Daily Health Policy Report

Wednesday, June 26, 2013

Last updated: Wed, Jun 26

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Latino Enrollment Key To Success Of Health Law Marketplaces

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Just as Latinos were crucial to President Barack Obama's re-election success in 2012, they are now key to the success of his health law. And the administration is doing everything it can to make sure that Latinos, like the Velandias, enroll. The administration announced this week that Health and Human Services Secretary Kathleen Sebelius will be making the rounds on Spanish-language media outlets to discuss the health law and the newly revamped CuidadoDeSalud.gov, the Spanish version of HealthCare.gov" (Gold, 6/25). Read the story.

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Insuring Your Health: With A Little Planning, Women Can Get Emergency Contraceptives For Free

Kaiser Health News consumer columnist Michelle Andrews reports: "Women of all ages will soon be able to pick up emergency contraceptive pills at pharmacies and other stores without a prescription or proof of age. What many may not realize, however, is that they can get the pricey pills free under the Affordable Care Act. Doing so, however, may take time and forethought" (Andrews, 6/25). Read the column.

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Capsules: Hospital Officials Complain About Medicare Efforts On Observation Care; Grassley: Who Approved These Hospital CEO Bonuses?

Now on Kaiser Health News' blog, Mary Agnes Carey reports on Mediare payment issues explored during a Senate Finance Committee hearing: "Recovery Audit Contractors – or RACs – uncover and collect improper payments made to hospitals, physicians, clinics and other providers. In 2011 the audits resulted in the return of nearly a half a billion dollars to the Medicare Trust Fund. 'We need to build on this success, but we can't overburden legitimate providers who play by the rules,' Finance Committee Chairman Max Baucus, D-Mont., said Tuesday. 'We need balance'" (Carey, 6/26).

Also on the blog, Jay Hancock reports on the response by Sen. Charles Grassley, R-Iowa, to KHN's coverage of hospital CEO bonuses: "Sen. Charles Grassley, a longtime member of the Senate Finance Committee and frequent critic of nonprofit hospitals, wants to know whose idea it was to pay hospital CEOs annual bonuses surpassing a million dollars in some cases" (Hancock, 6/25). Check out what else is on the blog.

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Political Cartoon: 'Can't Chute Straight?'

Kaiser Health News provides a fresh take on health policy developments with "Can't Chute Straight?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:


The rules are quite clear.
Talk, talk, talk... but do not lean.
If you do, they'll vote.
- 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

White House Takes Aim At Latinos, Young People With Health Law Outreach Efforts

Both populations are key to the success of new online health insurance marketplaces, which will begin enrolling people on Oct. 1 for coverage that takes effect Jan. 1.

Kaiser Health News: Latino Enrollment Key To Success Of Health Law Marketplaces
Just as Latinos were crucial to President Barack Obama's re-election success in 2012, they are now key to the success of his health law. And the administration is doing everything it can to make sure that Latinos, like the Velandias, enroll. The administration announced this week that Health and Human Services Secretary Kathleen Sebelius will be making the rounds on Spanish-language media outlets to discuss the health law and unveiled the newly revamped CuidadoDeSalud.gov, the Spanish version of HealthCare.gov (Gold, 6/25).

The Hill: Seeking To Woo Youths, White House Attempts To Make ObamaCare Cool
Administration officials have a daunting task in the weeks ahead: making ObamaCare "cool." Marketing experts say a hip branding effort is what's needed to draw people into the new health insurance exchanges ... (Viebeck, 6/26).

Meanwhile, officials are attempting to apply some of the lessons learned from the 2006 rollout of Medicare Part D -- 

Politico: Medicare Part D Offers Lessons For Obamacare
Three months before Obamacare goes prime time, health care vets are looking for lessons from another once politically volatile expansion of coverage: the Medicare prescription drug program. Just as Obama administration officials have warned about "glitches" and "hiccups" in the rollout of the health care law, similar bumps emerged around the 2006 launch of the now-popular Part D program, those in charge of its implementation say (Millman, 6/26).

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Tavenner Outlines Specifics On Health Exchanges, Other Health Law Issues

The Centers for Medicare & Medicaid Services chief Marilyn Tavenner discussed health exchanges, among other things, with Georgia Health News. Other news outlets detailed the exchange developments in Minnesota and Colorado.

