Daily Health Policy Report

Tuesday, June 3, 2014

Last updated: Tue, Jun 3

KHN Original Reporting & Guest Opinion


Health Reform

Administration News

Capitol Hill Watch

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Rape Victims May Have To Pay For Some Medical Services

Kaiser Health News consumer columnist Michelle Andrews writes: “The effects of a sexual assault can be long-lasting, but the medical bills shouldn’t be. Yet a new study finds that despite federal efforts to lift that burden from rape victims, a hodgepodge of state rules means some victims may still be charged for medical services related to rape, including prevention and treatment of pregnancy or sexually transmitted infections. ‘If you're exposed to HIV as a result of the attack, that’s something the state should be paying for, especially if we can give you prophylaxis to prevent infection,’ says Ilse Knecht, deputy director of public policy at the National Center for Victims of Crime” (Andrews, 6/3). Read the column.

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Capsules: Medicare Could Save Billions By Scrapping Random Drug Plan Assignment; Pre-Existing Condition Bans – Are They Really Gone?

Now on Kaiser Health News’ blog, Julie Rovner writes about a new study regarding Medicare’s drug plan assignment process: “In 2013, an estimated 10 million people who participate in the Medicare prescription drug program, known as Part D, received government subsidies to help pay for that coverage. They account for an estimated three-quarters of the program’s cost. Most of those low-income enrollees are randomly placed in a plan that costs less than the average for the region where the person lives” (Rovner, 6/2). 

Also on the blog, Rovner tells her own experience with insurance coverage and pre-existing conditions: “Now, as a health reporter, I knew the first letter was a mistake. The 1996 Health Insurance Portability and Accountability Act (HIPAA) provides that if you’ve had continuous coverage, meaning coverage without a break of more than 63 days, your new insurer may not impose a pre-existing condition waiting period. Obviously I hadn’t had a break of more than 63 days. I hadn’t had a break of even one day. I did that quite purposefully. But the mix up raised a broader question – What about the requirement of the Affordable Care Act that prohibited pretty much all pre-existing condition exclusions as of Jan. 1, 2014? Under the law, the only plans that may continue to exclude coverage for pre-existing conditions after that date are individual plans that are ‘grandfathered,’ or haven’t changed substantially since the law was passed in 2010’” (Rovner, 6/2). Check out what else is on the blog.

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Missouri's Declining Medicaid Caseload Stands Out In National Report

The St. Louis Post-Dispatch's Virginia Young, working in collaboration with Kaiser Health News, reports: "Missouri is seeing a bigger decline in its Medicaid rolls than nearly any other state, a ranking that the administration of Gov. Jay Nixon attributes to an improving economy and critics blame on application snafus. A new federal report compares Medicaid enrollment in March to the average for the three-month period of July through September 2013. Missouri’s caseload declined 3.9 percent, a drop second only to Wyoming, which declined by 5.6 percent. The Missouri Department of Social Services, which oversees Medicaid, attributed the decline to more people finding jobs" (Young, 6/2). Read the story.

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Political Cartoon: 'The Big Picture?'

Kaiser Health News provides a fresh take on health policy developments with "The Big Picture?" by Matt Wuerker.

Meanwhile, here's today's haiku:


Docs used to lean right.
Now they send cash to the left.
How directions change...

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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Medicare Data Highlight Variations In Hospital Charges, Increased Costs For Common Ailments

The data, released Monday by the Centers for Medicare & Medicaid Services, include 2012 prices for the most common inpatient stays at 3,376 hospitals.

The New York Times: Hospital Charges Surge For Common Ailments, Data Shows
Charges for some of the most common inpatient procedures surged at hospitals across the country in 2012 from a year earlier, some at more than four times the national rate of inflation, according to data released by Medicare officials on Monday. While it has long been known that hospitals bill Medicare widely varying amounts — sometimes many multiples of what Medicare typically reimburses — for the same procedure, an analysis of the data by The New York Times shows how much the price of some procedures rose in just one year’s time (Creswell, Fink and Cohen, 6/2).

The Washington Post’s Wonkblog: Further Evidence Of How Weird Hospital Pricing Is
The federal government last year for the first time released the prices that hospitals charge for the 100 most common procedures. The Medicare data from the 2011 fiscal year demonstrated wild variations in what hospitals charge the health-care program for seniors – for example, a joint replacement could be priced anywhere between $5,300 and $223,000 depending on the facility (Millman, 6/2).

