Daily Health Policy Report

Thursday, June 27, 2013

Last updated: Thu, Jun 27

KHN Original Reporting & Guest Opinion

Coverage & Access

Health Reform

Capitol Hill Watch

Medicare

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Capsules: Medicare Enhances Doctor-Rating Website; Test Driving The Obamacare Software

Now on Kaiser Health News' blog, Jordan Rau reports on Medicare's doctor-rating website: "Medicare Thursday added new features to its Physician Compare website as it prepares to start including quality data on thousands of doctors" (Rau, 6/27).

In addition, Jay Hancock reports on efforts to test Obamacare software: "All the outreach in the world won't count for much if the Obamacare ticket counter doesn't work. Behind the campaign to educate the uninsured about the Affordable Care Act is the assumption that software to sell the plans will be ready and user-friendly by Oct. 1, when enrollment is supposed to start. That assumption is not universally shared. Some wonder if systems will be tested and finished on time. Others worry the programs will lead consumers to make dumb insurance choices" (Hancock, 6/27).Check out what else is on the blog.

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Political Cartoon: 'Employee Wellness Plan?'

Kaiser Health News provides a fresh take on health policy developments with "Employee Wellness Plan?" by Rex May.

Meanwhile, here is today's health policy haiku:

BAD NEWS FOR RISK POOLS

Immigration bill
leaves crucial Latinos out
of ACA goods.
-Laura Mortimer 

And, as a bonus, here's the sentimental favorite:

THOSE WERE THE DAYS 

Just one year ago
the court had us all focused
on health policy.
-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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Coverage & Access

High Court's DOMA Ruling Will Impact Health Benefits For Gay Couples

The decision will affect benefits for federal employees, as well as people eligible for new coverage under the health law, and will likely lead employers in the states that recognize same-sex marriages to review employee-benefit packages to make sure they don't discriminate against gay spouses and comply with the law.

The Washington Post: At Supreme Court, Victories For Gay Marriage
The divided court stopped short of a more sweeping ruling that the fundamental right to marry must be extended to gay couples no matter where they live. But in striking down a key part of the 1996 Defense of Marriage Act (DOMA), the court declared that gay couples married in states where it is legal must receive the same federal health, tax, Social Security and other benefits that heterosexual couples receive (Barnes, 6/26).

The Wall Street Journal: Federal Rules, Taxes To Shift Due To Gay-Marriage Decision
Justice Anthony Kennedy's 5-4 opinion for the court noted a range of burdens gay couples faced under DOMA, "from the mundane to the profound." The invalidated law, he said, prevented married couples from obtaining government health-care benefits and raised their health-care costs by taxing health benefits that employers provide to workers' same-sex spouses. The law also deprived same-sex couples of more favorable consideration for student financial aid and denied them certain bankruptcy protections, Justice Kennedy said (Kendall and Saunders, 6/26).

NPR: How The End Of DOMA Will Affect Obamacare, Federal Employees
The Supreme Court's ruling that the Defense of Marriage Act is unconstitutional will not only make a big difference in health benefits for some federal employees, it could also affect people who will be newly eligible for Obamacare beginning next year (Neel, 6/26).

The New York Times: Federal Court Speaks, But Couples Still Face State Legal Patchwork
Consider two women living at Keesler Air Force Base in Biloxi, Miss., who travel to Maine to get married. When they get back to the base, the military will now recognize their marriage, affording them a variety of benefits that would go to any married couple, like health care and a housing allowance. But once they exit Keesler’s gates, they will find their marriage license means nothing to the state of Mississippi (Peters, 6/26).

The Wall Street Journal: Changes Loom For Employers
Wednesday's ruling now applies only to workers in the 12 states, plus the District of Columbia, that recognize gay marriage. Companies in those states will have to review their employee-benefit packages to make sure they don't discriminate against gay spouses and comply with the law, lawyers and benefits consultants said. … One of the biggest changes for married gay couples will be equal tax treatment of health-insurance premiums. Prior to the ruling, the value of a gay spouse's benefits coverage was treated as taxable income because he or she wasn't considered a spouse or dependent under federal law. By contrast, heterosexual couples paid for spousal benefits from pretax earnings. Now, in affected states, gay workers will enjoy the same tax status, potentially saving them thousands of dollars a year (Weber and Hofschneider, 6/26).