Georgia Health News: Answers About Expansion And Exchanges, From The Head Of CMS
Tavenner came to Atlanta on Wednesday and spoke to a conference sponsored by the Georgia Chamber. She also met with GHN for an exclusive interview, ... Q: Will the exchanges provide a competitive market for insurance? A: Here’s my honest opinion about that. Today, Atlanta is a classic example – Atlanta will remain competitive. We will have good premiums, and we will have the additional protections of the Affordable Care Act – no pre-existing conditions [that can bar coverage], no lifetime limits. It will have a better product at a competitive price. There are some marketplaces that are not competitive. In my opinion, this project may take two, three, four years to change a non-competitive market into a competitive market (Miller, 6/19).

MinnPost: Minnesota Health Exchange, As Expected, Encounters A Few 'Hiccups'
State lawmakers and officials have already run into "hiccups" this summer implementing MNsure, the health insurance exchange crafted by the Legislature this year. While such bumps in the road have been numerous — and even expected — since the exchange’s tumultuous beginnings, those working on the ambitious project say they are excited to move forward with the biggest health insurance reform in Minnesota in decades (Nord, 6/25).

PBS NewsHour: Colorado Struggles To Educate, Enroll Residents In New Health Insurance Exchange
Colorado is in the midst of preparing to roll out a new way for residents to get health coverage using an insurance exchange. ... The new insurance marketplace, called Connect for Health Colorado, starts enrolling individuals and small businesses on Oct. 1. ... State internal polling found only 10 percent of Coloradans know about the new marketplace. National surveys mirror similar findings. So health officials all across the country are scrambling for private and federal grants to help get people educated and enrolled (Bowser, 6/25).

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Ind., Ark. Medicaid Expansion Plans Take Shape, But Also Take Time

Also, news outlets examine the idea that the expansion's new enrollees will likely be healthier than current beneficiaries but this will probably not relieve the expansion's pressure on the health care workforce.

The Associated Press: Answer On Ind. Medicaid Plan Could Take Some Time
The head of the state Family and Social Services Administration said Tuesday the federal government is expected to approve an extension of the Healthy Indiana Plan, but a request to use the plan for an Indiana Medicaid expansion could take much longer (LoBianco, 6/25).

The Associated Press: Arkansas Releases Draft Of 'Private Option' Request
Arkansas' proposal to use federal Medicaid dollars to purchase private insurance for thousands of low-income residents will benefit everyone in the state by cutting health care costs and improving access, the state said Monday in a draft of its application to the federal government (6/25).

In related Medicaid news --

Modern Healthcare: Providers Likely To Feel Pressure As Medicaid Gets New Enrollees
New Medicaid enrollees may be healthier than the program's current beneficiaries, but that is unlikely to relieve much of the pressure on providers as millions of newly covered patients seek care next year. Researchers -- including some from the Centers for Disease Control and Prevention -- looked at national health data collected through detailed surveys of uninsured adults and concluded that new enrollees are less likely than current beneficiaries to have chronic diseases -- 30 percent compared with 39 percent. However, among the newly covered enrollees who do suffer from chronic conditions, their conditions are more likely to be undiagnosed and untreated (Daly, 6/25).

The Associated Press: Newly Insured To Deepen Primary Care Doctor Gap
Getting face time with the family doctor could soon become even harder. A shortage of primary care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage under the federal health care law next year. Doctors could face a backlog, and patients could find it difficult to get quick appointments (Sanner, 6/25).

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The Health Law's Coverage Expansion: Where There Are Benefits, Where There Is Confusion

The Fiscal Times reports on tools to help consumers understand changes that will occur as a result of the health law while HealthyCal reports that legislators in California are attempting to create a mechanism to provide health insurance for those who fall through the overhaul's cracks.

The Fiscal Times: Best Online Tools For The Toughest Health Questions
The health care landscape will change in 2014 when the most significant portions of the Affordable Care Act kick in. The new law will require all Americans to have health insurance (or pay a penalty) by January, and will require insurers to cover many folks who previously couldn't get coverage (Nance-Nash, 6/25).

