Daily Health Policy Report

Tuesday, June 24, 2014

Last updated: Tue, Jun 24

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Health Care Marketplace

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Advocates Worry Conn. Decision Could Undermine Autism Coverage

Kaiser Health News consumer columnist Michelle Andrews writes: “Today, many families with autistic children count on their insurance coverage to help pay for the often expensive, long-term treatment their kids need. But advocates and public policy experts say a recent bulletin issued by the Connecticut Insurance Department may undermine existing coverage protections and they're concerned that other states might follow suit” (Andrews, 6/24). Read the column.

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Drug Discount Program Has Drugmakers Crying Foul

Oregon Public Radio’s Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: “The law got bipartisan support and it was a boon for hospitals and the federal government. In the decades that followed, the drug discount program has grown in leaps and bounds. But this spring as the feds have been drawing up new rules for the program, a pitched battle has broken out between hospitals and drug manufacturers who say the program, known as 340B, is now bloated and badly regulated” (Foden-Vencil, 6/23). Read the story.

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Ohio Amish Reconsider Vaccines Amid Measles Outbreak

WCPN’s Sarah Jane Tribble, working in partnership with Kaiser Health News and NPR, reports: “The Amish countryside in central Ohio looks like it has for a hundred years. There are picturesque pastures with cows and sheep, and big red barns dot the landscape. But something changed here, when, on an April afternoon, an Amish woman walked to a communal call box. She called the Knox County Health Department and told a county worker that she and a family next door had the measles” (Tribble, 6/24). Read the story.

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Capsules: Employer Health Costs Forecast To Accelerate In 2015; Talking Medicare’s Hospital Fines For Too Many Patient Injuries

Now on Kaiser Health News’ blog, Jay Hancock reports on a forecast for employer health costs: “Health costs will accelerate next year, but changes in how people buy care will help keep them from attaining the speed of several years ago, PricewaterhouseCoopers says in a new report. The prediction, based on interviews and modeling, splits the difference between hopes that costs will stay tame and fears that they’re off to the races after having been slow since the 2008 financial crisis” (Hancock, 6/24). 

Also on Capsules, you can watch and listen to Jordan Rau’s Monday appearances on NPR and C-SPAN in which he talked about coming Medicare penalties for about a quarter of the nation’s hospitals as detailed in his recent KHN story about penalties for hospital-acquired conditions  (6/23). Check out what else is on the blog.

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Political Cartoon: 'Encroachment?'

Kaiser Health News provides a fresh take on health policy developments "Encroachment?" by Mike Lester.

Meanwhile, here's today's haiku:


Questions for the House:
Leaking policy secrets?
Insider trading?

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

Blistering Review Criticizes VA For Downplaying Whistleblower Reports Of Deficient Patient Care

Special Counsel Carolyn Lerner criticized the Department of Veterans Affairs in a Monday letter to President Barack Obama, noting that the agency failed to acknowledge allegations of poor patient care made by its own employees.  

The New York Times: Investigator Issues Sharp Criticism Of V.A. Response To Allegations About Care
In a blistering letter sent to President Obama on Monday, the head of the agency that investigates whistle-blower complaints in the federal government criticized the Department of Veterans Affairs for not digging deeper into widespread allegations made by its own employees of poor or severely delayed patient care for veterans (Oppel, 6/23).

Los Angeles Times: VA Fails To Acknowledge ‘Severity Of Problems,’ New Report Says
In another damning report on the Department of Veterans Affairs, the Office of Special Counsel on Monday assailed the VA for failing to acknowledge the “severity of systemic problems” that have put patients at risk. Special Counsel Carolyn Lerner said in a letter to President Obama that her office found a “troubling pattern of deficient patient care” and expressed concern about what she termed the department’s unwillingness to acknowledge the impact of its problems on the health and safety of veterans. Her office is investigating more than 50 cases brought by whistle-blowers (Simon, 6/23).

The Associated Press: VA Challenged On Handling Of Whistleblower Chargers
A top federal investigator has identified “a troubling pattern of deficient patient care” at Veterans Affairs facilities around the country that she says was pointed out by whistleblowers but downplayed by the department. The problems went far beyond the extraordinarily long wait time for some appointments — and the attempts to cover them up — that has put the department under intense scrutiny (6/23).

