Daily Health Policy Report

Monday, June 24, 2013

Last updated: Mon, Jun 24

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Coverage & Access

Women's Health

Public Health & Education

Health Policy Research

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Officials Prepare For 'Biggest Open-Enrollment Season We've Ever Seen'

Kaiser Health News staff writers Phil Galewitz and Jay Hancock report, "At the Silver State Health Insurance Exchange in Carson City, Nev., workers have been counting down the days until Oct. 1 on an office corkboard. Sunday is a big milestone --- 100 days to the deadline for opening the online marketplaces that are a linchpin of the federal health law known as Obamacare. 'We certainly will need every one of the days that we have left,' said Jon Hager, executive director of the Nevada exchange. 'But I am confident we will be ready to go.' ... Opening the marketplaces on time represents the Obama administration’s biggest opportunity to fulfill the law’s promise to extend coverage to uninsured Americans, including those who have been denied coverage in the past because of health conditions" (Galewitz and Hancock, 6/23). Read the story.

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Blue Cross-Blue Shield Bets Big On Obamacare Exchanges

Kaiser Health News staff writer Jay Hancock, in collaboration with The Washington Post, reports: "At a closed White House meeting in April, President Barack Obama told corporate insurance bosses 'we're all in this together' on implementing his signature health law. But some insurance companies seem to be more in than others. At least five Blue Cross and Blue Shield executives sat at the table of about a dozen CEOs with the president, according to those knowledgeable about the session, first reported by the New York Times. Just as significant is who wasn't there: chiefs of the country's biggest and third-biggest health insurers, UnitedHealth Group and Aetna" (Hancock 6/21). Read the story

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Better Hospital Food Brought To You By The Federal Health Law

Kaiser Health News staff writer Phil Galewitz, in collaboration with USA Today, reports, "When Lauren Heath learned she had to spend an extra day in Rex Hospital after delivering her baby girl in May, she wasn't complaining. 'It means I get three more, really good meals,' said Heath, 29, of Wake Forest, N.C. 'The food is amazing.' ... Rex, part of the University of North Carolina Health System, is one of a growing number of hospitals nationwide that are tossing out their fryers and adopting hotel-style 'room service' where patients can order food anytime from a large menu.  Many are also setting up gardens to grow their own vegetables, inviting local farmers to sell produce in their lobbies and turning food presentations into works of art -- even when made puree style" (Galewitz, 6/24). Read the story.

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Political Fight Jeopardizes Mississippi’s Entire Medicaid Program

Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with Kaiser Health News and NPR, reports, "Medicaid and controversy are welded together in many states lately, but for the most part, the wrangling is about 'new' Medicaid -- the Obamacare expansion of the health program for the poor and disabled. Mississippi, though, is raising the stakes. Democrats and Republicans in the state are in the middle of a game of political chicken that could threaten the very existence of the entire Medicaid program by the end of the month" (Hess, 6/22). Read the story.

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Political Cartoon: 'They Say It's Your Birthday'

Kaiser Health News provides a fresh take on health policy developments with 'They Say It's Your Birthday' By Paul Fell.

Meanwhile, here is today's health policy haiku:

EVERYDAY I HAVE THE BLUES

Proceed with caution
is the rule for insurers

- 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

Doctors, Hospitals, Insurers Prepare As Health Law Implementation Nears

The New York Times profiles a Louisville clinic's efforts to be ready for changes, while several outlets look at the progress of the health exchanges where consumers will be able to buy insurance plans.

The New York Times: A Louisville Clinic Races To Adapt To The Health Care Overhaul
One morning last month, a health clinic next to a scruffy strip mall here had an unlikely visitor: a man in a suit and tie, seeking to bring a dose of M.B.A. order to the operation. ... For doctors and their staffs, this is a period of fevered preparation for the far-reaching changes that are soon to come as the law moves out of the realm of political jousting and into the real world. To follow how the historic law is playing out, The New York Times will look periodically at its impact in Louisville, a city of 600,000 that embodies both the triumphs and the shortcomings of the medical system in the United States (Goodnough, 6/22).