HealthyCal: Covering The Uninsured Left Behind The ACA
Millions of Californians will remain uninsured after the signature reforms of the Affordable Care Act roll out in 2014. Legislators are proposing an employer-funded trust to insure many of those who will likely fall through the cracks of the Affordable Care Act. Assemblyman Manuel Perez introduced Assembly Bill 175, which would establish a trust fund, paid for by employers, private donors and philanthropic organizations, to provide comprehensive health insurance coverage, including primary care, dental and mental health benefits, to workers who are not covered by the ACA or the proposed expansion of Medi-Cal (Graebner, 6/26).

Meanwhile, nerves continue from within the restaurant industry --

Georgia Health News: Restaurant Industry Nervously Eyes ACA's Changes In Insurance Rules
Simon is co-founder of Fifth Group Restaurants, which operates seven restaurants and other businesses in the Atlanta area, employing more than 500 people. Currently, Fifth Group offers health insurance to its managers only. But under the 2010 Affordable Care Act, when it is fully implemented next January, a business with 50 or more full-time workers must offer all employees working at least 30 hours a week a health plan that's considered "affordable."’ If it doesn’t, the business must pay a penalty. This "employer mandate" represents a great unknown for Fifth Group, Simon says. The impact on the business could range from $50,000 to $400,000, he says. Indeed, much of the restaurant industry, with its many low-wage workers and its generally low rates of offering insurance, may face a financial jolt from the law (Miller, 6/24).

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Capitol Hill Watch

Cruz Says Immigration Plan Would Affect Workers' Benefits Under Health Law; Senate Panel Hears Concerns About Medicare Audits

Sen. Ted Cruz, R-Texas, criticizes the pending immigration bill and health law while Medicare observation care and audits are hot topics during a Senate Finance Committee hearing. Also in the news, Sen. Charles Grassley, R-Iowa, talks about hospital CEO pay. In addition, he and Sen. Ron Wyden, D-Ore., push to open the Medicare claims payment database.

 The Hill: Cruz: Immigration Bill, ObamaCare Create 'Enormous Incentive' To Hire Immigrants
Sen. Ted Cruz (R-Texas) argued Tuesday that because the comprehensive immigration reform bill prohibits immigrant workers from getting ObamaCare benefits, employers will fire U.S. workers and replace them with immigrants. Cruz said he wanted to offer an amendment to address the "most egregious aspect" of the immigration bill (Cox, 6/25).

Kaiser Health News: Capsules: Hospital Officials Complain About Medicare Efforts On Observation Care
Recovery Audit Contractors – or RACs – uncover and collect improper payments made to hospitals, physicians, clinics and other providers. In 2011 the audits resulted in the return of nearly a half a billion dollars to the Medicare Trust Fund. "We need to build on this success, but we can't overburden legitimate providers who play by the rules,' Finance Committee Chairman Max Baucus, D-Mont., said Tuesday. "We need balance" (Carey, 6/26).

CQ HealthBeat: Senators Sympathetic To Complaints That Medicare Audits Are Too Burdensome
Senate Finance Committee members from both sides of the aisle expressed concern Tuesday that a Medicare program that audits provider reimbursement claims creates unreasonable administrative burdens on hospitals. But Chairman Max Baucus stopped short of saying after the hearing that he'll push legislation to address problems with the Recovery Audit Contractor program (Reichard, 6/25).

Kaiser Health News: Capsules: Grassley: Who Approved These Hospital CEO Bonuses?
Sen. Charles Grassley, a longtime member of the Senate Finance Committee and frequent critic of nonprofit hospitals, wants to know whose idea it was to pay hospital CEOs annual bonuses surpassing a million dollars in some cases (Hancock, 6/25).

CQ HealthBeat: Wyden Says Opening Up Medicare Data Will Unleash Market Force
Opening up Medicare's claims payment database would have a "transformative" effect on the U.S. health care economy, Oregon Democratic Sen. Ron Wyden told a Washington, D.C., forum Tuesday. Wyden and Republican Sen. Charles E. Grassley of Iowa introduced a bill (S 1180) on June 18 that would require the Health and Human Services secretary to make available a searchable Medicare payment database that the public could access at no cost (Reichard, 6/25).