The Wall Street Journal: Veterans Affairs Watchdog Downplayed Medical Care Problems, Probe Finds
A Department of Veterans Affairs internal watchdog created to safeguard the medical care provided to former service members instead routinely played down the effect of treatment errors and appointment delays, a federal special counsel alleged Monday. … The strongly worded critique adds a new layer to the veterans-care scandal that has rocked the VA and the Obama administration in recent months (Phillips and Kesling, 6/23).

Politico: Report: VA Overlooked Whistleblowers
The Department of Veterans Affairs has put patients at risk by overlooking reports from whistleblowers detailing dirty medical equipment and illegal narcotic prescriptions, an independent federal investigator said on Monday (French, 6/23).

USA Today: VA Employee: I Kept A Secret Phoenix VA List
A scheduling employee for the Phoenix VA Health Care System disclosed Monday that she was the keeper of a "secret list" of veterans who waited months for medical care. She also accused others of altering records after the scandal broke to try to hide the deaths of at least seven veterans awaiting care. Pauline DeWenter went public as a whistle-blower Monday, saying she has spoken to investigators in the Department of Veterans Affairs' Office of Inspector General about the waiting list and her suspicions of an orchestrated cover-up (Wagner, 6/24). 

The Arizona Republic: Phoenix VA Officials Knew Of False Data For 2 Years
The Department of Veterans Affairs has consistently ignored whistle-blower warnings about dangerous practices that jeopardize patient safety, according to a scathing letter sent to President Barack Obama by the Office of Special Counsel. The letter sent Monday by the independent federal investigative agency says the failure of Phoenix VA officials to heed alerts about fraudulent appointment scheduling is part of a "troubling pattern" nationally where the VA investigated and verified complaints but did nothing to correct problems. "The VA, and particularly the VA's Office of the Medical Inspector, has consistently used a 'harmless error' defense, where the department acknowledges problems but claims patient care is unaffected," says the letter (Wagner, 6/23).

The Boston Globe: Patients Neglected At Brockton VA Facility, Officials Say
Two psychiatric patients at a veterans facility in Brockton received no regular evaluations of their condition for years, part of a “troubling pattern of deficient patient care” that federal investigators say they have confirmed at veterans health care facilities nationwide. One of the neglected patients at the Brockton Community Living Center who had been admitted for “significant and chronic mental health issues” was living in the 106-bed facility for eight years before he received his first psychiatric evaluation, investigators reported. The other unidentified patient, although he was classified as 100 percent mentally disabled due to his military service, had only a single “psychiatric note” placed in his medical file between 2005 and 2013 (Bender, 6/24).

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Health Reform

Virginia House Obstructs Governor's Effort To Expand Medicaid

Virginia's Republican House Speaker William J. Howell killed a line item veto from Democratic Gov. Terry McAuliffe that would have allowed the governor to use federal funds to expand the low income health care program. In other state health law implementation news, data about health law premium costs is emerging in Colorado. 

The Washington Post: Virginia Lawmakers Finalize Budget, Averting A Shutdown As GOP Thwarts McAuliffe Veto
The Virginia General Assembly completed work late Monday on a two-year, $96 billion state budget, averting a government shutdown and at least temporarily thwarting Gov. Terry McAuliffe's key priority of expanding health coverage under the Affordable Care Act. The setback for McAuliffe (D) — and the long-delayed finalization of the budget — came months into a bitter political standoff between the governor and legislative Republicans over whether to expand government-funded health coverage to 400,000 low-income Virginians under the controversial federal law. The issue has come to define McAuliffe’s young term as governor (Vozzella and Portnoy, 6/23).

The Associated Press: Va. House Tosses Out Governor’s Vetoes
One veto Howell tossed out was of a Republican-backed amendment aimed at preventing him from expanding Medicaid without legislative approval. The House GOP majority blocked McAuliffe’s top legislative priority, leading to a protracted budget stalemate that threatened to shut down government (6/23).