Kaiser Health News: Blue Cross-Blue Shield Bets Big On Obamacare Exchanges
At a closed White House meeting in April, President Barack Obama told corporate insurance bosses 'we’re all in this together' on implementing his signature health law. But some insurance companies seem to be more in than others. At least five Blue Cross and Blue Shield executives sat at the table of about a dozen CEOs with the president, according to those knowledgeable about the session, first reported by the New York Times. Just as significant is who wasn’t there: chiefs of the country's biggest and third-biggest health insurers, UnitedHealth Group and Aetna (Hancock 6/21).

Politico: Multistate Affordable Care Act Plans May Not Spur Competition
A program meant to beef up competition on Obamacare exchanges may not add much to the mix of insurance options after all. The Multi-State Plan Program — which was the closest thing to a watered-down "public option" that made it into the final health law — is eventually supposed to provide at least two new insurance options in every state. The problem is that the only insurers likely to be able to quickly scale up coverage across the country are already doing just that: selling their plans from coast to coast (Norman, 6/24).

The Hill: 10 To Watch On ObamaCare Rollout
The Obama administration’s implementation of the 2010 healthcare law will help shape the president’s legacy, for better or worse. Federal and state officials are preparing to launch the health law’s insurance exchanges on Oct.1. But while most attention is trained on federal Health secretary Kathleen Sebelius, there are many others behind the scenes playing important roles in setting up the health exchanges, preparing for the Medicaid expansion and trying to get the public on board (Viebeck, 6/23).

USA Today: Government Begins Education Blitz For Uninsured
A week after a Government Accountability Office report said new health insurance exchanges may not be fully ready to launch in October, the government Monday began a 100-day public education blitz by releasing a new website, call center and publicity campaign. The campaign is designed to educate those who do not have insurance about how the marketplaces will work and how to obtain health insurance (Kennedy, 6/24).

The Washington Post: Obamacare Starts In 100 Days
There are, arguably, two big things that need to happen between now and October. The first is technical: The federal government needs to finish building the infrastructure that allows multiple government agencies to transmit information, determining whether an individual should qualify for tax subsidies. This is a really big lift. ... Also in the technical arena, the federal government needs to finish building the federal exchange, an online portal that most states will have their residents use to purchase health insurance (Kliff, 6/23).

Kaiser Health News: Officials Prepare For 'Biggest Open-Enrollment Season We've Ever Seen'
At the Silver State Health Insurance Exchange in Carson City, Nev., workers have been counting down the days until Oct. 1 on an office corkboard. Sunday is a big milestone --- 100 days to the deadline for opening the online marketplaces that are a linchpin of the federal health law known as Obamacare. "We certainly will need every one of the days that we have left," said Jon Hager, executive director of the Nevada exchange. "But I am confident we will be ready to go." ... Opening the marketplaces on time represents the Obama administration’s biggest opportunity to fulfill the law’s promise to extend coverage to uninsured Americans, including those who have been denied coverage in the past because of health conditions (Galewitz and Hancock, 6/23).

Baltimore Sun: Health Reform Outreach Begins In Maryland And Across The Across
As a multimillion-dollar national campaign launches Sunday to enroll Americans in the nation's new health care program, Maryland officials have already begun enlisting local groups in a similar drive. In one example, 200 Christian, Jewish and Muslim religious leaders were brought together in Baltimore in May to discuss the health care initiative — part of a series of meetings and webinars to engage hospitals, religious congregations, insurance brokers and other groups seen as crucial to the outreach campaign. The state will begin more aggressive steps, including a door-to-door effort to reach the most vulnerable residents, later in the summer and early fall, ahead of the October opening of the enrollment period for Maryland's health exchange (Walker, 6/22).

In other health overhaul news -

The Associated Press: Promise Of Price Cut On Hospital Bills Is In Limbo
Huge list prices charged by hospitals are drawing increased attention, but a federal law meant to limit what the most financially vulnerable patients can be billed doesn't seem to be making much difference. A provision in President Barack Obama's health care overhaul says most hospitals must charge uninsured patients no more than what people with health insurance are billed. The goal is to protect patients from medical bankruptcy, a problem that will not go away next year when Obama's law expands coverage for millions (Alonso-Zaldivar, 6/24).

The Associated Press: Some Immigrants Excluded From Health Care Overhaul
President 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 in the country illegally. 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 (Silva, 6/21). 

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Companies Examine Ways To Cut Health Costs, Deal With Obamacare

The New York Times explores how employers are wrestling with approaches to health costs, as well as the health law's new requirements.