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Health Care Marketplace

WellPoint Program Would Let Employers Pay Set Amount For Medical Services

In a separate story, the Journal reports on the ongoing changes at Health Management Associates.

The Wall Street Journal: WellPoint Helps Cut Employers' Health Cost
As companies seek ways to curb health-care spending, insurer WellPoint Inc. is rolling out a program that lets employers pay only a set amount for a medical service, asking workers who select costlier care to pay the difference. The idea has been tested for years by a limited number of large employers. But the new option from the second-biggest U.S. insurer, which will be available for coverage that kicks off next January, will be offered broadly to any client with at least 100 employees (Mathews, 6/25).

The Wall Street Journal: Glenview Seeks Board Overhaul At Health Management
Glenview's growing activist role at Health Management—in which the investor has amassed a 14.6% stake, making it the largest shareholder—has fueled Wall Street expectations that Health Management could be sold. Health Management shares were down slightly to $15.31 in midday trading Tuesday, but they have soared nearly 39% since the company adopted a shareholder-rights plan in response to Glenview's share accumulation. New York-based Glenview has said it has no intentions to acquire Health Management, and in a long letter to shareholders Tuesday, said that it didn't know whether it is best to sell the company or "change management and build long-term independent value." But the investor did call a potential acquisition by a larger chain "compelling," and said a new board is needed to review such options (Kamp, 6/25).

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Health Information Technology

Electronic Health Records Bring Risks As Well As Benefits

Bloomberg: Digital Health Records' Risks Emerge As Deaths Blamed On Systems
When Scot Silverstein's 84-year-old mother, Betty, starting mixing up her words, he worried she was having a stroke. So he rushed her to Abington Memorial Hospital in Pennsylvania…Electronic health records are supposed to improve medical care by providing physicians quick and easy access to a patient's history, prescriptions, lab results and other vital data. While the new computerized systems have decreased some kinds of errors, such as those caused by doctors' illegible prescriptions, the shift away from paper has also created new problems, with sometimes dire consequences (Robertson, 6/25).

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State Watch

Texas Democrats Defeat Abortion Bill After Midnight Drama

Democrats in the Texas Senate late Tuesday successfully filibustered abortion legislation that would ban the procedure after 20 weeks of pregnancy and also shutter all but a few abortion clinics in the state.

The Texas Tribune: Led By Davis, Democrats Defeat Abortion Legislation
The nation watched on Tuesday -- and into Wednesday -- as Democratic Sen. Wendy Davis and hundreds of impassioned reproductive rights advocates stalled proceedings and ultimately defeated controversial abortion legislation in a storm of screams and shouts as the clock struck midnight (Aaronson, 6/26).

The Associated Press: Texas Abortion Bill Falls After Challenge
Despite barely beating a midnight deadline, hundreds of jeering protesters helped stop Texas lawmakers from passing one of the toughest abortion measures in the country. As the protesters raised the noise to deafening levels in the Texas Senate chamber late Tuesday, Republicans scrambled to gather their colleagues at the podium for a stroke-of-midnight vote on some of the toughest abortion restrictions in the country (Vertuno and Tomlinson, 6/26).

The New York Times: Texas Abortion Bill Fails After Tense Standoff
Hours after claiming that they successfully passed some of the toughest abortion restrictions in the country, Republican lawmakers reversed course and said a disputed late-night vote on the bill did not follow legislative procedures, rendering the vote moot and giving Democrats a bitterly fought if short-lived victory (Fernandez and Eckholm, 6/26).

Los Angeles Times: Texas Abortion Bill Fight Ends In Chaos After Marathon Filibuster
When Texas state Sen. Wendy Davis arrived at the Capitol in Austin on Tuesday morning wearing pink sneakers, everyone knew that a daylong, marathon filibuster was about to begin. So was a controversy. Davis, 50, a Democrat from Fort Worth, had been specially chosen by her caucus to mount a last-ditch attempt to block sweeping legislation to ban abortions at 20 weeks and force the state's abortion clinics to upgrade or close. Whether she succeeded was unclear (Hennessy-Fiske, 6/26).

