Daily Health Policy Report

Monday, June 23, 2014

Last updated: Mon, Jun 23

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Women's Health

Capitol Hill Watch

Quality

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

More Than 750 Hospitals Face Medicare Crackdown On Patient Injuries

Kaiser Health News staff writer Jordan Rau reports: “A quarter of the nation’s hospitals – those with the worst rates – will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761. When Medicare sets final penalties later this year, that list may change because the government will be looking at performance over a longer period than it used to calculate the draft penalties” (Rau, 6/22). Read the story; a list of hospitals at highest risk of penalties; or an explanation of the methodology regarding how hospital-acquired infections are calculated.

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Drug Discount Policy For Hospitals, Clinics Under Scrutiny

Kaiser Health News staff writer Mary Agnes Carey reports: “A federal program designed to allow certain safety net hospitals and clinics to save money on drug purchases is under fire from critics who say the facilities are using that money to pad profits rather than help patients. The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25 to 50 percent discount. Participants can then charge higher rates to insured patients and keep the additional revenue” (Carey, 6/23). Read the story, which also ran in The Washington Post

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Political Cartoon: 'Shake Diet?'

Kaiser Health News provides a fresh take on health policy developments "Shake Diet?" by Lee Judge.

Meanwhile, here's today's haiku:

TRACKING HOSPITALS' PATIENT INJURIES AND MEDICARE PENALTIES

Crunching the numbers
offers clues about which ones
are missing targets.
  -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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Administration News

HHS Sec. Burwell Makes Management Changes To Healthcare.gov

The steps are being taken in an effort to prevent a repeat of the difficulties that took place during last year's launch of the federal online insurance marketplace.   

The New York Times: Health Site Is Changing Supervision
The Obama administration hired a top executive from the UnitedHealth Group on Friday to bolster management of the federal health insurance marketplace and to prevent a repetition of the chaos that engulfed the program last fall. The executive, Andrew M. Slavitt, was in charge of work on HealthCare.gov by Optum, a unit of UnitedHealth, one of the nation’s largest insurers. Starting on July 10, the administration said, Mr. Slavitt will become the principal deputy administrator of the federal Centers for Medicare and Medicaid Services, in charge of policy and operations. He will supervise and coordinate the work of the federal insurance exchange, Medicare and Medicaid, which together provide coverage to more than 100 million people (Pear, 6/20).

The Wall Street Journal: HHS Forms New Positions To Oversee HealthCare.gov
The new head of the Department of Health and Human Services said she was creating two executive-level positions to oversee HealthCare.gov, and bringing in-house the head of the private contractor that had been tasked with fixing the site, to try to avert problems in the law's second sign-up period (Radnofsky, 6/20).

The Washington Post: HHS’s Burwell Makes Management Changes
Health and Human Services Secretary Sylvia Mathews Burwell announced a series of management changes Friday that are intended to put a single administrator in charge of the federal health insurance marketplace — something both critics and allies of the Obama administration have urged since the troubled rollout of HealthCare.gov last year (Goldstein, 6/20).

The Associated Press: New Health Chief Revamps HealthCare.gov
Health and Human Services Secretary Sylvia Burwell appointed a new high-level operations manager to closely supervise the online portal to coverage under President Barack Obama's health care law. She also announced that she's hiring a CEO and a technology leader to specifically handle all aspects of the health law's coverage expansion. The CEO would be able to take concerns directly to Burwell (Alonso-Zaldivar, 6/20).

Reuters: U.S. Creates New CEO Position For Obamacare Insurance Marketplace
The Obama administration on Friday announced the creation of a new chief executive position to oversee operations of the federal Obamacare marketplace that provides private health insurance to consumers in 36 U.S. states. As part of a series of management announcements, U.S. Health and Human Services Secretary Sylvia Burwell also announced a new permanent chief technology officer for the marketplace served by the website HealthCare.gov, which crashed on launch last October (6/20).

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VA Executives Received High Ratings Before Scandal

Data released at a congressional hearing shows that all of the 470 senior executives at the VA received annual ratings of "fully successful" over the past four years, even though the health system was having delays in processing compensation claims and veterans were having trouble getting access to care.

The New York Times: Every Senior V.A. Executive Was Rated 'Fully Successful' Or Better Over 4 Years
All of the 470 senior executives at the Department of Veterans Affairs received annual ratings over the last four years indicating that they were "fully successful" in their jobs or even better, according to data released at a congressional hearing on Friday, despite delays in processing disability compensation claims and problems with veterans' access to the department’s sprawling health care system. None of the department's senior executives received either of the two lowest of five possible job ratings, "minimally satisfactory" or "unsatisfactory," in any of the past four fiscal years (Oppel, 6/20).