The Washington Post's Wonk Blog: The Feds Now Must Recognize Same-Sex Marriage. That Changes Obamacare.
With the United States recognizing same-sex marriage, a same-sex couple can be counted by the federal government as one family unit. Instead of two separate individuals applying for health benefits, each judged by the federal poverty line for one person, they’re now a team. Their federal poverty line is $15,510 (Kliff, 6/26).

The New York Times' Bucks Blog: How Supreme Court Decision Affects Gay Couples
Medicaid. Having a federally recognized marriage can help or hurt an individual when it comes to Medicaid programs, "or perhaps even some of both," said Vickie Henry, a senior staff lawyer at Gay and Lesbian Advocates and Defenders. The fact that both spouses' incomes will be used to determine eligibility may hurt some couples. But if one spouse is in a nursing home or other long-term care institution, the couple may benefit from Medicaid's "spousal impoverishment" provisions. … Medicare. Individuals may be eligible for free Part A coverage, which generally covers hospital services and nursing homes, based on a spouse's earning record, according to the Medicare Rights Center. Married people may also be able to delay enrolling in Part B coverage, which covers things like preventative visits to the doctor, while a spouse is still working and for up to eight months afterward (Siegel Bernard, 6/26).

The Hill: DOMA Ruling Affects ObamaCare, Medicaid Eligibility
The Supreme Court's ruling Wednesday on the Defense of Marriage Act has big implications for healthcare benefits. The court struck down the central piece of DOMA, which said same-sex couples could not obtain federal benefits, even in states that recognize same-sex marriage (Baker and Viebeck, 6/26).

The Baltimore Sun: Doctors, Researchers Applaud Supreme Court's Gay Marriage Rules
In the hours after the U.S. Supreme Court handed down decisions in U.S. vs. Windsor and Hollingsworth vs. Perry, health groups chimed in support of the rulings -- and gay marriage. American Psychological Assn. president Donald Bersoff said in a statement Wednesday that the ruling in U.S. vs. Windsor, which in overturning a key part of the Defense of Marriage Act gives married gay couples equal access to the federal benefits that straight married couples receive, was "a triumph for social science and recognition of the basic dignity of all American citizens" (Brown, 6/26).

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Health Reform

Democrats To Sebelius: Confusion Over Health Law Persists

Politico reports that congressional Democrats shared concerns with Health and Human Services Secretary Kathleen Sebelius that seniors, among others, remain fearful about the health law's impact on their benefits. Meanwhile, the Los Angeles Times explores a loophole that could allow insurers to avoid some of the law's provisions for another year and The Associated Press reports the individual mandate exemption has been broadened for Native Americans.

Politico: Dems To Kathleen Sebelius: Seniors Confused On Obamacare
Congressional Democrats told Health and Human Services Secretary Kathleen Sebelius on Wednesday that Americans are still very confused about the health care law — including older people who worry that Obamacare will change their Medicare. Sebelius went to the Hill for another update with Democrats on Obamacare rollout. HHS this week overhauled its website, focusing more on the exchange enrollment, which starts Oct. 1 (Cunningham and Haberkorn, 6/27).

Los Angeles Times: Healthcare Law's Renewal Loophole Divides Health Insurers
Ahead of next year's healthcare overhaul, some major insurers and consumer advocates want California lawmakers to bar companies from renewing most individual policies beyond Jan. 1. At issue is a loophole in the federal Affordable Care Act that enables health insurers to extend existing policies for nearly all of 2014, thereby avoiding changes under the healthcare law (Terhune, 6/26).