The Richmond Times-Dispatch: House Again Blocks McAuliffe On Medicaid
Gov. Terry McAuliffe faces another roadblock erected by the House of Delegates in his quest to use federal funds to expand health coverage for uninsured Virginians. The question is: Will the governor run through it? House Speaker William J. Howell, R-Stafford, refused on Monday to allow the House to consider McAuliffe’s veto of budget restrictions on his ability to use federal funds for health coverage without the approval of the General Assembly (Martz, 6/23).

Denver Post: Insurance Rates Changes In Colorado Are Mixed Bag
The first data about Colorado health care costs under the Affordable Care Act were released Monday, but it is impossible to tell whether health reform is increasing or lowering costs as the two top providers took different paths on premiums. Kaiser is predicting an average increase of 7 percent in 2015 premiums while HMO Colorado Inc., better known as Anthem, is predicting its average premium will drop 5 percent, the filings show. ACA supporters had promised the reform would eventually reduce rates, while ACA opponents said it will increase costs (Kane, 6/23).

Meanwhile, news from the Centers for Medicare & Medicaid Services -

The Hill: Obamacare Spokeswoman To Leave Administration
The administration official who battled the press during ObamaCare's troubled rollout is resigning her position to seek other opportunities, the Centers for Medicare and Medicaid Services (CMS) announced Monday. Julie Bataille, the lead CMS spokeswoman, became known last fall as the main voice on press calls where journalists grilled the administration daily about problems and repairs at HealthCare.gov (Viebeck, 6/23).

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Md. Governor Closely Watches How Health Marketplace Plays In Race For Successor

Maryland voters' views of the roll-out of the online exchange could impact the primary election and have political implications for Gov. Martin O'Malley, who may be considering a presidential run. And in Mississippi, the incumbent senator's style on issues like the health law may be a disadvantage.

The Associated Press: Md. Primary Could Play A Role In O'Malley's Future
Sure to be paying as much attention to the results in Tuesday’s primary election in Maryland as Lt. Gov. Anthony Brown will be the man Brown wants to replace — Gov. Martin O'Malley. ... While Brown led the state’s efforts around health care reform and adoption of President Barack Obama's health care overhaul, it was O’Malley who took the lead in providing updates on the status of Maryland’s badly troubled health care exchange website, which crashed shortly after it debuted Oct. 1 (Witte, 6/23).

The New York Times: Mississippi Race Points To Appeal Of Partisanship
For decades, powerful figures like Senators Trent Lott, John C. Stennis and Thad Cochran, the six-term incumbent, and Representatives Sonny Montgomery and Jamie L. Whitten made serving the parochial needs of Mississippi their No. 1 priority, often dismissing the baser aspects of politics with an aw-shucks shrug. But comity may no longer get the job done in the Tea Party era. Chris McDaniel, the Tea Party-backed challenger to Mr. Cochran, has built his campaign on a promise to voters that he will add his voice to the national political fights against the health care law, big government and meddling bureaucrats — something Mr. Cochran seems temperamentally incapable of doing (Weisman and Schleifer, 6/23).

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Capitol Hill Watch

SEC Sues After House Resists Insider Trading Probe

The Securities and Exchange Commission has sued a House committee and its staff director in federal court to enforce subpoenas for documents and testimony about possible tipping of confidential government information about a planned change in Medicare reimbursement rates that reached investors and sent health insurance stocks soaring. 

The Wall Street Journal: U.S. House Sought Immunity For Aide
Lawyers for the U.S. House sought a deal with the Securities and Exchange Commission to shield from prosecution a congressional aide who has become a key figure in an insider-trading investigation. The SEC rejected the offer and instead went to court Friday to force the House to turn over documents and evidence in the matter (Mullins and Ackerman, 6/23).

The New York Times’ DealBook: House Resists S.E.C.’s Insider Trading Inquiry
Members of Congress certainly like to talk the talk, but when it comes to insider trading there seems to be little interest in walking the walk by cooperating with an investigation into a possible leak of confidential information that allowed for lucrative trading (Henning, 6/23).

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Health Care Marketplace

Employers May Delay New Hires' Health Benefits For Up To 4 Months

A new rule, set to take effect Aug. 25, applies to coverage beginning in plan year 2015, reports CQ HealthBeat. Meanwhile, retiree medical liabilities fall as Americans live longer and interest rates remain low, and PricewaterhouseCoopers projects accelerating employer health costs next year.