In other VA news -

The New York Times: Report Calls For Tracking Data On Stress Disorder
The Department of Defense and the Veterans Affairs Department should track their efforts to treat post-traumatic stress more carefully, to see how effective those efforts are, a government-sponsored report released Friday said (Carey, 6/20).

Los Angeles Times: Government's PTSD Treatment For Veterans Lacking, Report Finds
Despite spending billions of dollars a year to treat military service members and veterans with post-traumatic stress disorder, the government has little evidence that its efforts are working, according to a new report commissioned by Congress. The report described PTSD care in the military health system as "ad hoc, incremental and crisis driven" and said the Department of Veterans Affairs had not hired mental health providers fast enough to keep pace with the rising demand (Zarembo, 6/20).

The Associated Press:  Veterans Affairs Falls Short On Female Medical Issues
Already pilloried for long wait times for medical appointments, the beleaguered Department of Veterans Affairs has fallen short of another commitment: to attend to the needs of the rising ranks of female veterans returning from Iraq and Afghanistan, many of them of child-bearing age. The head of the VA's office of women's health acknowledges that persistent shortcomings remain in caring for the 390,000 female vets seen last year at its hospitals and clinics — despite an investment of more than $1.3 billion since 2008, including the training of hundreds of medical professionals in the fundamentals of treating the female body (Burke, 6/23).

The Fiscal Times: Congress Would Give VA A Blank Check To Fix Health Care Mess
When lawmakers head to conference to try to reform the embattled Veterans Affairs health care system, they will consider a Senate-passed measure that includes authorizing $200 million to lease additional medical facilities to alleviate the backlog of veterans waiting for treatment. The problem is the VA has recently come under scrutiny for mismanaging a large portion of the leases it already holds—leading to delays in opening medical centers across the country. A report from the Government Accountability Office shows that 39 of 41 leasing projects reviewed -- worth a total of $2.5 billion -- experienced delays ranging from 6 months to 13 years (Ehley, 6/23).

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Health Reform

Virginia Gov. Signs Budget, Vetos Medicaid Amendment

Gov. Terry McAuliffe will try to bypass the Republican-controlled legislature to expand health coverage for hundreds of thousands of uninsured residents. Medicaid expansion developments in Wisconsin, California and Pennsylvania are also tracked.

The Washington Post: Gov. Terry McAuliffe Vetoes Portions Of Virginia Budget, Vows To Expand Medicaid
Virginia Gov. Terry McAuliffe vetoed portions of the state budget Friday and vowed to defy the legislature by expanding Medicaid without its approval, setting up a legal showdown with Republicans even as he averted a government shutdown. ... Legislators will act on McAuliffe’s vetoes Monday when they reconvene in Richmond, and the outcome is uncertain. The GOP’s majority is large enough in the House of Delegates to override a veto, but not in the Senate (Vozzella, Laris and Weiner, 6/20).

The Richmond Times-Dispatch: McAuliffe To Sign Budget, Veto Medicaid Amendment
Gov. Terry McAuliffe will try to bypass the General Assembly to expand health coverage for hundreds of thousands of uninsured Virginians, while attempting to block legislative priorities ranging from judicial appointments to an overhaul of the Capitol complex in Richmond. McAuliffe said Friday that he will sign a two-year state budget that does not include his top legislative priority — expansion of Medicaid — in order to protect public services and Virginia’s triple-A bond rating in the face of a projected $1.55 billion revenue shortfall. But the governor also discarded a politically paralyzed legislative commission on Medicaid reform as a way to expand health coverage. He promised instead to move forward without legislative consent to take advantage of billions in federal funding for the uninsured under the Affordable Care Act (Martz, 6/20).

The Associated Press: Va. Governor Vows To Expand Medicaid On His Own
Democratic Gov. Terry McAuliffe vowed Friday to bypass the General Assembly and expand Medicaid eligibility for about 400,000 low-income residents on his own, a move Republican lawmakers immediately promised to fight. At a Capitol news conference, McAuliffe denounced leaders of the GOP-controlled House of Delegates, saying they are unwilling to help the state's poor (Suderman, 6/20).

Reuters:  Virginia Governor Will Veto Bid To Block Medicaid Expansion
Virginia Governor Terry McAuliffe said Friday he will veto a Medicaid amendment to the state budget advanced by a Republican-dominated legislature that could prevent him from expanding access to the program through executive action. Expanding Medicaid, a federal-state healthcare program for the poor, has been the Democratic governor's top legislative objective since taking office in January, as well as the centerpiece of his gubernatorial campaign against a Tea Party-backed opponent.(Robertson, 6/20).