The Associated Press/Washington Post: Exemption From Health Law's Individual Mandate Broadened For Native Americans
The Obama administration on Wednesday broadened an exemption for American Indians from the new health care law's requirement that virtually every U.S. resident has health insurance starting next year. New rules clarify that people who are eligible to receive medical care through the federal Indian Health Service will be exempt from the requirement to have health insurance or face fines from the Internal Revenue Service. The Indian Health Service, a division of U.S. Health and Human Services, oversees a network of clinics that are required through treaty obligations to serve all patients of Indian ancestry, even if they cannot document their federal tribal status (6/26).

CQ HealthBeat: Final Rule On Exemptions Similar To Proposed Rule
A final rule released Wednesday that outlines who would be exempt from health law penalties if they don’t have insurance coverage next year largely mirrors the proposal Health and Human Services made in January The 139-page regulation spells out who will be eligible to get certificates showing that they are exempt from the requirement to have health coverage. The penalties are one of the health care overhaul’s most unpopular features (Adams, 6/26).

And California Healthline looks at how the Supreme Court's decision one year ago upholding most of the health law has affected implementation --

California Healthline: One Year Later: What's Changed Since The Obamacare Verdict
Much has changed, certainly, since Chief Justice John Roberts cast the deciding vote to uphold the law. (Beyond those bettors' account balances, and the existence of InTrade itself, which mysteriously shut down in March.) Here's a look at how the Supreme Court's decision on June 28, 2012, affected five hot-button issues related to the health law (Diamond, 6/26).

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Exchanges Look To Software And Sports Teams

News outlets report on enrollment activities, including efforts to recruit sports teams, as well as the testing of software for the new online insurance marketplaces.

Kaiser Health News: Capsules: Test Driving The Obamacare Software
All the outreach in the world won’t count for much if the Obamacare ticket counter doesn't work. Behind the campaign to educate the uninsured about the Affordable Care Act is the assumption that software to sell the plans will be ready and user-friendly by Oct. 1, when enrollment is supposed to start. That assumption is not universally shared. Some wonder if systems will be tested and finished on time. Others worry the programs will lead consumers to make dumb insurance choices (Hancock, 6/27).

Politico: Recruiting Local Sports For Team Obamacare
President Barack Obama's love of the Chicago White Sox is no secret, but he'd probably be an even bigger fan if his hometown baseball team goes to bat for Obamacare. It’s not just the Obama administration looking to join forces with professional sports leagues to enroll people in health insurance. Some states are also looking to get a lift from local teams this fall, when millions can start signing up for coverage (Millman, 6/27).

Philadelphia Inquirer/Kaiser Health News: Navigators Will Play Key Role As Marketplace Launch Nears
This new venue is expected to raise a tsunami of questions from consumers. Where will potential enrollees turn if they can't use the Internet or don't speak English? Consumers can call on "navigators," trained people who will provide face-to-face assistance. Or, it is hoped, the navigators will call on them (Diamond, 6/27).

Health Policy Solutions (a Colo. news service): Exchange Bracing To Slash $9 Million
Colorado’s health exchange managers are bracing to cut expenses by about $9 million because federal sequestration is expected to axe 7.5 percent from a $125 million federal grant designed to help launch the exchange. Exchange CEO and Executive Director Patty Fontneau said during a finance committee meeting this week that managers are expecting a 7.5 percent cut in the newest implementation grant. Fontneau said some programs might have to withstand higher cuts than others because managers have already signed some contracts for services or technology so they cannot spread the cuts evenly across all programs (Kerwin McCrimmon, 6/26).

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When States Reject Medicaid Expansion, Safety-Net Hospitals In A Bind

The Washington Post highlights a Georgia hospital to illustrate the choices safety net hospitals will face if their states opt against the health law's Medicaid exansion. Also, a number of states continue to grapple with debate and decisions related to the expansion issue.

The Washington Post's Wonk Blog: This Georgia Hospital Shows Why Rejecting Medicaid Isn't Easy
The Affordable Care Act was originally written such that every state would have to accept a Medicaid expansion. But the Supreme Court struck down that part of the law last year. The result is an unexpected bind for safety-net hospitals in states that are refusing Medicaid. How bad of a bind? Just look at the choices facing Atlanta's Grady Memorial Hospital (Blau, 6/26).