NPR: Texas Lawmaker's 11-Hour Filibuster Ended On A Technicality
By midnight Texas time, it was all over but the parliamentary inquiries. After a nearly 11-hour filibuster attempt by state Sen. Wendy Davis to block sweeping restrictions on abortion, the Republican-dominated Texas Senate successfully shut down the filibuster on points of order. (See update at the bottom of this post.) "This is probably the worst night that I've experienced since I've been in the Senate, maybe since I've been in public life," said state Sen. Kirk Watson, a Democrat from Austin (Hu, 6/26).

USA Today: Texas Abortion Bill Misses Deadline
The bill, known as SB 5, would ban abortion after 20 weeks of pregnancy and force many clinics that perform the procedure to upgrade their facilities and be classified as ambulatory surgical centers. Also, doctors would be required to have admitting privileges at a hospital within 30 miles. If signed into law, the measures would close almost every abortion clinic in Texas, a state 773 miles wide and 790 miles long with 26 million people. A woman living along the Mexico border or in West Texas would have to drive hundreds of miles to obtain an abortion. The law's provision that abortions be performed at surgical centers means only five of Texas' 42 abortion clinics are currently designated to remain in operation (Hjelmgaard, 6/26).

Reuters: Marathon Speech Helps Democrats Block Texas Abortion Bill
Texas state Democrats blocked a drive for new abortion restrictions on Wednesday after a marathon speech in the capitol in Austin caused some Republican backers of the bill to cast votes after a midnight deadline. Democrat Senator Wendy Davis spoke for more than 10 hours in a bid to pull down the voting window on a measure that would place a ban on abortions after 20 weeks of pregnancy (MacLaggan, 6/26).

Fox News: Texas Abortion Bill Falls After Dispute Over Vote
Texas' lieutenant governor acknowledged early Wednesday that Republicans missed their deadline to pass new abortion restrictions after protesters screamed down lawmakers as the final 15 minutes passed before the special legislative session's deadline. Initially, Republicans insisted they had started voting before the midnight deadline and passed the bill that Democrats spent much of Tuesday filibustering. But after official computer records and printouts of the voting record showed the vote took place on Wednesday, and then were changed to read Tuesday, senators convened for a private meeting (6/26).

CNN: Texas Abortion Bill Dies As Confusion Marks End Of Session
The Texas legislature's special session ended in chaos and confusion early Wednesday, when a marathon filibuster failed -- but so did a Republican effort to pass a bill that would have greatly restricted abortions in the state. The Republican-dominated Senate needed to vote "yea" on the bill by midnight to send it to the governor to sign into law. But at 3 a.m., Lt. Gov. David Dewhurst stepped to the Senate floor to declare the bill dead and the special session over (Payne, 6/26).

In other state-based abortion legislation news --

The New York Times: Lawsuit Challenges North Dakota's Abortion Limits
A women's rights group filed a lawsuit in federal court on Tuesday to block the country’s most stringent abortion law, a North Dakota ban on abortions as early as six weeks into pregnancy (Eckholm 6/25).

The Associated Press: Panel Adds Abortion Regulations To Ohio Budget
Abortion providers in Ohio would have to inform pregnant women in writing about the presence of a fetal heartbeat before the procedure under a last-minute change slipped into the state budget. The amendment which also requires providers to say, to the best of their knowledge, the statistical probability of bringing the fetus to term was added Tuesday night by a Republican-dominated, six-member legislative committee (Sanner, 6/25).

Des Moines Register: Iowa Group Tries To End 'Telemedicine' Abortions
An Iowa organization opposed to abortions said Tuesday it is asking state medical officials to block a remote-control method of distributing abortion-inducing pills. Iowa Right to Life, based in Des Moines, said in a statement that it has filed petitions that have more than 20,000 signatures with the Iowa Board of Medicine. ... The petitions target a long-distance video system used by Planned Parenthood of the Heartland. The system allows a physician in Des Moines to deliver pills to patients in remote clinics around the state (Petroski, 6/25).

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Hospital News: Layoffs At Pa.'s Temple University Health System

Layoffs, affiliations and big revenue numbers make news at hospitals in Pennsylvania, Massachusetts and Texas.