The Wall Street Journal: Hospitals' Prices For Common Services On The Rise
Federal data released Monday show an increase in the average price hospitals charge to treat common conditions, with vascular procedures and chest-pain treatment showing some of biggest upticks. The numbers from the Centers for Medicare and Medicaid Services include 2012 prices at 3,376 hospitals for the 100 most common inpatient stays by Medicare patients. It is the second year the agency has released such data, and it reflects $57 billion in payments from Medicare, the federal insurance program for the elderly and disabled (Armour, Weaver and Beck, 6/2).

More on the data -

CQ Healthbeat:  Medicare Releases Trove of Claims Data Showing Regional Variations
Medicare officials on Monday released volumes of 2012 claims data featuring interactive "dashboards" permitting analysts to compare how per capita spending varies down to the county level and pinpointing the sharply varying burden of chronic diseases in the Medicare population across different parts of the United States. The geographic variation dashboard shows that per capita Medicare spending in Florida's Miami-Dade County totaled $14,905 in 2012. But at the southern tip of the state, in Monroe County, which includes the Florida Keys, it stood at $7,678. Statewide, per capita Medicare costs averaged $10,728 (Reichard, 6/2).

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Medicare To Pay For Hep C Screenings For Baby Boomers

The decision comes amid controversy surrounding the costs of new drugs to treat the blood-borne virus. Meanwhile, two studies find that Medicare could save billions if doctors switched from an expensive eye medication to a similar, much cheaper one and, also, if Part D plans were selected based on the actual drugs patients take. The Fiscal Times looks at how spending on new specialty drugs is forecast to skyrocket.

Modern Healthcare:  CMS Targets Boomers, Those At High Risk, For Hep C Screenings
The CMS has finalized its coverage decision to reimburse for hepatitis C virus screenings for two target populations, including baby boomers.  That decision comes amid controversy surrounding the costs of treatment that could result from screening, since screening may identify asymptomatic people who carry the virus but may not need to be treated (Dickson, 6/2).

USA Today: Cheaper Eye Drug Could Save Medicare $18 Billion
Switching from an expensive eye medication to a similar, much cheaper medication could save Medicare $18 billion over the next decade, a report released Monday finds. Lucentis to Avastin are used to treat wet macular degeneration and diabetic macular edema. Avastin costs $55 per treatment, and Lucentis costs $2,023 per treatment. Both are made by Genentech, a subsidiary of health care company Roche. The medications made headlines recently when Medicare released its provider-payment data for 2010 and showed that one Florida doctor was paid $21 million by Medicare for his use of Lucentis (Kennedy, 6/2).

Kaiser Health News: Capsules: Medicare Could Save Billions By Scrapping Random Drug Plan Assignment
If Part D plans were selected based on the actual drugs patients take, it could save those patients hassle and money, and potentially save the government billions of dollars, according to a study by researchers from the University of Pittsburgh (Rovner, 6/2).

In other news related to drug costs -

The Fiscal Times: Get Ready For A Surge In Costly Specialty Drugs
In recent years, spending in just about every area of the nation’s health care system remarkably has slowed. U.S. health care costs rose by just 3.7 percent in 2012, according to a report by the Centers for Medicare and Medicaid Services (CMS), marking the fourth consecutive year of slow growth.  Even spending  on prescription drugs has continued to slow over the past several years, largely because of the rise of cheaper generic drugs – and the expiration of patents of several big-name drugs including Lipitor and Plavix. That allowed cheaper generics to enter the market. The one exception, however, has been spending on new innovative specialty drugs that are being rapidly cranked out by pharmaceutical companies to treat multiple sclerosis, rheumatoid arthritis, leukemia, and osteoporosis – even erectile dysfunction (Pianin, 6/3).

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Health Reform

Some Insurers Plan Double-Digit Health Exchange Premium Increases

The filings in Arizona and Connecticut are shedding light on what insurers might do elsewhere. News outlets also report on developments in Nevada and Maryland related to health exchange costs and coverage issues.