Minneapolis Star Tribune: Minnesota Medicaid Rolls Could Expand Rapidly With Health Reform Law
Minnesota could see tens of thousands of people sign up for Medicaid starting next year if it follows a pattern detected by University of Minnesota researchers in Massachusetts after the law known as Romneycare took effect. A "welcome mat" effect triggered by the 2006 law seemed to encourage enrollment by residents who were eligible for Medicaid but had never signed up, according to the study, which was published Monday in the influential journal "Health Affairs." (Griffin, 6/26).

The Associated Press: Health Care Workers Discuss Medicaid Expansion
Access to health care professionals and reimbursement options were among the topics discussed at a meeting of a state task force studying the possibility of expanding Medicaid in South Dakota on Wednesday. The 29-member panel appointed by Gov. Dennis Daugaard is made up of lawmakers, medical facilities directors and other health care workers (Eaton, 6/26).

The Associated Press: New Hampshire Lawmakers OK $10.7B Budget, Medicaid Study
The New Hampshire Legislature passed a $10.7 billion bipartisan budget Wednesday that eases the waiting time for services to the disabled and mentally ill, but puts off a decision on whether to expand Medicaid to 58,000 poor adults. The Senate voted unanimously to pass the budget, followed by the House passing each bill in the two-bill package by over 300 votes (Love, 6/27).

Detroit Free Press: GOP Senate Group To Study Possible Medicaid Expansion
State Senate Majority Leader Randy Richardville, R-Monroe, has formed a work group to study possible Medicaid expansion in Michigan — an issue that he said is not dead, despite a decision last week by senators to leave for break without taking a vote on it. The six members are all Republicans but represent different views, said Richardville’s spokeswoman Amber McCann (Erb 6/26).

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Florida Firm Gets Religious Reprieve From Health Law's Contraception Rule

An update on employers' legal challenges to the provisions requiring contraceptive coverage.

Tampa Bay Times: Largo Business Challenging U.S. Health Care Law Gets Religious Reprieve
A Largo high-tech engineering firm doesn't have to offer emergency contraception under its medical plan while its case challenging part of the federal health care law is pending in court, a judge said this week. Beckwith Electric Co. is owned by Thomas Beckwith, a devout Southern Baptist who believes emergency contraceptives are immoral and amount to "killing innocent human life." ... Because its insurance plan was up for renewal this month, Beckwith could have been required to start covering the contraceptives while the case was under review. U.S. District Judge Elizabeth Kovachevich granted Beckwith a reprieve, saying the company may be due religious protections under federal law (Tillman, 6/26).

The Associated Press: W. Va. Auto Dealer Seeks Relief From Health Rule
A West Virginia auto dealer has gone to court to block the federal government from requiring his business to provide insurance coverage for abortion-inducing drugs and contraceptives. Joe Holland contends that the requirement will force him and his dealership, Joe Holland Chevrolet in South Charleston, to violate their religious beliefs (6/27).

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Capitol Hill Watch

Former CMS Head: Tie Doc Payment Reforms To Patient Outcomes

A former Centers for Medicare and Medicaid Services administrator told the Senate Finance Committee Wednesday that Medicare should focus on fewer quality measures in their assessments, letting patient outcomes dictate what constitutes quality care instead.

CQ HealthBeat: Medicare Doc Payment Bill May Be Vehicle To Tighten Quality Measurement
Medicare and other insurers should sharply reduce the number of measures they use to assess the quality of care so that they focus on a few pivotal outcomes of treatment -- not on how care is delivered. That was the message delivered in testimony Wednesday before a Senate Finance Committee hearing that included sometimes blistering criticism of the state of the national quality improvement movement (Reichard, 6/26).

Medpage Today: Align Doc Pay With Outcomes, Congress Told
Quality measures in health care still need refining, and in the meantime Congress needs to make outcomes align better with physician payment reforms, a former Medicare chief told lawmakers Wednesday. Payment reforms need to include more efforts that focus on the episode or person level of care because that's where true gains in improving quality can be made, Mark McClellan, MD, PhD, administrator of the Centers for Medicare and Medicaid Services (CMS) from 2004 to 2006, said. Meanwhile, quality measurements can be refined to better track quality, McClellan told the Senate Finance Committee during a hearing on measuring quality in health care. Quality should also be based on patient outcomes -- and not processes (Pittman, 6/26).