Wisconsin State Journal:  Wisconsin Gubernatorial Race Spotlights Medicaid Issue
A Republican governor, Tommy Thompson, started Wisconsin's BadgerCare health insurance for low-income families in 1999. A Democratic governor, Jim Doyle, expanded it in 2008. The parties have disagreed on details over the years, but no aspect of the Medicaid program has been as explosive as a further expansion allowed this year through the federal Affordable Care Act. Republican Gov. Scott Walker rejected the expansion. Democratic gubernatorial candidate Mary Burke said she would accept it (6/22).

The Associated Press: California Expands Medi-Cal While Continuing Cuts
California has been praised by health advocates for its early embrace of the federal healthcare expansion, but the new state budget has raised questions about its commitment to getting the poorest residents into doctors' offices and dentists' chairs. Gov. Jerry Brown on Friday signed a budget for the 2014-15 fiscal year that accommodates an influx of uninsured residents into Medi-Cal, the state's Medicaid program. But at Brown's request, the Legislature left in place a 10% recession-era cut to most doctors, dentists and other healthcare providers who treat Medi-Cal patients, many whom are children (6/21).

The Associated Press: Pa. Gov Nets Nine Insurers For Medicaid Alternative
Pennsylvania Gov. Tom Corbett's administration said Friday that insurers are showing strong interest in the Republican's plan to extend private health insurance to hundreds of thousands of working poor and pay for it with federal Medicaid expansion dollars. Nine insurers have signed up to provide the Medicaid-subsidized insurance in Pennsylvania, though only one would cover the entire state, Corbett's office said (6/21).

The Philadelphia Inquirer: Corbett Names Insurers For Medicaid Plan
The Corbett administration on Friday announced the list of insurance companies that had met its qualifications to provide coverage to hundreds of thousands of the uninsured by early 2015. ... The companies that met the bid requirements in the southeast are United Healthcare, Aetna Better Health, Health Partners, Gateway Health, and Vista. If Corbett's "Healthy Pennsylvania" plan receives federal approval, the uninsured individuals could be enrolled by Jan. 1 (Worden, 6/22).

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States, Tech Companies Wrestle Over Efforts To Fix Troubled State Marketplace Sites

States seek to recoup funds from technology companies that were involved in creating the online insurance portals that malfunctioned. Meanwhile, Massachusetts reaches a deal on payment while Maryland considers moving to the federal marketplace.

The Wall Street Journal: States, Firms Spar Over Insurance-Exchange Funds
States and technology companies, including Xerox Corp. and Oracle Corp., are locked in disputes over more than $100 million allocated for Affordable Care Act insurance exchanges that had troubled rollouts. Oregon, Maryland, Massachusetts and Nevada are seeking to recoup funds or withhold money for work they say wasn't properly done. Poorly functioning exchanges in those states hampered enrollment last fall, and states blame contractors (Armour, 6/20).

The Boston Globe: Deal Reached On Botched Mass. Health Site
Massachusetts agreed Friday to pay $35 million to the Canadian technology developer that created the botched health insurance website, which the state abandoned last month. Counting $17 million already paid last year to the company, CGI, the state's bill will total $52 million for a site that malfunctioned from the start when it launched last October. State officials said the deal will ensure an orderly end to CGI’s work for the state, avoid litigation, and pay for the company’s assistance in recent months and its contributions to a replacement website (Freyer, 6/20).

The Baltimore Sun:  Weighing Maryland's Switch To Connecticut Vs. Federal Health Exchange
Since Maryland health exchange officials decided to replace their troubled website with technology used in Connecticut, critics have asked whether it would be cheaper and less risky to join the federal website. Exchange officials said the federal option could be a good deal for some states. But Maryland's antiquated Medicaid system couldn't hook up to the federal site, and building a separate system would be costly, they said (Cohn, 6/21).

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Chicago Hospitals See Little Change In ER Visits; Calif. Probes Anthem's Provider Lists

The Chicago Sun-Times examines the health law's effect on local emergency rooms, while the Los Angeles Times reports that state officials are investigating whether Anthem Blue Cross and Blue Shield of California violated state law by posting inaccurate provider lists.

The Chicago Sun-Times: Six Months In, Obamacare Impact On Emergency Room Visits Unclear
Six months after new health insurance options took effect for millions nationwide, most Chicago-area hospitals say they haven’t seen a noticeable change in the number of emergency room visits. The theory was that people who previously didn’t have insurance would no longer go to emergency rooms for treatment; under the Affordable Care Act, commonly called Obamacare, they would make a doctor’s appointment, lowering health care costs by reducing ER visits. Emergency rooms charge higher prices for minor illness and injury care than other ambulatory care settings, because they offer more services. But so far, at least, there is little evidence of an impact (Thomas, 6/23).