The Arizona Republic: Health Insurers Expected To Raise Rates For Next Year
More than 120,000 Arizona residents signed up for private health insurance during the first year of the Affordable Care Act's marketplace. But it's the second year that analysts will scrutinize, to see whether health insurers increase rates or discontinue selling plans over the federal exchange. New filings trickling into the Arizona Department of Insurance show at least two health insurers plan to increase rates more than 10 percent. Cigna wants to increase rates an average of 14.4 percent and Humana, 25.5 percent (Alltucker, 6/2).

The CT Mirror: Exchange Premiums Could Rise More Than 10 Percent Next Year
Two of the three insurers selling health plans through Connecticut’s exchange want to raise rates by more than 10 percent next year, according to proposals filed with the Connecticut Insurance Department. The rate proposals for the third company, HealthyCT, weren’t available from the department Monday night. (The company said it filed its proposals Monday morning.) Meanwhile, individuals who buy coverage through the exchange are likely to get a fourth option in 2015. UnitedHealthcare indicated in a filing with the insurance department that it intends to sell individual-market plans through Access Health CT, the state’s exchange (Becker, 6/3).

The Associated Press:  Confusion Likely As Nevada Switches From State To Federal Health Exchange
Switching to a federally supported state health exchange won't be immediate and will bring added confusion for Nevada consumers during the transition into next year's open enrollment period, an interim legislative committee was told Monday. As Nevada moves from a health exchange operated by Xerox, consumers will be faced with three different call centers depending on the type of transaction, said Steve Fisher, interim director of the Silver State Health Insurance Exchange. Fisher added that while Nevada moved to terminate its contract with Xerox after months of persistent problems, the operator will continue to play a role in the health exchange through early next year (Chereb, 6/2).

The Washington Post: Anthony Brown Says He Should Have Taken Direct Role In Maryland Health Exchange Rollout
Democratic gubernatorial front-runner Anthony G. Brown said Monday that he should have taken a more direct role in overseeing Maryland’s online health insurance exchange, a project that turned out to be deeply flawed. Brown, the state’s lieutenant governor, made the remark during a spirited, hour-long debate with his two leading rivals that also included clashes over the candidates’ commitment to expanding pre-kindergarten education in coming years and the tax environment in the state (Wagner, 6/2).

Meanwhile, a new study pinpoints a boost in the number of people who purchased health insurance at the beginning of the year from sources outside the health law's online marketplaces --

The Hill:  Surge Reported In Sales Of Health Care Plans
The number of people who bought health insurance on their own outside of the Obamacare exchanges surged at the beginning of the year, according to a new report. The Kaiser Family Foundation estimates between 3 million and 3.5 million new people signed up for health insurance either through insurance companies or brokers in March. It estimates a total of 15 million people now have individual insurance through the private market (Al-Faruque, 6/2).

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Nearly 3 Million Medicaid Enrollees Still Waiting To Get Applications Processed

Technological snags and bureaucratic tangles have slowed the health law's promise of coverage to many low-income Americans, CQ Healthbeat reports. In other news on the law's Medicaid provisions, the Chicago Tribune examines the demographics of new local beneficiaries.

CQ Healthbeat: The Hidden Failure Of Obama's Health Care Overhaul
At least 2.9 million Americans who signed up for Medicaid coverage as part of the health care overhaul have not had their applications processed, with some paperwork sitting in queues since last fall, according to a 50-state survey by CQ Roll Call. Those delays — due to technological snags with enrollment websites, bureaucratic tangles at state Medicaid programs and a surge of applicants — betray Barack Obama’s promise to expand access to health care for some of the nation’s most vulnerable citizens (Adams, 6/3).

Chicago Tribune: Cook County Releases 1st Snapshot Of New Medicaid Patients
New data released in May offer the first look at the health, habits and demographics of about 100,000 new enrollees in Cook County's expanded Medicaid program under the Affordable Care Act. The picture it paints is bleak. More than half the new patients covered by Cook County's Medicaid expansion program haven't seen a doctor in the past 12 months. Eighty-five percent of them are unable to obtain needed medications. Nearly one-fourth have spent time in a hospital in the past six months and an additional 1 in 5 are worried about finding a place to stay in the near future (Frost, 6/2).