The New York Times: Employers Test Plan To Cap Medical Spending
Hoping to cut medical costs, employers are experimenting with a new way to pay for health care, telling workers that their company health plan will pay only a fixed amount for a given test or procedure, like a CT scan or knee replacement. Employees who choose a doctor or hospital that charges more are responsible for paying the additional amount themselves. Although it is in the early stages, the strategy is gaining in popularity and there is some evidence that it has persuaded high-priced hospitals to lower their prices (Abelson, 6/23).

Related, earlier KHN story: Companies Steering Workers To Lower Priced Medical Care (Appleby, 9/22/11)

The New York Times: Why A Health Insurance Penalty May Look Tempting
Once new health insurance exchanges are up and running in October, companies with 50 or more full-time employees will face a choice: Provide affordable care to all full-time employees, or pay a penalty. But that penalty is only $2,000 a person, excluding the first 30 employees. With an employer’s contribution to family health coverage now averaging $11,429 a year, taking that penalty would seem to yield big savings. Yet there may be costs in employee satisfaction, especially if companies don’t raise pay enough to keep workers whole when they buy insurance on the exchanges (Bernasek, 6/22).

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Mississippi Political Fight Threatens Medicaid Program, Care For 700,000

The state's Democratic and Republican lawmakers are embroiled in a game of chicken that threatens to blow up the Medicaid program, which serves 700,000 poor Mississipians. Meanwhile, reports from Indiana, Montana and California detail other developments related to state officials' decisions about whether to expand the program under the health law.

Kaiser Health News: Political Fight Jeopardizes Mississippi's Entire Medicaid Program
Medicaid and controversy are welded together in many states lately, but for the most part, the wrangling is about "new" Medicaid -- the Obamacare expansion of the health program for the poor and disabled. Mississippi, though, is raising the stakes. Democrats and Republicans in the state are in the middle of a game of political chicken that could threaten the existence of the entire Medicaid program by the end of the month (Hess, 6/22).

The Billings Gazette: The New Montana Health Insurance Marketplace
Come October, Montanans should be able to shop for health insurance on a new Internet marketplace, and anywhere from 150,000 to 200,000 Montanans will be eligible for federal subsidies to help pay for the policies. The subsidies should make health insurance available and affordable for tens of thousands of Montanans currently without it, say supporters of the Affordable Care Act, also known as "Obamacare." ... Yet surveys also indicate that the majority of people eligible for the subsidies don’t even know about them (Dennison, 6/23).

Evansville Courier & Press: With Loss Of Funds Projected, Indiana Hospitals Pray For Medicaid Expansion
It probably sounded like a good trade-off at the time: Hospitals would give up $155 billion in Medicare and other government payments to help provide more money for a Medicaid coverage expansion that begins in January. But subsequent events have put the deal in doubt in Indiana. Hospitals could be left with nothing to show for the payment reductions, which began with the Affordable Care Act in 2010, if the federal government doesn’t accept Gov. Mike Pence's idea for administering the Medicaid coverage expansion (Langhorne, 6/22).

HealthyCal: Counties Build Bridge To Obamacare
The Supreme Court decision that kept Obamacare intact made one major change to the legislation: the Medicaid expansion became optional. But California, one of the states leading on reforms, started the expansion of the state Medicaid program—known as Medi-Cal— three years ago. The early expansion in California and other states was intended to show the benefits and pitfalls of reforms before they were rolled out nationwide and to provide models for success (Shanafelt, 6/24).

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Health Care Marketplace

Reimbursement Caps Mean Some Calif. Hospitals Reduce Surgery Prices

The program saved $5.5 million over two years, the study found. News outlets covered developments in the industry. 

Los Angeles Times: Hospitals Cut Some Surgery Prices After CalPERS Caps Reimbursements
When the California Public Employees' Retirement System told its Anthem Blue Cross members it would pay only up to $30,000 for a knee or hip replacement surgery, some patients shopped around for a cheaper hospital. What may be more surprising is that about 40 higher-priced hospitals in the state cut their surgery prices significantly to avoid losing patients. That response accounted for about 85 percent of the $5.5 million CalPERS saved over two years, researchers at UC Berkeley found, with the rest of the savings coming from patients opting for lower-cost hospitals (Terhune, 6/23).