A new bill would pay some on Medicare to improve their health --

The Hill: New Bill Would Pay Seniors For Staying Healthy
New bipartisan legislation introduced Wednesday would allow Medicare to pay seniors if they improve and maintain their health. The measure from Sens. Ron Wyden (D-Ore.) and Rob Portman (R-Ohio) would create a new program within Medicare to pay seniors hundreds of dollars for meeting certain health criteria (Viebeck, 6/26).

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Medicare

Treating People In Docs' Offices Instead Of ERs May Not Save As Much As Thought

Helping people avoid the ER and caring for them in doctors' offices instead may not help save as much money to the health care system as initially thought, a new study suggests.

Reuters: Most Pricey Medicare Patient Care May Be Unpreventable
Treating the costliest Medicare patients in doctors' offices instead of emergency rooms or hospitals whenever possible may not save as much money as originally hoped, according to a new study. After analyzing recent data on more than one million Medicare patients, researchers found that only about a tenth of the money spent on the program's most expensive patients was for care that could be provided without a trip to the hospital (Seaman, 6/26).

In other Medicare news  -

Kaiser Health News: Medicare Enhances Doctor-Rating Website
The federal health care law requires the Centers for Medicare & Medicaid Services to publish performance data on doctors, including how patients rate them, how well the physicians’ medical interventions succeed and how well they follow clinical guidelines for basic care. The site has been up since 2010, but contained only basic information about doctors and group practices, such as their addresses, specialties and clinical training. The updated site expands the way people can search for doctors (Rau, 6/27).

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State Watch

Texas Abortion Fight Inspires Activists

The victory of Texas abortion-rights activists may be shortlived -- Texas Gov. Rick Perry announced he would reconvene lawmakers next week to vote again on the measure -- but it is rallying people across the country on both sides of the issue.

Politico: Texas Abortion Fight A Rallying Cry
A late-night Lone Star State showdown that stopped an abortion bill in its tracks galvanized people on both sides of the battles that are raging in states -- fights that could eventually land in the Supreme Court (Glueck, 6/26).

Los Angeles Times: Texas Sen. Wendy Davis' Abortion Filibuster Galvanizes Activists
Wendy Davis' filibustered victory, which ricocheted around the world via social media, may prove short-lived. Gov. Rick Perry announced Wednesday he would reconvene the Legislature on Monday in a second and likely successful attempt to pass the measure. But the celebrity Davis garnered and the passions the Fort Worth Democrat ignited -- at one point she generated 6,000 Tweets a minute with the hashtag #StandWithWendy -- may prove longer lasting (Hennessy-Fiske and Barabak, 6/26).

In other news about state efforts to restrict abortions --

North Carolina Health News: Bill Will Require Middle-Schoolers To Be Taught About Causes Of Pre-Term Birth
After a contentious debate on the House floor, North Carolina lawmakers tentatively voted to require middle school teachers to instruct their students on the top five causes of preterm birth, and tell them that one of those causes is having had an abortion (Hoban, 6/27).

Des Moines Register: 14 Iowa Medical Professionals Protest 'Webcam' Abortions
Iowa doctors would be required to perform a physical examination of a pregnant woman before providing abortion-inducing pills under proposed state regulations sought by 14 Iowa medical professionals. The medical professionals, including Dr. Susan Beck of Clive, made the request in a petition for rule-making filed Tuesday with the Iowa Board of Medicine. The petition is aimed at halting the use of videoconferencing by Planned Parenthood of the Heartland, in which doctors based in Des Moines prescribe and remotely distribute abortion-inducing drugs to women in rural Iowa communities (Petroski, 6/27).