Las Vegas Sun: Nevada's Health Exchange For Medicaid To Cost $25 Million
The cost to replace the Medicaid section of Nevada’s flawed online health insurance exchange will be $25 million, a state official told a legislative committee today. The federal government will pay $22.5 million and Nevada will pay the rest, said Mike Wilden, director of the Nevada Department of Health and Human Services. Wilden broke the news this morning during a meeting with members of the Legislative Committee on Health Care (Roerink, 6/2).

Virginia Pilot: Retired Admirals Endorse Medicaid Expansion Alternative
Two retired Navy admirals have joined the roster of those urging state lawmakers to accept federal funds so thousands of uninsured Virginians can access health care, including many military veterans. Henry C. Giffin III and John T. Kavanaugh, retired vice admiral and rear admiral, respectively, in a May 29 letter to several South Hampton Roads legislators voice support for a state plan "to close the coverage gap" through an approach "that relies on private, free-market based solutions." That reads like an endorsement of the "Marketplace Virginia" plan drawn to recapture state health care tax dollars to purchase private health care for needy Virginians as an alternative to true Medicaid expansion (Walker, 6/2).

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Administration News

Big Differences In VA Care Quality

Sloan Gibson, the acting head of the Department of Veterans Affairs, pledged to end delays in care for veterans Monday. And, as the VA begins to address its problems, McClatchy looks back on what it might have done well.

The Wall Street Journal: Veterans Affairs Hospitals Vary Widely In Patient Care
The Phoenix facility at the heart of the crisis at the Department of Veterans Affairs is among a number of VA hospitals that show significantly higher rates of mortality and dangerous infections than the agency's top-tier hospitals, internal records show. The criticism that precipitated last week's resignation of VA Secretary Eric Shinseki has focused largely on excessive wait times for appointments across the VA's 150-hospital medical system (Burton and Paletta, 6/2).

Reuters: Acting VA Chief To Get U.S. Vets Into Clinics, Stop Abuses 
The acting chief of the U.S. Department of Veterans Affairs on Monday pledged to swiftly address medical scheduling abuses at the agency and get thousands of veterans off waiting lists and into clinics for care. VA Acting Secretary Sloan Gibson, who took over after Eric Shinseki resigned on Friday over the care delay scandal, said he would swiftly address the misconduct or mismanagement that led to cover-ups of long appointment delays for veterans (Lawder, 6/2).

McClatchy: VA’s Health Care System: Problems Undo Years Of Progress
Wanted: A heath care system “uniquely positioned to lead the country in making ... positive changes in the way health care is delivered.” It’s not likely that the Department of Veterans Affairs will be getting many takers on that anytime soon. But just four months ago, that was the assessment the head of the VA’s health care system offered in an article for a publication that serves health care professionals working in government health services (Adams, 6/2).

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Capitol Hill Watch

Senate Democrats, House Republicans Spar Over VA Health System Fixes

In the meantime, younger veterans groups call for swift action and new priorities in the revamping of the agency, and Americans' confidence in the VA plummets, according to a new poll.

The Associated Press: Reid Vows Quick Senate Action On VA Health Bill
A refashioned bill to address problems plaguing the Veterans Affairs Department should be approved by the Senate as soon as possible, Senate Majority Leader Harry Reid said Monday. The bill, sponsored by Sen. Bernie Sanders, I-Vt., would give the VA authority to immediately remove senior executives based on poor job performance while preventing "wholesale political firings" that Sanders said could be allowed under a similar bill approved by the House (Daly, 6/2).

Politico: Harry Reid: GOP 'Double-Speak' On Veterans
Senate Majority Leader Harry Reid accused Republicans of prioritizing the wealthy over the health of military veterans, arguing that "every senator" should support Democrats' plan to boost medical care access for veterans, no matter the price tag. Reid on Monday slammed Republicans for rejecting a veterans bill written by Sen. Bernie Sanders (I-Vt.) in February. Reid accused the GOP of "double-speak" by criticizing the Veterans Affairs Department but denying the agency the funding it needs. He bashed Republicans for spending billions on Iraq paid for by "the taxpayers' of America’s credit card" while failing to invest in care for those returning from overseas conflicts (Everett, 6/2).