Bloomberg: Surgery Cost Caps Save Pension Funds Without Hurting Health
The nation’s largest pension fund and health insurer WellPoint Inc. cut medical costs 19 percent by capping the price of some surgeries, in the latest sign payers are taking a tougher line against rising hospital claims. ... Hospital charges have come under renewed scrutiny as the government seeks to increase the number of insured Americans under President Barack Obama’s 2010 health-care law. Cost capping, which steers consumers away from high-priced providers that don’t produce better outcomes, is gaining currency among employers grappling with the wide variation in hospital expenses, said Kenneth Goulet, a WellPoint executive vice-president. (Nussbaum, 6/24).

In the meantime, some doctors in Texas are not allowed to deliver babies at one hospital unless they've completed a three-year residency program, prompting legal action --

The Texas Tribune/The New York Times: A Policy Keeps Some Texas Doctors From the Delivery Room
But Dr. [Jeff] Alling no longer has a place to deliver babies in the county. The community hospital in Bridgeport that he helped found in 2008 merged its obstetrics unit with the Wise Regional Health System in Decatur in March. That hospital, where Dr. Alling delivered babies before he left for Bridgeport, instituted a policy in 2009 that allowed physicians to deliver babies only if they had undergone a three-year residency program specializing in obstetrics and gynecology. ... As a result, Dr. Alling and three other family physicians were denied obstetrics privileges at Wise Regional and are in legal mediation with the hospital. They estimate that 50 to 100 pregnant patients, the majority of whom live in rural areas and are covered by Medicaid, have been affected by Wise Regional’s refusal to grant them obstetrics privileges (Aaronson, 6/22).

Kaiser Health News looks at hospital food and the health law --

Kaiser Health News: Better Hospital Food Brought To You By The Federal Health Law 
When Lauren Heath learned she had to spend an extra day in Rex Hospital after delivering her baby girl in May, she wasn’t complaining. "It means I get three more, really good meals," said Heath, 29, of Wake Forest, N.C. ... Rex, part of the University of North Carolina Health System, is one of a growing number of hospitals nationwide that are tossing out their fryers and adopting hotel-style “room service” where patients can order food anytime from a large menu.  Many are also setting up gardens to grow their own vegetables, inviting local farmers to sell produce in their lobbies and turning food presentations into works of art -- even when made puree style" (Galewitz, 6/24).

And costs are examined as hospitals hire doctors --

Tampa Bay Times: As Hospitals Hire Doctors, Costs Rise, Medicare Report Finds
As they buy up physician practices, hospitals promise to streamline patient care and cut costs. But just the opposite is happening, warns a federal Medicare advisory panel. The same services cost the government's Medicare program much more when performed on an outpatient basis at a hospital, rather than at a doctor's office. A common type of echocardiogram can be done in a doctor's office for $188. But for the same procedure in a hospital setting, the total payment is $453, reported the Medicare Payment Advisory Commission (Stein, 6/23).

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Coverage & Access

More Options For Dental, Vision Coverage For Federal Employees

In the meantime, the nation's largest public pension fund, the California Public Employees Retirement System, moves to provide equal access to health care for transgender people.

The Washington Post: Federal Employee Dental And Vision Insurance Program To Expand
More insurance companies will participate in the dental and vision insurance program for federal employees and retirees in 2014, the first expansion since the program was created in 2006, the Office of Personnel Management announced Friday. ... In the FEDVIP program, federal employees and retirees can purchase one or the other type of coverage or both, and can cover certain family members (Yoder, 6/21).

The Hill: Top Pension Fund To Cover Transgender Health Care, Advocates Say
The country's largest public pension fund has moved to provide equal access to health care for transgender people, advocates said. The California Public Employees Retirement System, or CalPERS, reportedly voted Wednesday to remove exclusionary language from the healthcare policies offered to its 1.3 million enrollees (Viebeck, 6/21).

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Women's Health

Texas House Approves 20-Week Abortion Ban

In Texas, lawmakers cut short debate and approved new abortion regulations that would ban most abortions after 20 weeks of pregnancy, among other things. In Wisconsin, a bill would require an abortion doctor to make burial arrangements for a fetus.