CQ HealthBeat: Employers May Delay New Hires’ Health Coverage For Up to 4 Months Under Rule
Employers in some circumstances will have up to four months to delay the start of health benefits for new hires, according to a new rule jointly issued by three federal agencies. The rule, set to take effect August 25, addresses the effects of “orientation periods” for new employees in determining how long they must wait for health coverage to begin. It applies to coverage beginning in “plan year” 2015. Employers and insurers differ in what they interpret as the start of a plan year (Reichard, 6/24).

The Wall Street Journal’s CFO Journal: Retiree Medical Liabilities Fall
Companies may lose the savings they booked last year on retiree medical costs as Americans live longer and interest rates remain low. Among the Fortune 1,000 companies, the combined liabilities for retiree medical benefits totaled $285 billion at the end of last year, down nearly 16% from 2012, according to benefits adviser Towers Watson & Co. These obligations stem largely from long-ago promises to unionized employees. Most companies have shut their plans to new workers. In fact, only half of the companies studied continued to carry retiree medical liabilities on their balance sheets (Chasan, 6/24).

Kaiser Health News: Capsules: Employer Health Costs Forecast To Accelerate In 2015
Health costs will accelerate next year, but changes in how people buy care will help keep them from attaining the speed of several years ago, PricewaterhouseCoopers says in a new report. The prediction, based on interviews and modeling, splits the difference between hopes that costs will stay tame and fears that they’re off to the races after having been slow since the 2008 financial crisis (Hancock, 6/24). 

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How Will Hepatitis C Drug Affect Health Care Spending?

Elsewhere, pharmaceutical companies are upset over new rules for a drug discount program -- known as 340B.

The Wall Street Journal’s Pharmalot: What Impact Will Hepatitis C Drugs Have on Medical Costs? Look Here
Just what impact will hepatitis C treatments have on medical spending over the next few years? The answer to this question has been the subject of heated debate thanks to the Sovaldi treatment sold by Gilead Sciences. The medication can cure 90 percent of the patients who have the most common form of the affliction, and costs $1,000 a day for a 12-week course, or $84,000 for one patient (Silverman, 6/24).

Kaiser Health News: Drug Discount Program Has Drugmakers Crying Foul
The law got bipartisan support and it was a boon for hospitals and the federal government. In the decades that followed, the drug discount program has grown in leaps and bounds. But this spring as the feds have been drawing up new rules for the program, a pitched battle has broken out between hospitals and drug manufacturers who say the program, known as 340B, is now bloated and badly regulated (Foden-Vencil, 6/23).

Additional, related KHN coverage: Drug Discount Policy For Hospitals, Clinics Under Scrutiny (Carey, 6/23).

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Coverage & Access

Where You Go When You Survive But Don't Recover

The number of critically ill patients in the nation's long-term acute care hospitals has more than tripled in the past decade to 380,000, many of them sustained by respirators and feeding tubes, reports The New York Times. Meanwhile, MinnPost examines services for rural seniors who live at home.

The New York Times: At Acute Care Hospitals, Recovery Is Rare, But Comfort Is Not
The man, who asked not to be identified to protect his privacy, was a patient at the Hospital for Special Care here, one of 400 long-term acute care hospitals in the United States. These are no ordinary hospitals: Critically ill patients, sometimes unresponsive or in comas, may live here for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives (Kolata, 6/23).

MinnPost: To Live At Home, Rural Seniors Need Food, Socialization, Support
Late-in-life care often results in leaving your home for a supervised living situation. Nobody wants to leave their home any earlier than necessary, and since supervised care is expensive, it’s often in the best interest of the families and the state to put off that move as long as possible. But that doesn’t mean services aren’t available. Minnesota is divided into seven Area Agencies on Aging, and these organizations work to provide basic services to the elderly as well as offer information about other services. This installment will focus on some efforts that help rural seniors remain in their homes; future stories will explore housing options, physician shortages, transportation challenges and other rural health concerns for the older patient (Fitzgerald, 6/23).

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State Watch

Texas Slow To Move Those With Disabilities Out Of Institutions

Georgia also struggles to move the developmentally disabled out of state hospitals and into community residences, and in Wyoming, cuts are leaving some disabled people with fewer opportunities to get care.