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State Highlights: Miss. Lawmakers Ready For Special Session On Medicaid

A selection of health policy stories from Mississippi, New York, South Carolina, Kansas, Oregon, California and Colorado.

The Associated Press: Miss. Lawmakers Start Medicaid Session Thursday
Mississippi lawmakers return to the Capitol at 10 a.m. Thursday for a special session designed to keep Medicaid alive and funded. Much is at stake: Medicaid is a government health insurance program for the needy, and it covers about 644,000 of the state's nearly 3 million residents (6/27).

The Associated Press/Wall Street Journal: Paid Sick Times Law Passes In NYC, Veto Overridden
New York City is becoming the most populous place in the United States to make businesses provide workers with paid sick time, after lawmakers overrode a mayoral veto early Thursday to pass a law expected to affect more than 1 million workers. With the vote, the city joined Portland, Ore.; San Francisco; Seattle; Washington, D.C.; and the state of Connecticut in requiring the benefit for at least some workers. Similar measures have failed in some other places, including Milwaukee, Denver and Philadelphia (Peltz, 6/27).

Oregonian: Oregon Slashes 2014 Health Insurance Premium Requests By As Much As 35 Percent
Oregonians who buy their own insurance have the first clear indication of what 2014 premiums will look like after state regulators Tuesday slashed carriers' rate requests by as much as 35 percent. ... The insurers' filings do not come with details on claim-handling policies or the extent of available provider networks. But the state decisions do settle long-standing speculation that "rate shock" will hit the individual market due to changes under the federal Affordable Care Act (Budnick, 6/26).

The Associated Press: SC Budget: Hospital Regulation Program Loses $1.7M
A program that state health officials use to regulate whether South Carolina hospitals can add new beds, build additional facilities or even buy expensive equipment appears to have been gutted after the House agreed Tuesday with Gov. Nikki Haley to remove more than $1.7 million in funding. House members voted 56-65 on Wednesday to sustain the Republican governor's veto of money for the Department of Health and Environmental Control's Certificate of Need program (Collins, 6/26).

Kansas Health Institute: Governor's Mental Health Initiative Taking Shape
A state official today named the five community mental health centers chosen to help carry out a reform initiative proposed by Gov. Sam Brownback in an effort to reduce the number of people sent to state mental hospitals or jails (Ranney, 6/26).

The Lund Report: Hospital Association Pressures Lawmakers To Drop Mandates To Protect Nurses
Pinal Patel is only 29 years old, but the certified nursing assistant has already suffered two major injuries from lifting patients at Legacy Emanuel Medical Center in north Portland. "I live with pain," she told the House Health Committee. "It's clear to me that I won't be able to continue this work up until retirement. It feels like my body is deteriorating day by day" (Gray,  6/26).

California Healthline: Assistants Could Do More Under Proposed Bill
Medical assistants yesterday moved a step closer to being able to perform certain clinical tasks under the jurisdiction of a physician assistant or nurse practitioner, rather than the direct authority of a physician. The Assembly Committee on Business and Professions approved the last step in the committee process for SB 352 by Sen. Fran Pavley (D-Agoura Hills) -- a bill which she hopes will reach a floor vote quickly, before the end of the current session. The measure aims to alleviate the current and growing need for more primary care physicians by expanding the ability of secondary providers to carry out clinical tasks without a physician needing to physically be in the same building (Gorn, 6/26).

Health Policy Solutions (a Colo. news service): Obesity A Disease, Cure Elusive
Since leaders of the American Medical Association last week trumped advice from their own committee of experts and declared obesity a disease, speculation has been rife. Will this be a game-changing decision? Or has the tree fallen in the forest and no one cares? … According to the most recent data, 27 percent of Colorado children ages 10 to 17 are either overweight or obese compared to 31.6 percent nationally (Kerwin McCrimmon, 6/26).