The Associated Press: Texas Lawmakers Approve Abortion Restrictions
Republicans used their majority to cut short debate and give preliminary approval early Monday to some of the toughest abortion restrictions in the country as time was running out on the Texas Legislature's special session. ... The measure would ban abortions after the 20th week of pregnancy, require doctors to have admitting privileges at nearby hospitals and limit abortions to surgical centers. Supporters say the bill will raise the standard of women's health care, but opponents point out the bill would shut down 37 out of 42 abortion clinics in the state (Tomlinson, 6/24).

Milwaukee Journal Sentinel: Abortion Bills Await Governor's Signature Or More Debate
Just days after the passage of legislation requiring an ultrasound before an abortion, a bill proposed by an Assembly Republican would require an abortion doctor to make burial or cremation arrangements for an aborted fetus. Proposed by Rep. Garey Bies (R-Sister Bay), the legislation would require a fetus more than 10 weeks old to be either buried, cremated or donated for medical training or research. The woman would not have to give her consent to the arrangements, nor would she have to be told they are occurring, under the bill (Phillis, 6/23). 

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Public Health & Education

Transplant Officials To Consider Changes In Organ Donation

NPR: Proposed Changes In Organ Donation Stir Debate
The nation's organ transplant network will consider a controversial proposal Monday to overhaul the guidelines for an increasingly common form of organ donation. The board of directors of the United Network for Organ Sharing will open a two-day meeting at the organization's headquarters in Richmond, Va., to consider new guidelines for donation after cardiac death. Donation after cardiac death involves removing organs minutes after life-support has been stopped for patients who still have at least some brain activity (Stein, 6/24).

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HHS Inspector General Details Prescription-Writing Abuses

The new report finds that health providers such as massage therapists, chiropractors and athletic trainers often wrote prescriptions -- and Medicare paid for them.

ABC News: Massage Therapists, Chiropractors Wrote Drug Prescriptions They Shouldn't Have—And Medicare Paid
In 2009, massage therapists, athletic trainers, chiropractors and other professionals wrote hundreds of thousands of drug prescriptions without the authority to do so. In some cases these were controlled substances like oxycodone, but Medicare Part D, which covers prescription drugs, paid for them anyway. A report by the Department of Health and Human Services' inspector general outlines how, in 2009, Medicare's prescription-drug benefit paid for prescriptions written by health and health-related professionals who did not have the authority to write them under Medicare's rules (Good, 6/21).

The Associated Press: Wiser Medication Use Could Cut Health Costs
If doctors and patients used prescription drugs more wisely, they could save the U.S. health care system at least $213 billion a year, by reducing medication overuse, underuse and other flaws in care that cause complications and longer, more-expensive treatments, researchers conclude. The new findings by the IMS Institute for Healthcare Informatics improve on numerous prior efforts to quantify the dollars wasted on health care (6/23).

At the same time, genomic medicine was a subject of interest on Capitol Hill last week --

CQ HealthBeat: NIH Leaders Tutor Hill Aides On Promise Of Genomic Medicine As New NIH Cuts Loom
National Institutes of Health leaders marked the tenth anniversary of the completion of the Human Genome Project this week by walking Hill aides through the rapid progress U.S. scientists have made in genomic science and medicine. As almost any NIH presentation on Capitol Hill is wont to be these days, the briefing in part was an understated case for keeping federal funds flowing into the medical research agency. NIH lost $1.5 billion this year, and faces a new round of deep cuts in the fiscal year that starts in October (Reichard, 6/21).

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In Effort To Reduce Veterans' Suicide Rate, Officials Seek To Deal With 'Moral Injury'

WBUR: Defining The Deep Pain PTSD Doesn't Capture
An estimated 22 veterans kill themselves in the U.S. each day. And suicide among men and women on active duty hit a record high last year -- 349. As veterans and researchers try to figure out why, there's growing interest in a condition known as "moral injury," or wounds to a veteran's spirit or soul from events that "transgress deeply held moral beliefs and expectations." The concept has helped former Marine Corps Capt. Tyler Boudreau understand years of pain that medication and therapy for PTSD didn't address. He tells his story, somewhat reluctantly, from the living room of his blue clapboard home in Northampton, Mass (Bebinger, 6/24).