Texas Tribune: Advocates For Disabled Split On Keeping Institutions For Disabled Open 
On Monday, 15 years after a U.S. Supreme Court decision paved the way for some people with disabilities to move out of institutions and into community homes, advocates for Texans with disabilities called on state lawmakers to speed up that process here. The anniversary of Olmstead v. L.C. -- which advocates marked one day late with a press conference and cake -- comes as Texas is weighing whether to close some of the state’s 13 living centers for people with mental disabilities. The Supreme Court held in Olmstead that institutionalizing a person with disabilities is discrimination if appropriate community-based services can be reasonably accommodated and the person doesn’t object to such a move (MacLaggan, 6/23).

Georgia Health News: Transfers Of Disabled Patients Still A Problem
Almost 10 percent of the 480 people with developmental disabilities who have moved out of state hospitals since July 2010 have died after their placement in community residences. Chris Bailey, a spokesman with the Georgia Department of Behavioral Health and Developmental Disabilities, when asked about deaths after hospital transfers, told GHN that 44 occurred from mid-2010 to early May of this year.  On Sunday, Alan Judd, in an AJC article, described horrific incidents of abuse or neglect following the transfer of these patients into group homes. Forty patients placed in group homes have died, Judd reported, with 30 of those deaths classified as unexpected (Miller, 6/23).

The Associated Press: Wyoming Cuts Mean Less Care For Needy
The state is inadequately funding and managing one of Wyoming's main disability services programs, resulting in cuts in services and parents of mentally and physically disabled children left with feeling bullied, advocates for the disabled said Monday. The head of the state Department of Health, which administers the program, said the agency is trying to balance changes required by state and federal law as well as bring more disabled people into a program that costs $250 million over two years. Some 2,200 Wyoming residents with disabilities receive care through the Home and Community-Based Waivers program, which is administered as part of Medicaid. The program helps pay for services such as day programs and home-based assistance from mostly private contractors (6/24).

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Missouri Proposes 'Assistant Physician' Role For Rural Areas

The bill, if signed by Gov. Jay Nixon, would allow medical school graduates to see patients before completing their residencies. The governor has already signed legislation, however, that tries to coax doctors and nurses out of retirement to care for patients again, and allows dentists to give some flu vaccines.

St. Louis Post-Dispatch: Medical School Grads Could Go Directly To Patient Care In Missouri Under Proposal
It could get easier to be a doctor in Missouri under a proposed law to add the classification of “assistant physician” to the state medical license. Under the measure, an assistant physician would be a graduate of a four-year medical school program who has passed licensing exams but has not completed residency training. Residency programs are the three to seven years after medical school that doctors spend in primary and specialty clinical training (Bernhard, 6/23).

The Associated Press: Missouri Legislation Would Allow Assistant Docs 
Medical school graduates could start seeing patients sooner under legislation that is intended to address doctor shortages in parts of Missouri. The bill pending before Gov. Jay Nixon would create a classification of "assistant physician" for graduates who have passed licensing exams but have not completed residency training. They would be allowed to provide primary care and prescribe drugs in rural or urban areas that are considered to be medically underserved. Nixon has not said whether he will sign the legislation (6/23).

St. Louis Post-Dispatch: New Illinois Law Taps Retired Doctors, Nurses
Illinois Gov. Pat Quinn signed legislation Saturday aimed at bringing doctors and nurses out of retirement to help as volunteers in free medical clinics. Quinn also signed into law a measure allowing dentists to give flu vaccines under certain circumstances. Both laws, which take effect immediately, are intended to expand access to care as thousands of Illinois residents are gaining insurance coverage under the nation’s health care overhaul (6/21).

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State Highlights: Texas Immigrant Surge Brings Health Crisis

A selection of health policy stories from California, Texas, Ohio, Maryland, North Carolina, Kansas and Massachusetts.

Los Angeles Times: Automated Defibrillators Not Required In Big-Box Stores, Justices Rule
Large stores in California need not keep automated external defibrillators for customers who suffer heart attacks, the California Supreme Court decided. In a unanimous ruling Monday, the state's highest court said California law requires only that fitness centers have such potentially life-saving devices and encourages most public buildings to keep them (Dolan, 6/23). 