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Weekend Reading

Weekend Reading: Chemo Revolution, Lyme Disease Confusion and The Residency Mismatch

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

The New York Times: Pregnant, Pill-Free And Panicked
Because I've lived so long with anxiety, there were lots of things I figured I'd never, ever do — having children was one of them. In fact, in my 20s, before I'd managed to stumble on the combination of drugs and exercise that allows me to be as sane as I can expect to be, I was so sure I'd never give birth that I got a tattoo of a giant koi fish extending from one end of my abdomen to the other. ... I found myself in a very ironic situation: my decision to have a child was the result of a sense of stability I enjoyed due to taking an array of anti-anxiety medications that I would be strongly advised by most doctors to stop taking now that I was pregnant (Alissa Nutting, 6/23).

Time: No More Chemo: Doctors Say It's Not So Far-Fetched
There's a revolution occurring in cancer treatment, and it could mean the end of chemotherapy. When it comes to taming tumors, the strategy has always been fairly straightforward. Remove the offending and abnormal growth by any means, in the most effective way possible. And the standard treatments used today reflect this single-minded approach — surgery physically cuts out malignant lesions; chemotherapy agents dissolve them from within; and radiation seeks and destroys abnormally dividing cells. ... But as effective as they are, these interventions can be just as brutal on the patient as they are on a tumor. So researchers were especially excited by a pair of studies published in the New England Journal of Medicine last week that showed a new type of anti-cancer drug, which works in an entirely different way from chemotherapy, helped leukemia patients tally up to an 83% survival rate after being treated for two years (Alice Park, 6/26).

The New Yorker: The Lyme Wars
Kaleigh Ahern was twelve years old when a tick bit her. She noticed it "perched" on her shoulder when she was taking a shower one morning. "I thought it was your average, everyday bug," Ahern told me recently. But, when she tried to brush it off, the tick wouldn’t budge. ... nearly everything else about Lyme disease -- the symptoms, the diagnosis, the prevalence, the behavior of the borrelia spirochete after it infects the body, and the correct approach to treatment -- is contested bitterly and publicly. Even the definition of Lyme disease, and the terminology used to describe it, has fuelled years of acrimonious debate. ... Public-health officials say that a few weeks of antibiotic treatment will almost always wipe out the infection, and that relapses are rare. In this view, put forth in guidelines issued by the Infectious Diseases Society of America, Lyme is normally easy to treat and easy to cure. For many people, though, the clinical situation is far more complicated (Michael Specter, 6/26).

New England Journal Of Medicine: The Residency Mismatch
For generations, the supply of practicing physicians in the United States has swung from too small to too large and back again. In 2006, alarmed about a growing physician shortage, the Association of American Medical Colleges (AAMC) recommended that medical school enrollments be increased by 30% over the next decade. ... But there's another barrier to creating enough practicing physicians: there are insufficient residency posts to accommodate all these medical graduates (John K. Iglehart, 6/19).

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Editorials and Opinions

Viewpoints: Late Hospital Bills Perplex Consumers; Personal Health Data Can 'Revolutionize' Care

Los Angeles Times: A Bill From The Blue
Flavio de Pecol hit the trifecta after taking his daughter to the emergency room for a horse-riding injury: hours of waiting, a 16-mile ambulance ride to a different facility and bills for more than $40,000. At least, he thought, that was the end of it. But nearly two years (later), ... De Pecol, of Newport Beach, has received yet another bill, this time for $1,054.53. ... "How can I trust that this isn't a mistake when a hospital takes 21 months to bill me?" De Pecol asked. ... Good questions, and yet another example of the way consumers are at the mercy of the healthcare industry's opaque and byzantine billing practices (David Lazarus, 6/25). 

The Wall Street Journal: 'Unspecified Mental Disorder'? That's Crazy
The American Psychiatric Association released a revision of its diagnostic bible in May, the first major rewrite in two decades. "The Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders," or DSM-5, is the official guidebook for diagnosing every conceivable psychiatric ailment. This new edition loosens the rules in a disturbing way (Leonard Sax, 6/26). 