The Washington Post: With Shinseki Out, What's Congress Going To Do About The VA? 
With [VA Secretary Eric] Shinseki's sudden departure, it's likely that Congress will take weeks, if not months, to sort out the situation. The debate will break down along familiar lines -- Democrats and Republicans agree in principle that something must be done, but the House and the Senate can't agree on how to do it. Senate Democrats are pushing to pass a comprehensive bill with several changes, while House Republicans are touting nine veterans-related measures that they've passed in recent months and seen ignored by the Senate. Meanwhile, the issue of veterans' care is fast becoming fodder on the campaign trail, with Democratic and GOP political operations already targeting incumbents and challengers for ignoring the VA scandal or voting against VA budget increases (O’Keefe, 6/2).

Los Angeles Times: Veterans Group Pushes For 'Marshall Plan' To Address VA Member Issues
As the Senate prepares to take up reform legislation growing out of the VA health care scandal, a group representing Iraq and Afghanistan war veterans called Monday for a "Marshall Plan" for veterans and for the president to appoint a post-9/11 veteran or someone who understands the younger generations of veterans as the next secretary of Veterans Affairs. The group also called for the Senate to swiftly pass legislation that would expand the VA secretary's authority to fire or demote senior staff for poor performance and for Congress to increase funding for VA health care and approve a bill designed to combat suicides among veterans (Simon, 6/2).

McClatchy: Iraq-Afghanistan Vets Demand More Than Just A New VA Chief
Veterans from Iraq and Afghanistan came to Washington on Monday to urge sweeping reforms of the scandal-plagued Department of Veterans Affairs and to push priorities for the massive agency’s next chief executive. They said President Barack Obama and Congress must do more than name and confirm a replacement for Eric Shinseki, the retired four-star general who resigned last week following reports of treatment delays and other problems at VA hospitals across the country. "What we need is a Marshall Plan for veterans," Paul Rieckhoff, head of Iraq and Afghanistan Veterans of America, told reporters at an outdoor briefing near the U.S. Capitol. "This is a defining moment in American history" (Rosen, 6/2).

USA Today: Poll: Confidence In Veterans' Care Plummets To New Low
Americans' confidence in the medical care provided for soldiers returning from Iraq and Afghanistan has plummeted to new lows in the wake of the VA scandal, a USA TODAY Poll finds. Most people see the problem as widespread and systemic. Just one in five rate the job the government does in providing veterans with medical care as excellent or good, about half the percentage who said that in a Pew Research Center survey in 2011. Then, half rated the care as "only fair" or poor; now seven in 10 do (Page, 6/2).

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Health Care Marketplace

Study: Based On Political Donations, Doctors Are Favoring The Left

These donor physicians have also become more generous, and the shift of these medical professionals from their historic preference for Republican candidates to their recent affinity for Democrats is attributed to the increase in women doctors and the decline in the number who run their own practice or work in small practices.

The Associated Press: Doctors Lean More Left, Political Donations Show
The first rigorous look at donor doctors also finds they’ve become increasingly generous, with political contributions surging to almost $200 million in recent years. An increase in female doctors — who more often than men donated to Democrats — and a decline in physicians working on their own or in small practices occurred during study years. Those changes likely contributed but reasons for the political shift are unclear, said study co-author David Rothman, a social medicine professor at Columbia University’s medical school (6/2).

The Washington Post’s Wonkblog: Doctors Are Donating Less Often To Republican Candidates
There have a few been recent hints at how the sweeping changes within the medical industry are reshaping the politics of being a doctor. But a new study suggests a profession once solidly aligned with Republicans has become more Democratic in the past 20 years, as the number of female doctors grows and the traditional small physician's office is on the wane. Researchers analyzing doctors' federal campaign contributions between the 1991-92 and 2011-12 election cycles found that doctors -- who once contributed to Republican campaigns at consistently higher rates than the entire donor population -- have become less enthusiastic donors to the GOP (Millman, 6/2).

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Insurer Sues Medtronic Over Bone-Growth Drug

Humana Inc. alleges the device maker violated federal racketeering statutes by conspiring with prominent physicians to promote unapproved uses of the drug, reports The Wall Street Journal. Meanwhile, Ventas, the nation's biggest health care real estate investment trust, said Monday it had agreed to acquire the American Realty Capital Healthcare Trust for $2.6 billion.