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Health Policy Research

Research Roundup: Examining The Health Of Future Medicaid Patients; Rural Trauma Care Issues

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

Journal of the AMA (JAMA): Health Status, Risk Factors, And Medical Conditions Among Persons Enrolled In Medicaid Vs. Uninsured Low-Income Adults Potentially Eligible For Medicaid Under The Affordable Care Act – Under the federal health law, states have the option of expanding Medicaid coverage to most-low income populations, potentially adding millions of new enrollees. Researchers analyzed 2007-2010 survey data  from a study population of more than 1,000 people, and found that, compared to adults already enrolled in state Medicaid programs, low-income uninsured adults who stand to gain from Medicaid expansion "will differ significantly from current Medicaid enrollees," the authors write. "The new Medicaid enrollees are likely to have fewer health conditions but more undiagnosed or uncontrolled conditions and are more likely to be male, non-Hispanic white, and better educated. They are also likely to have fewer health risks, … [But] Because many of the uninsured adults have not seen a physician in the past year and do not have a place they usually go for routine health care, they are likely to need care on first enrolling in Medicaid" (Decker, Kostova, Kenney and Long, 6/23).

JAMA Surgery: The Burden Of Unnecessary Interfacility Transfers In A Rural Trauma System – Regional trauma systems are intended to deliver the appropriate level of care to injured patients, according to the study’s authors. But sometimes patients are rapidly and unnecessarily transferred to a level I trauma center, "secondary overtriage."  After reviewing 7,700 patient records from Dartmouth Hitchcock Regional Hospital in New Hampshire from 2007 to 2011, researchers found that 24 percent of injured adults and 49 percent of injured children met their definition of secondary overtriage. “A significant number of injured patients who are transferred to our rural level I trauma center are minimally injured, do not require surgical intervention, and have less than a 48-hour length of stay,” they write, concluding: "Costs for transportation and additional evaluation for such a significant percentage of patients has important resource utilization implications." They recommend methods such as “teleradiology triage by neurosurgeons and orthopedic surgeons and telephone or video conference consultation between pediatric and adult trauma surgeons" (Sorensen et al., 6/19).

JAMA Internal Medicine: Differences In Human Immunodeficiency Virus Care And Treatment Among Subpopulations In The United States – Early diagnosis, antiretroviral therapy, prompt linkage to care and continued access to care reduce the human immunodeficiency virus (HIV) transmission and related illness and death. Noting that disparities in care and treatment for HIV exist and vary among population groups, authors analyzed data about all the people infected with HIV in the U.S., from the CDC's National HIV Surveillance System: "More than 850,000 persons with HIV did not have a suppressed viral load, including 79% of blacks, 74% of Hispanics or Latinos, and 70% of whites,” the authors write. Younger adults, those under the age of 45 years, were less likely than others to be aware of their infection or have a suppressed viral load. “Increasing the percentage of young persons diagnosed and receiving continuous care is critical to addressing HIV in the United States, ... Ensuring that people stay in care and receive treatment will increase the proportion of HIV-infected individuals who achieve and maintain a suppressed viral load,” they conclude (Hall et al., 6/17).

Georgetown Health Policy Institute/Robert Wood Johnson Foundation: Launching The Medicare Part D Program: Lessons For The New Health Insurance Marketplaces – Medicare Part D program provides prescription drug coverage for approximately 35 million people. And, according to the authors of this report, Part D’s establishment in 2003 is similar to the current and ongoing efforts to create health insurance exchanges under the federal health law because it required a massive public outreach campaign and relied in part on private insurance providers. "Past efforts to design and launch a large national health coverage program suggest that the experience will be far from perfect, at least at the outset,” the authors write. “However, the Medicare Part D experience teaches us that, when things went awry, federal and state officials were often able to identify problems and work with stakeholders to develop policy and operational solutions, so that consumers could obtain the promised benefits. Problems were not always addressed as quickly or as thoroughly as critics would have liked, but fixes were usually found. … eight years later, many of the initial difficulties have been forgotten. The public generally views the program as a success" (Hoadley, Corlette, and Monahan, 6/20).

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State Watch

State Highlights: Calif. Eyes Health Care For Immigrants; New Scrutiny For N.Y. Home Health Firms

The New York Times: California Pushes For Immigrant Health
When Congress passed President Obama’s health care overhaul, a critical compromise provision was that immigrants living in the United States illegally would not be allowed access to publicly subsidized health insurance. Even now, as lawmakers in Washington are debating an overhaul of immigration laws, leaders from both parties are arguing that no federal money should be spent on health care for immigrants on their way to obtaining citizenship. But not in California, where there are an estimated 2.6 million illegal immigrants (Medina, 6/23).