Los Angeles Times: California Probes Obamacare Doctor Networks At Anthem And Blue Shield 
California regulators are investigating whether Anthem Blue Cross and Blue Shield of California have violated state law in connection to patients struggling to find doctors under Obamacare. Officials at the California Department of Managed Health Care said they are looking into whether consumers were misled by inaccurate provider lists and the difficulty some patients are still having at locating a physician in narrower networks statewide (Terhune, 6/20).

The CT Mirror: Obamacare Glitch Leading To Canceled Policies, Some Say
Connecticut Republican leaders this week announced there's a new problem with Obamacare: Constituents calling to say their insurance policies had been canceled because the subsidies that help discount their premiums hadn't been paid. Like other controversies related to the health law, this one fell into something of a gray area. Its scope was unclear: Were these isolated cases, or signs of a widespread problem? In an election year, how much was this concern charged with politics? GOP leaders have been critical of the state's health insurance exchange and Obamacare, and the way they described the problem wasn't fully accurate. But according to people involved with insurance, the issue of mistaken policy cancellations is real, if not necessarily widespread (Becker, 6/20).

Modern Healthcare: Reform Makes Cash Tight For Providers, But Not Pharma and Payers
Hospitals and other providers face more financial challenges, and perhaps more near-term credit downgrades, than health insurers and pharmaceutical companies as healthcare reform unfolds, according to a new report from Standard & Poor's. To date in 2014, S&P has downgraded the credit ratings of 31 healthcare organizations—both not-for-profits and for-profits—compared with 22 upgrades. Most of the downgrades affected not-for-profit providers however. Lower service utilization is the biggest problem for providers, S&P analysts said. Patient admissions and visits began declining in earnest in late 2012, a trend experts initially attributed to the slow-recovering economy (Herman, 6/20).

The Associated Press: Get Covered America Targeting Small Biz Owners
Advocates are targeting small business owners across Florida to get their employees signed up for health coverage. Get Covered America met Saturday with 200 businesses across the state in its first outreach since open enrollment ended in April in an effort to educate consumers about the new health law (6/23).  

Meanwhile, some Capitol Hill lawmakers seek to fix a glitch in the law -

The Fiscal Times: A Bipartisan Baby Step to Fix An Obamacare Glitch
It only took four years, but Republicans and Democrats are actually starting to come together to fix the president's health care law. On Thursday, a bipartisan group of Senators introduced legislation that would resolve a glitch in the law that experts say negatively affects low-income patients. The issue stems from the law's pay-for performance provision intended to improve the quality of care and get away from the old fee-for service model. Under this initiative, Medicare and a large number of private insurance companies pay providers based on their performance as measured by patient outcomes. Hospitals are penalized for high readmission rates (Ehley, 6/23).

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Women's Health

Still Waiting On High Court's Decision On Birth Control Coverage Mandate

A decision could be issued any day. Also still in the mix is the court's ruling on a First Amendment challenge to a Massachusetts law that established a 35-foot buffer zone to restrict demonstrators outside of abortion clinics.  

The Washington Post’s Wonkblog: A Guide To The Supreme Court’s Birth Control Decision
Two Junes ago, we were waiting on a major Supreme Court decision on Obamacare. It's funny how history repeats itself. Any day now, the high court is set to rule on challenges to the administration's requirement that employer health plans provide a wide range of birth control at no-out-of-pocket cost. The challenges, Sebelius v. Hobby Lobby Stores, Inc. and Conestoga Wood Specialties Corp. v. Sebelius, was were brought by two employers who argue the contraception mandate violates their religious freedom (Millman, 6/20). 

USA Today: Eight Big Cases Await Supreme Court Rulings
The Supreme Court will issue decisions on three days this week as it seeks to conclude its 2013 term a week from today. … Abortion clinics. This is a First Amendment challenge to a Massachusetts law that restricted demonstrators outside abortion clinics by setting up 35-foot buffer zones. … Religious freedom. This is Obama's third major test pending before the court. His health care law mandates that most employers provide health insurance coverage for contraceptives. For-profit companies with religious objections are challenging (Wolf, 6/23). 

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Capitol Hill Watch

More Twists In Capitol Hill Insider-Trading Probe

The Securities and Exchange Commission is investigating whether nonpublic information related to a 2013 announcement by the Centers for Medicare and Medicaid Services regarding 2014 reimbursement rates was leaked improperly.