The Wall Street Journal: Humana Files RICO Claim Over Medtronic Bone Drug
Health insurer Humana Inc. is alleging that medical-device maker Medtronic Inc. violated the federal racketeering statute by conspiring with prominent physicians to promote unapproved uses of its bone-growth drug, according to a lawsuit Humana filed in federal court last week. Humana alleges that Medtronic paid $210 million to prominent physicians who advocated the drug's use in certain neck and spine surgeries that hadn't been approved by the U.S. Food and Drug Administration, according to Humana's complaint (Walker, 6/2).

The New York Times: Ventas To Buy American Realty Capital Healthcare For $2.6 Billion
Ventas, the nation’s biggest health care real estate investment trust, said on Monday that it had agreed to acquire the American Realty Capital Healthcare Trust for $2.6 billion in stock and cash. At $11.33 a share, the offer is 14 percent above the Friday closing stock of the company, known as A.R.C. Healthcare (6/2).

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State Watch

State Highlights: NYC Mental Health Task Force

A selection of health policy stories from New York, Delaware, Minnesota, North Carolina, Kansas, Texas, Maryland, Wisconsin and Georgia.

The Associated Press: Task Force To Aid NYC’s Mentally Ill Inmates
Mayor Bill de Blasio announced a new task force Monday to overhaul how New York City’s corrections system treats the mentally ill -- both in jail and out -- following the grisly deaths of two inmates with psychological problems (6/2).

Pioneer Press:  Minnesota Seeks Medical Marijuana Boss
Wanted: A medical marijuana chief. The Minnesota Department of Health is seeking a director for its new Office of Medical Cannabis, which will implement the medical marijuana bill signed into law last month by Gov. Mark Dayton. About 10 people are expected to work for the Office of Medical Cannabis, which will operate a patient registry to track whether people are helped by the treatment. About 5,000 people per year are projected to use Minnesota's medical marijuana program, which will be available to people with certain terminal illnesses or any of eight medical conditions (Snowbeck, 6/2).

North Carolina Health News: Research Indicates Health Disparities For Lesbian, Gay and Bisexual Community 
Results released recently from a study conducted by researchers at UNC-Chapel Hill’s Gillings School of Global Public Health indicate that lesbian, gay and bisexual North Carolinians face heightened health risks in several regards. Stress-related mental health issues are of particular concern. The report, titled “A Profile of North Carolina Lesbian, Gay and Bisexual Health Disparities, 2011”  was published in the American Journal of Public Health, offering the first statewide evidence of these disparities. In 2011, the state asked about sexual orientation for the first time in its Behavioral Risk Factor Surveillance System polling (Sisk, 6/3).

The Associated Press: Del. Lawmakers Eye Heroin Overdose Antidote
Delaware lawmakers are eyeing legislation to help drug addicts survive heroin overdoses. State officials last year adopted a pilot basic life support protocol that allows emergency responders to treat suspected narcotic overdoses with naloxone, a heroin overdose antidote known by the brand name Narcan (6/2).

North Carolina Health News: Deadline For Eugenics Compensation Program Quickly Approaches 
As the June 30 deadline to file a claim in the state’s eugenics compensation program draws near for victims of North Carolina’s dark history of forced sterilizations, advocates hope for an extension of the deadline so people have more time to file claims. In what has been described as one of the most aggressive and enduring sterilization programs in the country, an estimated 7,600 people were sterilized by force or uninformed consent under the authority of the Eugenics Board of North Carolina program from 1929 to 1974. Last year, North Carolina became the first state in the nation to offer compensation for victims of involuntary sterilization (Hoban, 6/3).

Kansas Health Institute News Service: Robot Helps Save The Day At Rural Hospital 
Some small, rural Kansas hospitals are using highly sophisticated medical robots in ways that are helping ease the shortage of specialists in their areas and -- in at least one instance -- boosting the bottom line. Hamilton County Hospital here was on the brink of closing little more than a year ago because of financial and staffing problems, but use of a robot has been a key factor in the facility’s dramatic turnaround, according to chief executive Bryan Coffey. First order of business for Coffey when he became the administrator in June 2013 was hiring doctors for a hospital that had none. He recruited a primary care physician and a cardiologist (Shields, 6/2).