Philadelphia Inquirer: Two Area Health Systems Cut Jobs
Temple University Health System announced the elimination of 11 positions at Fox Chase Cancer Center and 14 at Jeanes Hospital. Officials said efforts were underway to find new jobs in the system for the affected employees, who came from management and nonmanagement ranks but were not involved in patient care. Fox Chase and Jeanes have a combined 3,500 employees (Brubaker, 6/25).

Houston Chronicle: Texas, Nation's Non-Profit Hospitals Grossing Huge Amounts
Five Houston hospitals are among the nation's 100 top-grossing hospitals, two something of a surprise, but the greatest puzzler is one of the two Dallas hospitals on the list. Parkland Hospital, Dallas' equivalent of Ben Taub General Hospital, ranked 57th on the list, released Tuesday by Becker's Hospital Review (6/25).

Boston Globe: Winchester Hospital, Lahey Health Plan To Link
Winchester Hospital's board has signed a letter of intent to affiliate with Lahey Health, the parent organization of Lahey Clinic in Burlington, in the latest example of a community hospital seeking to join a larger health care network as the medical market consolidates. In a joint statement released late Tuesday afternoon, the two parties said they were teaming up to better coordinate care for the patients in communities stretching from Northeastern Massachusetts into Southern New Hampshire. The presidents of Lahey and Winchester both declined requests to discuss their affiliation plans (Weisman, 6/25).

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Calif. Fines Kaiser Health Plan $4M After Mental Health Care Delivery Delays

Regulators said the Kaiser Foundation Health Plan delayed treatment -- sometimes for more than 14 days -- for patients who needed mental health care, which is a violation of the law.

Modern Healthcare: California Fines Kaiser $4M For Violating Mental Health Laws
The Kaiser Foundation Health Plan was fined $4 million by the state of California for failing to correct violations of mental health laws, including publishing materials that wrongly said the organization could deny long-term mental health care services to some plan enrollees. The health plan, which is part of the giant, not-for-profit Kaiser Permanente integrated delivery system, also was accused of violating state law by making some patients wait more than 14 days for an initial mental-health appointment (Carlson, 6/25).

Sacramento Bee: Kaiser Mental Health Care Lacking, State Says; HMO Hit With $4 Million Fine
Imposing the second-largest fine in its history, the California Department of Managed Health Care on Tuesday slapped Kaiser health plans with a $4 million penalty for failing to provide mental health treatment in a timely manner. The department also issued a cease and desist order to Kaiser, forbidding the health plan from continuing practices in violation of state law, which ensures equal care for mental and physical health (Craft, 6/26).

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State Highlights: Ore. Targets Waste With Uniform Credentialing

A selection of health policy stories from Oregon, California, Minnesota, Louisiana, Georgia and North Carolina.

Lund Report: Oregon To Pioneer Electronic Credentialing System To Cut Waste
The Oregon House passed a bill with unanimous support Monday that supporters say could save the economy $150 million in administrative waste by crafting a single credentialing process that all insurers, hospitals and coordinated care organizations can share for thousands of health care providers. If Gov. Kitzhaber signs Senate Bill 604 into law, Oregon will also be the first state to have a uniform, electronic credentialing database where each provider can be quickly accessed. SB 604 passed the Senate unanimously last week. Sen. Alan Bates, D-Medford, told The Lund Report that with his medical practice he has to be credentialed each year by up to 40 different insurance companies as well as two different hospitals (Gray, 6/25).

CQ HealthBeat: California Experiment With Managed Care Offers Lessons
When California managed care plans took on the challenge in 2011 of caring for seniors and people with disabilities, the insurers initially didn't know which providers had been caring for the beneficiaries or even how to contact the new enrollees, according to panelists at a Kaiser Family Foundation forum on Tuesday. The session examined lessons from the transition that could apply to other states now shifting patients to such plans (Adams, 6/25).

The New York Times: Poll Finds Rural Voters Are Divided On Federal Role
With the economy rebounding slowly in some areas, 59 percent said the federal government had at least some responsibility to help the "working poor advance economically." At least 8 in 10 supported job training, Medicaid for health care, and tax refunds for low-income Americans (Yaccino, 6/25).