The Wall Street Journal: Insider-Trade Probe Eyes Call With House Aide
About an hour before stock trading closed April 1, 2013, a lobbyist at the center of a federal insider-trading probe spoke on the phone with a senior House health-care aide. The disclosure of that conversation represents the latest twist in a long-running federal investigation into whether congressional aides or other federal officials leaked word of a change in health-care policy to traders or anyone seeking information on behalf of investors. The conversation between the lobbyist, Mark Hayes, and Brian Sutter, staff director of the House Ways and Means Committee's health-care subpanel, was revealed Friday in court filings by the Securities and Exchange Commission (Ackerman and Mullins, 6/22). 

Reuters:  House Committee Ordered To Hearing As SEC Probes Medicare Insider Trading
A U.S. judge on Friday directed the House Ways and Means Committee and a staffer to appear at a July 1 hearing to address their alleged refusal to respond to U.S. Securities and Exchange Commission subpoenas as part of an insider trading probe. The order by U.S. District Judge Paul Gardephe in New York covers both the committee and Brian Sutter, staff director for its healthcare subcommittee, and came at the SEC's request. The SEC said it is examining whether material nonpublic information concerning an April 1, 2013 announcement by the Centers for Medicare and Medicaid Services of 2014 reimbursement rates for a Medicare program was leaked improperly, and whether anyone traded on that information (Raymond, Stempel and Lynch, 6/20).

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Quality

Patient Injuries Mean Medicare Payment Penalties For Some Hospitals

The preliminary analysis of penalties would lower Medicare payments to these hospitals by 1 percent for a year. Elsewhere, lawmakers introduce legislation to change how hospitals that serve a large number of poor patients are affected by Medicare's penalties.

Kaiser Health News: More Than 750 Hospitals Face Medicare Crackdown On Patient Injuries
A quarter of the nation’s hospitals -- those with the worst rates -- will lose 1 percent of every Medicare payment for a year starting in October. In April, federal officials released a preliminary analysis of which hospitals would be assessed, identifying 761. When Medicare sets final penalties later this year, that list may change because the government will be looking at performance over a longer period than it used to calculate the draft penalties. Vidant, for instance, says it lowered patient injury rates over the course of 2013, and Handron praises their efforts (Rau, 6/22).

Modern Healthcare: Bill Would Adjust Readmissions For Socio-Economic Factors
A group of U.S senators introduced legislation Thursday that aims to address growing concerns that hospitals serving low-income populations are unfairly penalized under Medicare's Hospital Readmissions Reduction Program.  The Hospital Readmission Accuracy and Accountability Act would require the CMS to account for patient socioeconomic status when calculating risk-adjusted readmissions penalties. Holding all other factors constant, socioeconomic conditions—such as poverty, low levels of literacy, limited English proficiency, minimal social support, poor living conditions and limited community resources—likely have direct and significant impacts on avoidable hospital readmissions, and adjusting for these factors would improve accountability and quality of care, according to the text of the bill (Rice, 6/20).

And some hospitals say they won't adhere to Medicare's rule on admitting patients to the hospital --

The Journal Gazette: Hospitals Say They Won’t Heed ‘2-Midnight Rule’ 
It's called the two-midnight rule, and some hospitals want to avoid it like a measles epidemic. Federal officials want to make sure that hospitals are admitting only those patients who really need extended expert medical care, which is expensive. So they drafted a plan to audit Medicare claims for inpatients whose hospital stays are shorter than two midnights. The theory is that any patient who stays in the hospital longer than that legitimately needs to be there (Slater, 6/22).

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Health Care Marketplace

Private Insurers Clamp Down On Drug Prices

More health plans are refusing to cover certain brand-name drugs unless drugmakers offer discounts for them, reports The New York Times. Meanwhile, drug companies are trying to change a federal program designed to allow certain hospitals that treat large numbers of the poor to buy drugs more cheaply, but which critics say allows them to use those savings to pad profits.

The New York Times: Health Insurers Pressing Down On Drug Prices
Determined to slow the rapid rise in drug prices, more health plans are refusing to cover certain drugs unless the companies charge less for them. The strategy appears to be getting pharmaceutical makers to compete on price. Some big-selling products, like the respiratory medicine Advair and the diabetes drug Victoza, have suffered precipitous declines in market share because Express Scripts, the biggest pharmacy benefits manager, recently stopped paying for them for many patients (Pollack, 6/20).