New England Journal Of Medicine: The FDA's Graphic Tobacco Warnings And The First Amendment
In the past, constitutional principle gave the government broad authority to regulate tobacco or pharmaceutical advertising. The state's power to safeguard the public health was strong, and companies' freedom to plug their products was weak. But the Supreme Court has changed course. Whereas it once did not view "commercial" speech as the kind of speech the First Amendment protects, it now gives businesses nearly the same rights to market their goods as it does individuals to speak their minds. And as the Court has broadened corporate freedom to advertise, it has narrowed governmental power to preserve the public's health (David Orentlicher, 6/26). 

New England Journal Of Medicine: The FDA And Graphic Cigarette-Pack Warnings – Thwarted By The Courts
On August 24, 2012, in R.J. Reynolds Tobacco Company v. Food and Drug Administration, the U.S. Court of Appeals for the District of Columbia ruled that the regulations proposed by the Food and Drug Administration (FDA) mandating the inclusion of graphic warnings on cigarette packs violated the First Amendment: they would compel companies to express antitobacco messages on their own dime. Seven months later, on March 14, 2013, the Department of Justice announced that the government would not appeal that decision to the Supreme Court (Ronald Bayer, David Johns, and James Colgrove, 6/26).

The New York Times' Opinionator: Building Networks For A 'Good Life,' Even After the Caregiver Is Gone
Vancouver is home to one of the world's most innovative disability support organizations: the Planned Lifetime Advocacy Network (PLAN), which helps people secure futures for family members with disabilities — not by providing them with professional services but by showing them how to build resilient and flexible networks of care. ... PLAN helped (family therapist Ted) Kuntz prepare a long-term care plan for (his son)Josh and build up a network of support, which included other parents of children with disabilities (David Bornstein, 6/26). 

Health Policy Solutions (a Colo. news service): The Cost Curve On Health Care – It's Bending
The biggest long-term concern with the American health care system is cost. The affordability of premiums, access to care and the impact of Medicare and Medicaid on state and federal budgets are all linked to the ever-rising costs of health care. Unless we bend the cost curve, the nation’s health care system will become increasingly unsustainable. The good news is that, even though costs and spending continue to increase, we have started to see a slowdown (Bob Serno, 6/26).

Politico: How Big Data Can Revolutionize Health Care
Right now, our population-based health care system leads us to draw conclusions for patients based on what we know of others and how we care for them. But Big Data provides us an opportunity to transition to a personal care system. Rather than making assumptions based on what has worked for other people, this personal view would allow us to take data about a patient’s genomes, medical history and behaviors to construct a virtual model that would help predict which treatments will be most effective and customize them to an individual — improving quality of life for the patient and saving the delivery system money. But how do we scale a data-driven, personal health system so access is afforded to everyone? (Eric Dishman, 6/26).

JAMA: New Evidence Supports, Challenges, And Informs The Ambitions Of Health Reform
The principle ambition of the ACA is to cover the uninsured. A major way it would do so is through the expansion of Medicaid. ... A frequently cited reason for not expanding Medicaid is the cost involved. It is widely believed that uninsured persons are sicker than those who are insured. Therefore, expanding Medicaid to cover poor, uninsured Americans would not only increase the size of the program but also make its risk pool sicker, compounding its increase in cost. In principle, few oppose reducing the number of uninsured persons as a goal, but many question the cost-effectiveness of expanding Medicaid. The report ... in this issue of JAMA directly informs this debate and contradicts several widely held beliefs about how uninsured but Medicaid-eligible (under ACA rules) persons may differ from those covered by Medicaid (Aaron E. Carroll and Austin B. Frakt, 6/26).

JAMA: Sorting Through The Arguments On Breast Screening
Views on the benefits and harms of breast cancer screening are sharply polarized and increasingly vocal. Allegations of harming women are flung in both directions. ... But the evidence on breast screening is more extensive than in many other areas relevant to population health. If this is not enough for an independent group, coming fresh to the debate, to reach a reasonable judgment, then evidence-based policy is a good deal more difficult than many would believe (Michael G. Marmot, 6/26).

St. Louis Post Dispatch: More Girls Should Be Getting HPV Vaccine
Most parents would do almost anything to protect their children. Yet many who could do more to save their daughters from cervical cancer choose not to (Dr. L. Stewart Massad, 6/27). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.