MPR News: The Fight For Rural Health Care Funding In Washington
It's harder to find allies for rural health care in a polarized Congress in Washington, a rural health policy official told attendees of the Minnesota Rural Health Conference here this morning. "We have lost a lot of the moderates," said Maggie Elehwany, policy vice president of the Kansas-based National Rural Health Association. "We've always found our greatest champions to be moderates in both parties." That's because those on the far left tend to be more urban and those on the far right might be primarily concerned with reducing budgets. She did say that Minnesota's rural hospitals and clinics are better represented than those in many states, by Sens. Al Franken and Amy Klobuchar. "You don't have to do a lot of selling," she said (Vogel, 6/25).

The Associated Press: Report: La. Has Too Few Dentists For Its Residents
Louisiana has one of the worst dentist shortages in the country, according to a new national report released Tuesday, only days before the state will slash its Medicaid reimbursement rates for dental care. The analysis, released by the nonpartisan Pew Charitable Trusts, says more than 24 percent of Louisiana's population is underserved by dentists and living in an area with a shortage of dentists, second only to Mississippi and tied with Alabama (Deslatte, 6/25).

Georgia Health News: Blue Cross Incentive Plan Focuses On Primary Care
Primary care doctors could earn as much as 30 percent more in a medical quality incentive plan that Blue Cross and Blue Shield of Georgia will launch July 1. The president of Blue Cross of Georgia, Morgan Kendrick, said the incentive pay program will begin in Athens, Rome, Columbus and Savannah, with more than 250 physicians serving 58,000 patients. The company will roll out the program in the Atlanta market and elsewhere in the state over the rest of the year, Kendrick said. Blue Cross is the leading health insurer in Georgia, with more than 2 million members (Miller, 6/25).

North Carolina Health News: NC Legislators Wade Into Debate Over Breast Cancer Screening
Legislators are poised this week to require physicians to talk to their mammogram patients about dense breasts. But the policy may not be keeping pace with the science (Hoban, 6/25).

California Healthline: Transparency Sought For Health Care Department
The Senate Committee on Appropriations yesterday unanimously approved a bill aimed at creating greater transparency and accountability at the state's Department of Health Care Services. "This bill is inspired by information we gathered at an oversight hearing last October and by seeing the way the Managed Risk Medical Insurance Board conducts its business," said Assembly member Richard Pan (D-Sacramento), author of AB 209. The oversight hearing last fall dealt with the transition of children from the Healthy Families program (which had been overseen by MRMIB) to Medi-Cal managed care plans (which are administered by DHCS). The contrast in transparency between the two state agencies was the impetus for the bill, Pan said (Gorn, 6/25).

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Editorials and Opinions

Viewpoints: Entitlements Driving U.S. Toward Insolvency; Shalala On Being Informed; Catholics Find Contraceptive Mandate Morally Wrong

Politico: Facing The Truth About Entitlements
As currently structured, entitlement programs can't keep up with longer life expectancies and changing demographics. Soon, one-third of Americans will be retired and will spend one-third of their lives in retirement. Meanwhile, the ratio of workers to retirees has dropped precipitously. During this decade and the next, the number of Americans 65 or older will jump 75 percent, while those of working age will nudge up by just 7 percent. Within a decade, the total price for Social Security, Medicare and Medicaid will reach $3 trillion a year, but we'll have fewer workers paying into the system and supporting those growing costs (R. Bruce Josten, 6/25). 

USA Today: What Americans Need To Know On Health Care
This fall, just four months from now, tens of millions of Americans who don't have health insurance will be able to get a quality plan tailored to their specific needs and budget. It's a major attribute of the nation's new health care law, the Affordable Care Act, and we need to make sure that Americans who are eligible gain access as quickly as possible. ... In the absence of facts, too many Americans know too little about the law that will have an immediate impact on the health of their families -- and that means they won't be able to take advantage of the benefits. To put it simply: whether you support the Affordable Care Act or not -- and I happen to be a strong supporter -- everyone should support making sure that all Americans have the basic information about their legal rights so that they can make the best decisions for their families (Donna Shalala, 6/25). 