Reuters: California’s Top Court Says Target Not Required To Carry In-Store Defibrillators
California's top court on Monday unanimously ruled that large retailers are not required to provide automated external defibrillators (AEDs) inside their stores, deciding in favor of Target Corp in a wrongful death lawsuit brought after a shopper's sudden death. The Supreme Court in California dismissed the argument that the U.S. retailer fell under a state health code statute that requires gyms and other "health studios" to make available the life-saving machines (Chaussee, 6/24).

Texas Tribune: Health Officials: Immigrant Surge Is A Medical Crisis
As the state's top elected officials debate how to halt a recent surge of immigrants -- many of them unaccompanied minors -- across the Texas-Mexico border, health officials and volunteer doctors are voicing concerns over what they say is the more serious challenge: a looming medical crisis. During a recent visit to two detention centers that house undocumented migrant children, officials with the Texas Department of State Health Services (DSHS) reported that conditions there posed a high risk for infectious disease outbreaks. Meanwhile, doctors providing medical care for immigrants being released by U.S. Border Patrol ahead of their court dates say those recent detainees were not appropriately screened or treated for illness while in federal custody (Ura, 6/24).

Kaiser Health News: Ohio Amish Reconsider Vaccines Amid Measles Outbreak
The Amish countryside in central Ohio looks like it has for a hundred years. There are picturesque pastures with cows and sheep, and big red barns dot the landscape. But something changed here when, on an April afternoon, an Amish woman walked to a communal call box. She called the Knox County Health Department and told a county worker that she and a family next door had the measles (Tribble, 6/24).

Baltimore Sun: People’s Health Clinics Attempt To Stave Off Closure
Officials with the financially troubled People's Community Health Centers say they are trying to keep their doors open -- even as other clinics are preparing to absorb their patients. At a small midday rally Monday in Brooklyn Park, Dr. Carlos Zigel, president of the organization's board of directors, said the nonprofit hasn't given up trying to save its five clinics, which serve some 11,000 low-income residents in Baltimore City and Anne Arundel County. The federal Health Resources and Services Administration provides $2.4 million a year to People's to provide care for uninsured patients. HRSA spokesman Mark Kramer said Monday the agency is "still working" with People's and that grant funding remains in place (Wood, 6/23).

Baltimore Sun: Social Services Agency Pairing With Nursing Center For Low-Cost Triage Care
He moved to Baltimore to take a job as a property manager, but when the company he worked for collapsed, Ganesh Boodram said, he found himself living in the streets. Homelessness was cruel to the Boston native. He was hit by a car, shattering a shoulder. Despite his skills as a handyman, few would hire him. He rarely got to see his grown daughters. Things got so bad not long ago, he said, he decided to take his own life. Then he walked into a small health center in Southwest Baltimore (Pitts, 6/22).

North Carolina Health News: Stronger Oversight Of Prescription Pain Pills Recommended 
Say you go to the dentist and need to have a root canal. As you leave, the dentist writes a prescription for a opioid pain reliever such as Vicodin or Percocet. When you arrive at the pharmacist to fill your prescription, what you probably don’t know is that your name and prescription information will be entered into a database of people in North Carolina who receive controlled substances. Doctors are encouraged to check the database before writing a prescription; pharmacists are supposed to check it to see that the medications they’re distributing haven’t been given too often to a specific person. A group of senators at the NC General Assembly wants to see better use of the state’s controlled substance database as a way to reduce opiate abuse (Hoban, 6/24).

Kansas Health Institute News Service: Kansas Changes Process For Nursing Home Inspection Reports
The Kansas Department for Aging and Disability Services is changing the way it shares its reports on nursing home conditions with the public. The new system, officials say, will make the reports more accurate and more accessible. But for a group that supports nursing home residents and their families, the changes will make it harder to know which homes are the subjects of complaints and investigations of substandard care (Ranney, 6/23).