Kaiser Health News: Drug Discount Policy For Hospitals, Clinics Under Scrutiny
A federal program designed to allow certain safety net hospitals and clinics to save money on drug purchases is under fire from critics who say the facilities are using that money to pad profits rather than help patients. The 340B drug pricing program lets thousands of hospitals, community health centers and family planning clinics buy outpatient prescription medications from manufacturers at an estimated 25 to 50 percent discount. Participants can then charge higher rates to insured patients and keep the additional revenue” (Carey, 6/23).

In other marketplace news, KPMG is boosting its health care consulting practice -

The Wall Street Journal: KPMG Expected To Announce Deal To Boost Health-Care Practice
KPMG LLP is buying Zanett Commercial Solutions, a Cincinnati-based technology-consulting firm that will help the Big Four accounting firm beef up the services it provides to health-care clients. The deal is expected to be announced Monday. Financial terms aren't being disclosed (Rapoport, 6/23).

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State Watch

State Highlights: BlueCross BlueShield Plan Faces Ore. Lawsuit

A selection of health policy stories from Ohio, Oregon, New York, Colorado, Iowa, New Jersey, North Carolina, Georgia, California and Minnesota.

Columbus Dispatch: Ohio Seeks Better Managed-Care, Lower Costs
About 115,000 residents who receive health coverage through Medicare and Medicaid will be moved into managed-care plans under a three-year demonstration known as MyCare Ohio. They represent nearly two-thirds of so-called dual eligibles. That group, which has received two mailings from the state, has until Thursday to sign up for a Medicaid managed-care plan, or one will be assigned to them after MyCare enrollment starts on July 1. They will then have 90 days to change plans. By coordinating services, state officials hope to improve care and save money. But many being forced to make the changes worry they’ll be worse off (Candisky and Pyle, 6/22).

The Oregonian: Lawsuit Claims Regence BlueCross BlueShield No Longer Acting Like Nonprofit
Lawyers have filed a class-action lawsuit against Oregon nonprofit health insurer Regence BlueCross BlueShield, saying it is acting like a for-profit company by stockpiling excess funds that support large salaries rather than health care for policyholders. The lawsuit, filed Friday in Multnomah County Circuit Court, asks a judge to rule that Regence is not fulfilling the public-purpose clause of its own bylaws, and is failing to use its excess earnings for the benefit of its members (Budnick, 6/20).

The New York Times: Judge Upholds Policy Barring Unvaccinated Students During Illnesses
In a case weighing the government’s ability to require vaccination against the individual right to refuse it, a federal judge has upheld a New York City policy that bars unimmunized children from public school when another student has a vaccine-preventable disease (Mueller, 6/22).

PBS NewsHour: ‘Right To Try’ Law Gives Terminal Patients Access To Drugs Not Approved By FDA
In May, Colorado became the first state to pass a so-called 'right to try' law, allowing terminal patients access to experimental drugs without FDA approval -- and Missouri is about to follow suit. NewsHour Weekend examines the issue by speaking with the Missouri bill's sponsor and his daughter, who is suffering from cancer (6/21).

Des Moines Register: Wellmark Seeks Insurance Rate Increases
About a quarter of a million Iowans would see their insurance rates rise next year should the state approve a request from Iowa's dominant health insurer. Wellmark Blue Cross and Blue Shield announced Friday that it is seeking to raise premium rates for 253,000 policyholders in Iowa. Those rate increases would affect individual policyholders and small businesses (Patane, 6/20).

Politico: Chris Christie Pushes ‘Pro-Life’ Reforms
New Jersey Gov. Chris Christie argued Friday for reforms in education and the treatment of non-violent drug offenders as part of a “pro-life” philosophy that extends beyond abortion. ... “I believe if you’re pro-life, as I am, you need to be pro-life for the whole life,” Christie said. “You can’t just afford to be pro-life when a human being is in the womb. You have to be pro-life after … Sometimes being pro-life is messy, sometimes it’s difficult. Because human beings make bad choices, we are flawed. And I doubt that there’s one person in this audience who hasn’t made a bad choice, or a bad decision in your life” (Glueck, 6/20).

McClatchy: Parents, Nurses Fear School Nurse Cutbacks Can Be Dangerous To Children’s Health
Parents in Charlotte, N.C., celebrated last week when their county commissioners approved a budget that includes $1.8 million to make sure every public school has a full-time nurse. The agreement capped two years of work by a parents advocacy group started by Teri Saurer, the mother of daughters who just finished first and third grades. Saurer got involved with the nurse issue in the Charlotte-Mecklenburg Schools because her younger daughter, Hannah, has a history of seizures and serious food allergies. But she said nurses made schools safer for all students. Other parent advocates joined the effort because their children suffered concussions at school. One had a child who experienced a first-time food allergy (Schoof, 6/20).