The New York Times: State Rewards Home Care Firms Once Rebuked
Hunting for ways that the incoming governor could close a $2 billion budget deficit late in 2010, New York State officials scrutinized Medicaid spending on home health care, and made some startling discoveries. The cost of caring for frail elderly and disabled people at home had more than doubled from 2003 to 2010, to $1.3 billion, even though fewer people were being served. And that huge cost increase had been driven by just a half-dozen certified home health agencies out of 140, most located in Brooklyn (Bernstein, 6/23).

Oregonian: Oregon Smokers Face New Costs: Most Health Insurers To Charge More For Habit
Health experts have long contended that smoking significantly boosts health care costs due to increased rates of lung cancer, heart and pulmonary disease. Next year, for the first time in more than a decade, Oregon insurers will be able to charge smokers more for health coverage. Some will, and some won't. The federal Affordable Care Act will kick in next year, requiring insurance for most people. The new law bans insurers from considering pre-existing health conditions in granting coverage, including even drug or alcohol abuse -- with one notable exception: tobacco use. The law allows insurers to charge smokers as much as 50 percent more than non-smokers. The change applies to small business as well as individual policies for those who buy their own insurance (Budnick, 6/21).

The New York Times: Legislature Approves Bill Allowing Pharmacists to Give Meningitis Vaccination
The State Legislature has passed a bill permitting pharmacists to give meningitis vaccinations, a measure aimed at a deadly outbreak among gay and bisexual men in New York City (Hartocollis, 6/23).

San Jose Mercury News: Cost Of Dying: A Shift In How We End Our Lives
The experience of death is changing in America, gradually shifting from costly, high-tech battles against death in hospitals into hospices that gently accept the inevitable end. A new national database shows that 25 percent of Medicare patients died in a hospital in 2010, down from 28 percent in 2007. More than 47 percent died in hospice environments, often at home, up from 42 percent. The Bay Area mirrors the trend, but hospital deaths still exceed the national average: Medicare patients' death rates in Bay Area hospitals range from about 30 percent in the Contra Costa, Alameda and San Mateo regions to 33 percent in San Francisco's, a modest decline since 2007 (Krieger, 6/22). 

Kansas City Star: In-House Nurse Program Lowers Jailhouse Ambulance Calls At KC’s Police Headquarters
Shortly after Kansas City police booked a man into jail Wednesday for an outstanding warrant from Independence, he complained of chest pains. He'd been in pain for a day and a half and had consumed a "half-pint" that morning. A jail nurse took his vital signs, examined him and concluded he was simply drunk and didn't want to be in jail. … But now police have an in-house nurse, and she determined he was suffering from nothing other than "jail-itis." He was sent back to the tank until Independence police could pick him up. Before the nurse program, police put five to seven inmates with similar complaints onto ambulances each day, racking up hundreds of thousands of dollars in medical costs and lost work time for police, firefighters and doctors (Vendel, 6/23).

Arizona Republic: Home-Visit Program Aims To Cut Cost Of Health Care
Vicki Merrick was hauling a bale of hay on a flat-bed truck to her ranch in Hereford when a car slammed on its brakes in front of her. An emu had wandered on the road. Merrick stopped the truck and told her grandson to find a rope. … Merrick gently roped the long-legged bird and craned her neck toward her grandson when she felt her arm pull in the opposite direction. The emu scrambled away and sliced her left calf with a spur. … Merrick is among the first people to join an experimental program under the nation's health care law that aims to keep people healthy and out of the hospital. The program dispatches hospital-trained nurses to patients' homes to do whatever is necessary -- manage prescription drugs, take blood-sugar readings, teach healthy eating habits or even arrange delivery of a motorized wheelchair (Alltucker, 6/22).

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Editorials and Opinions

Viewpoints: Mich. Gov. Says Medicaid Expansion Would Save Money, Lives

Detroit Free Press: Expanding Medicaid Saves Taxpayers Of Michigan Money -- And Lives
The people of Michigan elected the members of the state Senate to be leaders, not vacationers. Unfortunately, the Senate forgot that Thursday and adjourned for its summer vacation. It left Lansing without voting on a bill that would provide health care coverage to nearly half a million working Michiganders. Ensuring access to affordable, quality health care is one of the most significant challenges facing Michigan. The Healthy Michigan plan developed over the past several months is a plan that addresses many of the state’s needs and reflects the state’s values (Gov. Rick Snyder, 6/23).