The Boston Globe: A Transformative Change
The state’s public insurance program for low-income residents announced Friday that it plans to revoke a longstanding exclusion for gender reassignment surgery that placed it in a category of “experimental, unproven, or otherwise medically unnecessary procedures or treatments.” The administration of Governor Deval Patrick has directed MassHealth to provide coverage for hormone therapy and gender reassignment surgery, and the administration said it will recommend similar changes to the Group Insurance Commission, which provides coverage for thousands of state and municipal employees and their dependents (Fox, 6/23). 

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Editorials and Opinions

Viewpoints: Overlooked Costs For Insurers; Medicaid Disparities; Dropping Doctors From Medicare Advantage

The Wall Street Journal's Washington Wire: How The Sequester Could Cost Obamacare Insurers
In a Think Tank post Thursday, I wrote about how insurers deciding to participate next year in the health exchanges established under Obamacare could be expecting funds that the federal government may not have legal authority to disburse. But that's not the only potential pitfall for carriers: They could also end up on the hook for payment reductions caused by sequestration (Chris Jacobs, 6/23). 

Philadelphia Daily News: Poor Bill Of Health
In one respect, the Affordable Care Act has also become a perfect controlled experiment: Almost exactly half the states have accepted a federal expansion of Medicaid as part of ACA, and the other half -- all ruled by Republicans -- haven't. ... Recently, the Robert Wood Johnson Foundation and Urban Institute studied this petri dish to measure the impact on expansion of Medicaid to the uninsured, by studying 14 big cities around the country, including Philadelphia. Seven of those cities are in states with expanded Medicaid and seven are in states without. While the outcomes of Medicaid expansion should shock no one, the disparity between those states that have expanded and those that haven't is disturbing (6/23).

Roanoke Times: McAuliffe And Medicaid: Beware The Precedent
Democrats may cheer [Gov. Terry McAuliffe's vow to bypass the legislature to expand Medicaid] now, but someday could rue the precedent if a future Republican governor can't get his way with the legislature. Two other governors confronted with legislative opposition have expanded Medicaid through executive action -- Democrat Steve Beshear in Kentucky and, curiously, Republican John Kasich in Ohio, who otherwise opposes Obamacare but bucked his own party because he thought Medicaid expansion was a better deal for Ohioans than the alternative. He explained it to talk show host Laura Ingraham this way last winter: "Conservatism means that you help people so they can help themselves and that they can enter into the economic strength of our country." Those, however, are different states with different laws and different constitutions (6/24).

The San Jose Mercury News: Health Care Challenge: Medi-Cal Insurance Doesn't Guarantee Access
Expanding Medi-Cal is one of the important ways the ACA increases access to health insurance, but providing insurance does not ensure health care will be available. It's important to understand the facts related to access to health care in our state. Thankfully, California is one of the states that committed to expanding government coverage for the poor and uninsured. At this time, the number of Californians served by Medi-Cal is increasing and approaching one-third of our population, or 10 million. Unfortunately, reimbursement rates for providers who serve the poor are declining drastically (Reymundo C. Espinoza, 6/23).

St. Louis Post-Dispatch: UnitedHealthCare Disadvantages Medicare Advantage
One of the major flaws in the Patient Protection and Affordable Care Act is also one of the reasons it was able to pass: It accommodated, and in some ways enhanced, the role of for-profit insurance companies. Last week, the Post-Dispatch’s Tara Kulash reported that thousands of Missouri seniors and hundreds of its doctors had learned that they'd be paying a high price for this accommodation. The patients are among the 95,000 Missourians who purchased a Medicare Advantage plan from UnitedHealthCare (2013 profits: $10 billion). ... The company, the nation's largest seller of Medicare Advantage plans, is reducing the number of doctors in its approved-provider network. It appears to be trying to steer patients into large hospital-affiliated physician groups, where there are economies of scale. By Sept. 1, eight months into the coverage year, patients will have to find new doctors. Had there been the political will to enact a single-payer national healthcare system, this sort of problem could have been avoided (6/24).

Tampa Bay Times: Florida Falling Short For Seniors
Florida has undermined its reputation as an attractive retirement destination for seniors by failing to provide enough resources for their long-term care. A new national study ranks Florida 43rd among 50 states and the District of Columbia in helping seniors live independently and stay out of nursing homes. As baby boomers get older, the need for long-term care services will increase exponentially, and the state is woefully unprepared to keep up with demand (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.