Cincinnati Enquirer: Heroin Addicts Left Trapped Between Abstinence and Methadone Choices
Kenny and Lori Sandlin understand the urgency for better treatment options for heroin addiction, but it came too late for their daughter. Desi Sandlin grew up 15 miles south of Cincinnati in Kentucky. She started experimenting with drugs at 14, progressing to pain pills. By 19, she was addicted to heroin. ... Medical treatments for heroin and other opiates have been around for years and promising new methods are emerging, despite stagnant research funding. Many people kicked heroin because of methadone, but some health care leaders are now backing away from it (Cochran, 6/21).

Georgia Health News: Building Georgia’s Primary Care Workforce
The state’s pipeline for new physicians is getting wider. Gwinnett Medical Center has joined a phalanx of hospitals developing residency programs in primary care -- an effort that could help ease Georgia’s physician shortage. The Lawrenceville-based health system launched its new family medicine residency program last week, the first physician training offered there in the organization’s history (Miller, 6/22). 

The San Francisco Chronicle: Hiker Wants Break On Health Insurance
A hiker on the Pacific Crest Trail has a proposal for the health care industry that would save a fortune for Bay Area hikers, bikers and other outdoor athletes on their health insurance costs. Just as the banking industry gives you a credit score to assess your financial risk, the health industry should give you a medical score to assess your health risk, she said. "You would then pay for insurance according to your number," she said. "People who hike or bike, like so many in the Bay Area, who don't smoke, are in good shape and have good genetics would get a very high score" (Stienstra, 6/22).

The Star Tribune: Sick, Frail And Abandoned By Home Care Firms
Jerry Parson lay motionless on the bedroom floor, pain shooting through his back. The screams of his companion, Joyce, pierced the morning silence of their Bloomington apartment. They were helpless. A personal care attendant they had hired to move Parson from his bed to his wheelchair each day had failed to show up for work. Frantic calls to her employer, a company called Crystal Care Home Health Services, had gone unanswered (Serres, 6/20).

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Editorials and Opinions

Viewpoints: Concerns About ACOs; Problems In Va. Gov.'s Strategy; Medicaid 'Black Hole'

The New York Times: Bigger Health Companies: Good For Medicare, Maybe Not For Others
Although Obamacare’s health insurance expansion has directly provided coverage to only about 4 percent of Americans, changes embedded in the Affordable Care Act could affect many more people, and not always in good ways. One such change is a provision that allows organizations that join forces to manage care for a large population to receive bonuses from Medicare for controlling costs and hitting quality targets (or face penalties if they do not). Medicare's Accountable Care Organization model, as it’s called, favors larger health provider organizations that can manage the costs and quality of all types of care Medicare pays for, from primary care to high-intensity hospitalization and everything in between (Austin Frakt, 6/23).

The Washington Post: Virginia's Governor Claims He Can Expand Medicaid On His Own Say-So
[Gov. Terry] McAuliffe on Friday announced that he would go it alone, bypassing the General Assembly and unilaterally expanding access to affordable health care in the state. In a public address, the governor insisted that he had many legal avenues, and he assigned his secretary of health and human services to bring him a plan by Sept. 1. There’s no way to pass judgment on the governor’s plan until one exists. Perhaps there is a sensible and legal way for him to push through a coverage expansion in line with what the Affordable Care Act envisioned for Virginia, respectful of the prerogatives of the General Assembly. But much as we support the goal of wider coverage, we’re skeptical about the prospect of unilateral action (6/20).

Los Angeles Times: Can We Finally Agree That Obamacare Is Working?
At the end of a war, some people will remain holed up in the trees, thinking they can still turn the tide of a lost cause. Increasingly, that's the best description of the anti-Obamacare dead-enders, including Congressional Republicans, who continue to depict the Affordable Care Act as a failure despite facts (Michael Hiltzik, 6/20).

Charlotte Observer: Expand Medicaid – It Has Value In N.C.
N.C. lawmakers don't seem inclined to reconsider their unwise decision not to expand Medicaid. But that doesn’t mean we should stop shouting loudly why they should. A new Robert Wood Johnson Foundation report last week underscores the value for the Tar Heel state. The report looked at the Affordable Care Act’s impact in 14 large U.S. cities. ... The report points out that had North Carolina expanded the state's Medicaid program for low-income and disabled residents, the decrease in uninsured in Charlotte would be even greater – an estimated 57 percent. That would be an additional 36,000, bringing the number of Charlotte residents gaining insurance to 99,000 by 2016 (6/22). 