Tampa Bay Tribune: Expanded Medicaid Makes Economic Sense
Leadership matters. In Arizona, Republican Gov. Jan Brewer set aside her opposition to health care reform, called the legislature into special session and forced it to approve Medicaid expansion. In Florida, Republican Gov. Rick Scott had a similar epiphany but hardly lobbied Republican lawmakers who refused to expand Medicaid. Now that he has signed into law or vetoed most legislation, Scott should refocus on the most important issue facing Florida and demand action. There are moral and medical arguments for expanding Medicaid in Florida (6/21). 

Politico: Cure For Affordable Medical Devices
For years, Medicare has been paying sky-high prices for basic equipment like wheelchairs and walkers based on outdated and overpriced payment rates. ... These inflated Medicare payment rates also helped fuel the rampant proliferation fraud, waste and abuse of durable medical equipment, prosthetics, orthotics and supplies — or DMEPOS — benefit. In 2011, as required by law, CMS implemented a DMEPOS competitive bidding program to bring prices for certain medical equipment and supplies in line with the current market, ... The program has saved more than $400 million in its first two years of operation in only nine areas of the country. ... And yet the industry continues to insist that this program will harm beneficiaries and prevent them from getting needed equipment and supplies (Jonathan Blum, 6/23). 

The Wall Street Journal: Why The VA Is Buried In Disability Claims 
[N]early 900,000 disability claims are backlogged or sitting in the processing queue. Veterans wait, on average, 273 days for their claims to be processed. ... By categorizing minor conditions as disabilities, the process threatens to become a kind of stealthy welfare system, where those with minor conditions might feather their nests at the expense of both taxpayers and truly disabled veterans trapped behind them in a line that stretches over the horizon. This also harms the veterans who are being told the lie that they are "disabled" and being paid to believe it (Lt. Col. Daniel Gade, 6/23).

The New York Times: Profiting From Pain
The use of narcotic painkillers, or opioids, has boomed over the past decade .... In the short run, treating a patient with an opioid like OxyContin, which costs about $6,000 a year, is less expensive than putting a patient through a pain-treatment program that emphasizes physical therapy and behavior modification. But over time, such programs, which run from $15,000 to $25,000, might yield far lower costs (Barry Meier, 6/22).

Boston Globe: A Strong Leader Needed For Top U.S. Doctor
On June 12, Dr. Regina Benjamin announced that she would be stepping down as surgeon general. She is certainly an inspiring figure. … Obesity was the central target of her efforts; whether organizing walks or visiting schools during lunchtime, she took a stand against what may be the defining health issue of our time. Upon the announcement of Benjamin’s resignation, influential voices like Health and Human Services Secretary Kathleen Sebelius and the American Public Health Association praised her service. However, in many important ways, she did not fulfill the job. She avoided the spotlight and concentrated on the agreeable issues of diet and exercise (Nathaniel Morris, 6/24).

Los Angeles Times: Hoag's Underhanded Abortion Ban
In a most underhanded and insidious way, women's reproductive health rights in California were dealt a significant blow last month. That was when the availability of elective abortions at Hoag Memorial Hospital Presbyterian, one of Orange County's elite medical centers, was abruptly ended. The ban on abortions was imposed by Hoag administrators effective May 1, shortly after the hospital entered a corporate partnership with St. Joseph Health System, a Roman Catholic chain with five hospitals in Orange County (Michael Hiltzik, 6/21).

Sacramento Bee: Nevada Hospital Reviews Look Like A Whitewash
Nevada Gov. Brian Sandoval, U.S. Health and Human Services Secretary Kathleen Sebelius and the agencies that should be overseeing mental health care are whitewashing Nevada's practice of busing its mentally ill patients to all corners of the continental United States. It's easier that way. Sandoval hired experts to conduct what he claimed was an independent investigation of Rawson-Neal Psychiatric Hospital and use of Greyhound buses to transport patients to other states. Not surprisingly, the consultants last month praised the care provided by Rawson-Neal and said busing patients to their home states "is a kindness to them and to their families" (6/24).

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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.