clear evidence of wide differences in costs and utilization both across geographic regions and institutions. When the Colorado 208 Commission studied the issue, it also found that there were great variations among what insurers, the government and individuals pay. And, recently, the Colorado Division of Insurance analyzed insurance proposals for the health exchange.  Again, wide variations in insurance premiums are being proposed (Francis M. Miller, 6/20).

The New York Times: My Abortion, At 23 Weeks
My world stopped. I loved being pregnant with twins and trying to figure out which one was where in my uterus. Sometimes it felt like a party in there, with eight limbs moving. The thought of losing one child was unbearable. The M.R.I., at Seattle Children's Hospital, confirmed our fears: the organs were pushed up into our boy’s chest and not developing properly. We were in the 22nd week. In Washington State, abortion is legal until the 24th week. After 10 more days of tests and meetings, we were in the 23rd week and had to make a decision. My husband is more conservative than I am. He also is a Catholic. I am an old-school liberal, and I am not religious. But from the start, and through this ordeal, we were in complete agreement. We desperately wanted this child and would do whatever we could to save him, if his hernia was fixable and he could have a good quality of life (Judy Nicastro, 6/20). 

Bloomberg: Other Nations Don’t Compare To U.S. Health Care
It's a simple truism, often repeated, that other developed nations achieve better health outcomes than the U.S. does despite spending less money on care. … It's all so obvious, simple, widely agreed upon among health-care experts -- and completely irrelevant. (Economist Robert) Frank's comparison reflects a common misunderstanding of the real relationships between health, health care and government policy in the U.S (David Goldhill, 6/20).

Star Tribune: Move Forward On Medical Device Tracking
You may not yet depend on a pacemaker, defibrillator, stent, joint implant or any of the other life-­changing, potentially lifesaving products made by the medical device industry. But chances are you or a family member will be a patient some day. The number of knee replacements performed annually is projected to soar 673 percent by 2030, for example, with hip replacements increasing by 174 percent in the same time frame. That’s why it isn't just the medical device industry that has a stake in the timely rollout of a long-overdue national system to better track the safety and whereabouts of devices once they're on the market or in use. The millions of people in Minnesota and elsewhere who already rely on medical devices, and the millions more who will do so in the future, deserve to have this important new public health protection in place as soon as possible (6/21). 

Sacramento Bee: Physician Shortage Raises Questions
Right now, we simply don't have enough doctors to deliver high-quality primary care. Add to this the 25 million uninsured Americans who will have access to care in January when the Affordable Care Act goes into effect and we have the makings of a disaster. Medical schools across the country are doing an exceptionally poor job of addressing this shortage. Their press releases tout large numbers of medical students going into residencies that produce primary care doctors, yet these numbers are grossly misleading (Dr. Michael Wilkes, 6/20). 

Kansas City Star: OK, Call Obesity A Sickness If It Leads To Wellness
Up until now, the medical establishment has described obesity as "a major public health problem." That's a soothingly impersonal way to put it. Collectively, too many obese people constitute a problem. But people don't normally wake up in the morning and think, "Hey, I am part of a major health problem." Now the ground has shifted. The American Medical Association this week officially recognized obesity as a disease. That strikes a lot closer to home. One could conceivably look in the mirror and say, "I have an illness." Would that help or harm? Obesity is a scourge (Barbara Shelly, 6/20). 

Medpage Today: What’s Wrong With What We've Got Now?
Creating a Patient-Centered Medical Home within our existing system seems, at times, like a Herculean task. Getting all the pieces in place so that we can make the needed changes sometimes seems too vast to get it all right. We find ourselves asking: Why bother? Is our healthcare system that broken? Is the way we take care of patients now failing, satisfactory, or outstanding? If we just continue on the path we are on, is there anything wrong with that? Americans receive endless amounts of healthcare, but, we also have to ask, is it healthcare of endless value? (Dr. Fred Pelzman, 6/20).

Politico: Pathway Shouldn't Exclude Safety Net
The Congressional Budget Office estimates the (Senate immigration) bill will raise $451 billion of new revenue over 2014-2023 and another $1.5 trillion in the decade after that, mostly from income and payroll taxes paid by immigrants. Immigrants on the pathway to citizenship contribute to the funding of all federal programs with their tax dollars, but nearly all of them will be barred from using federal safety net programs for at least 13 years. ... The 13-year-long pathway to citizenship will be hard enough without these restrictions. Work hard to save up money not just for your kids’ school supplies, but to pay the penalties in the bill. Lose your job and you risk losing your legal status and being deported. The restrictions in the bill make the pathway even more treacherous. Pay your taxes, but don't get sick. Pay your taxes, but don't come to us for help (Sen. Mazie Hirono, D-Hawaii, 6/20).

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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.