Bloomberg/BusinessWeek: The Medicaid Black Hole That Costs Taxpayers Billions
Here's some cheerful news: States and the federal government are doing little to stop a costly form of Medicaid fraud, according to a government report released last week. Medicaid, the federal-state health insurance program for poor Americans, now covers more than half its members through what’s known as Medicaid managed care. States pay private companies a fixed rate to insure Medicaid patients. ... Despite the growth of managed care in recent decades, officials responsible for policing Medicaid "did not closely examine Medicaid managed-care payments, but instead primarily focused their program integrity efforts on [fee-for-service] claims," according to the Government Accountability Office (John Tozzi, 6/23).

USA Today: Washington Won't Let Me Help My Patients
Every year, lawmakers wrap health care providers like me in ever-tighter reams of red tape. Their ceaseless pen-pushing raises prices, limits availability and reduces face-to-face time between doctors and patients. This problem preceded the Affordable Care Act by decades. Whether it's Medicare, Medicaid or something else, every federal health care reforms only empower bureaucracies to write the tune to which health care providers must dance. Yet Obamacare worsened the bureaucratic burden like nothing I've ever seen (Kathryn Chenault, 6/22).

Politico: How Congress Brought The Measles Back
In 2000, the Centers for Disease Control and Prevention made a stunning declaration: Measles — a disease that once infected 3 million to 4 million Americans each year, and killed 500 of them — had been eliminated in the United States. It was a victory decades in the making, the product of a highly effective vaccine and a strong public health system. But today, measles is back. Just this month, the CDC reported more cases in the country in the first six months of 2014 — 477 — than during that same period in any year since 1994. Public health has taken a giant, 20-year step back, and we have Congress to thank (Sarah Despres, 6/22).

The New York Times: The Heavy Burden of Post-Traumatic Stress Disorder
Post-traumatic stress disorder has reached staggering levels in the American military. ... The Departments of Defense and of Veterans Affairs have poured billions of dollars into treating the debilitating condition. Yet neither department really knows whether the treatments offered and applied are effective, according to a report issued Friday by the Institute of Medicine, a unit of the National Academy of Sciences, which had been asked by Congress to evaluate the programs (6/20).

The Washington Post: A Mississippi Infant's Case Opens A New Door On Studying A Cure For HIV
The possibility of achieving an HIV cure for thousands of infants is too important not to pursue vigorously. The National Institutes of Health will soon launch a carefully monitored clinical trial in 12 countries, including the United States. The study aims to replicate the results of the Mississippi baby case in other infants exposed to HIV in the womb. It is hoped that this study will prove that immediate treatment for HIV-infected newborns can protect them from a lifetime of anti-HIV therapy, while furthering our understanding of how we might pursue a cure for HIV infection in adults (Anthony S. Fauci, 6/20).

The Washington Post: A Father's Day Goodbye
Father’s Day found me with a man who often doesn't remember who I am, although we have spent much of his 93 years together. My father has dementia. ... I was angry at first. I couldn't save him. Diapers. Confusion. Indignity. He was a proud man. Respected. I didn't like deciding whether he needed medication that I knew would knock him out. The resentment is gone now, replaced by abiding sadness (Pete Earley, 6/20).

Bloomberg: Big Leagues Should Kick the Habit
It's hard to be shocked by anything involving the tobacco companies, but what's really bewildering is the MLB Players' Association's continued role in enabling them. Minor league baseball banned smokeless tobacco in 1993 and levies hefty fines for those caught chewing; but those players are not unionized and thus presented little roadblock. The MLBPA, meanwhile, uses its position as the most powerful union in all of sports -- and, arguably, the country -- to fight a losing battle to retain their players’ right to chew (Kavitha A. Davidson, 6/20).

The Washington Post: Best State In America: Vermont, For Its Healthy Kids
A lifetime of good health starts in childhood. Health insurance, access to health care and regular exercise make for fit kids with long life expectancies. And nowhere in America are kids healthier than in Vermont. Across a range of metrics, the Green Mountain State excels, according to the latest data collected by the Centers for Disease Control and Prevention (Reid Wilson, 6/20).

WBUR: Best Kept Secret For Postpartum Depression? Help At Home
In 2010, while pregnant with my only child, I lined up a postpartum doula before I even chose the hospital where I would give birth. I had worked with new families throughout the Boston area for fifteen years, mainly as a professional birthing coach (another type of doula), and occasionally as the postpartum type myself. So I knew getting help for myself after childbirth was the first thing I had to have in place. I’d seen up close how much help vulnerable new mothers need and how rarely they get it. And I was well aware of the more-common-than-you think risk of postpartum depression (Ananda Lowe, 6/20).

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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.