The New York Times: Economix: The Perils Of Significant Misunderstandings In Evaluating Medicaid
Whether you like or dislike the Affordable Care Act, it helps to understand the distinction between statistical significance and practical importance. Taxpayers want to know whether the government programs they pay for actually make a difference, so measurement is a critical part of policy evaluation. ... Statistical significance has little to do with “significance” as understood by laymen, who think of practical importance when they read that term. ... The commentators on both sides of the Medicaid debate made exactly this error (Casey B. Mulligan, 6/26). 

Richmond Times-Dispatch: Expand Medicaid?
As state leaders and members of the public ponder the merits of expanding Medicaid, they might pause to ask what advocates of expansion hope to achieve. If the aim simply is to provide more health care to the poor and near-poor, expansion would do that. A study published in the New England Journal of Medicine found Medicaid expansion in Oregon "did increase the use of health services." But that is different from actually making people healthier. Medicaid expansion has not been shown to do that (6/24).

Richmond Times-Dispatch: Medicaid Reform Must Come First
Medicaid is a broken program that needs serious reform. Until the federal government gives Virginia the flexibility to make these reforms – and until we can be absolutely certain Virginia taxpayers will not get stuck with a massive bill – Virginia cannot begin to consider expansion (James M. O'Bannon and R. Steven Landes, 6/23).

San Antonio Express: Opposition To Medicaid Expansion Misguided 
Gov. Rick Perry's comment that Medicaid is a failed federal program is just plain wrong. Medicaid, overall, has been a success since it began in 1965. The Medicaid expansion will save lives and reduce poverty; have little to no cost and save money; boost local economies and save jobs; build a stronger health care system for all Texans; and provide roughly 1.5 million uninsured Texans with health coverage (Juan Flores, 6/21).

Philadelphia Inquirer: Expanding Medicaid Is The Smart Thing To Do
From New York to New Mexico, and Oregon to Alabama, state officials with diverse political outlooks are reaching the same conclusion: Expanding Medicaid under Obamacare is simply too good an idea to pass up. Not only that, it's a smart, compassionate public-health policy. But a still-reluctant Gov. Corbett and the Republican-controlled General Assembly continue to stall on Pennsylvania's adding more of its working poor to the health-insurance program. Unless they make a decision before the state budget process concludes this month, Corbett and company likely will stand by as Gov. Christie and other GOP governors start to reap billions in new federal aid for their states next year (6/24).

St. Louis Post-Dispatch: HHS Mandate Puts Our Religious And Personal Liberties At Stake
The legality and the right to purchase contraceptives — or an abortion for that matter — are not at stake here. Please take note of two words: "force" and "pay." Without getting into the merits of Catholic teaching and how men and women cooperate with our Creator to bring life into the world and the profound responsibility that goes along with human sexuality, it must be asked: If government can force Catholics to pay for something we find morally wrong, why can't it force you to participate in something you object to? (Archbishop Robert Carlson, 6/26).

The Washington Post: On Abortion, Republicans Treat Women Like Children
Last week, the House passed the most restrictive abortion bill to come to a vote in Congress in the past decade. Despite the efforts of Democrats and a few moderate Republicans who spoke out against the unconstitutional bill, which bans almost all abortions after 20 weeks, it passed 228 to 196. This is only the latest blow in the GOP's all-out assault on women's reproductive rights (Katrina vanden Heuvel, 6/25). 

MedPage Today: Recipe For Population Health
It strikes me that, in order to answer the Affordable Care Act's call for us to aggressively pursue population health, we must first understand what the recipe calls for. ... for those of us who practice medicine, positive change will come when we are able to reconcile population-wide, evidence-based recommendations with individualized care that is guided by each patient's unique genetic makeup (Dr. David Nash, 6/25).

Lund Report: Rationing Care Is The Wrong Way To Cut Oregon's Medicaid Costs
Imagine walking into your doctor's office and seeing someone else standing there, telling you they get to make the final decision about your healthcare. Instead of doctors and patients making important health decisions, they make the final call. For those in Oregon's social safety net, that day is coming. The Health Evidence Review Commission, or HERC, is designed specifically to cut healthcare costs by overriding decisions made by doctors and their patients (Debbie McCabe and Lorren Sandt, 6/26).

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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.