Texas Tribune: Uncertain Future At Institutions For Disabled Texans
The debate over the future of Texas' institutions for the disabled is a perennial one; advocates for community living want them closed, while families of their residents fight to keep them open. But a groundbreaking recommendation from the state's Sunset Advisory Commission to shutter six of Texas' 13 state-supported living centers has reopened a giant divide in the disability community that had seemed to narrow in recent years.  Ahead of the 2015 legislative session, staffers at the Sunset Commission, which is charged with highlighting inefficiencies at state agencies, have called for closing the Austin State-Supported Living Center and forming a panel to pinpoint five other centers statewide for closure. The facilities provide around-the-clock residential services for people with a wide range of physical and cognitive disabilities (Ura and MacLaggan, 6/3).

Baltimore Sun: Social Security Disability Backlog In Md. Among Highest In Nation
The Social Security Administration office that reviews disability claims for Central Maryland has the third-longest processing delay in the nation -- a backlog that prompted a member of the state's congressional delegation on Monday to call for action. Disability claimants with appeals at the Baltimore office wait an average of 17 months for a hearing, agency data show. That's longer than in New York, Philadelphia, Los Angeles and more than 150 other offices. In Chicago, by comparison, the average wait time is one year. Only the offices in Miami and Fort Myers, Fla., have longer waits (Fritze, 6/2).

The Milwaukee Journal Sentinel: Milwaukee Infant Mortality Rates Heading In Wrong Direction
Troubling increases in the rate at which babies continue to die in Milwaukee before their first birthday, and especially the rate at which African-American babies die, are moving the city further away from goals it set in 2011, according to new data the city will release Tuesday. Black infants are still about three times more likely than white infants to die in Milwaukee, and the city is in danger of not closing the racial gap of infant mortality within the next few years as multiple ongoing community initiatives battle to reverse the trend, according to Geoffrey R. Swain, chief medical officer for the Milwaukee Health Department and a professor at the University of Wisconsin School of Medicine & Public Health. Historically, Milwaukee has had one of the highest infant mortality rates in the country. Last year, 117 babies died in the city -- the equivalent of about four classrooms of schoolchildren, Swain said Monday (Herzog, 6/3).

Georgia Health News: Cost Is A Big Question, And Here’s An Answer
Millions of Americans have no health insurance. Millions of others have health coverage that includes high deductibles. Both these groups often have to pay upfront for the whole cost of a medical procedure or a visit to a doctor. And these prices can have wide variation, even within a single community (Miller, 6/2).

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Editorials and Opinions

Viewpoints: No Return To 'Bad-Old Days' Of Mental Health Commitments; Fighting Over School Lunches; Doctors' Role In Reform

The New York Times: Guns And Mental Illness
It is difficult to read stories about Elliot Rodger, the 22-year-old man who went on a murderous spree in Isla Vista, Calif., last month, without feeling some empathy for his parents. We know that his mother, alarmed by some of his misogynistic YouTube videos, made a call that resulted in the police visiting Rodger. The headline from that meeting was that Rodger, seemingly calm and collected, easily deflected the police's attention. But there was surely a subtext: How worried — how desperate, really — must a mother be to believe the police should be called on her own son? ... The mainstream sentiment among mental health professionals is that there is no going back to the bad-old days when people who were capable of living on their own were locked up for years in mental hospitals (Joe Nocera, 6/2). 

The New York Times' The Upshot: Calling An Ordinary Health Problem A Disease Leads To Bigger Problems
As any parent knows, babies spit up. It's gastroesophageal reflux, a pediatrician will explain .... The bigger problem, though, is that the vast majority of these infants weren't "sick." We just gave them an official diagnosis. This labeling of patients with a "disease" can have significant consequences, for both people's health and the nation’s health care budget. About 50 percent of healthy infants will spit up more than twice a day. About 95 percent of them completely stop doing that without treatment. When a majority of infants have (and have always had) a set of symptoms that go away on their own, it isn't a disease — it's a variation of normal (Aaron E. Carroll, 6/2). 

The Washington Post: Kids Hate School Lunches? Let Them Eat Cake.
In 2010, alarmed by the growing girth of children around the country, Congress directed the Agriculture Department to make school meals healthier. The USDA soon issued expert-recommended standards that require, for example, more vegetables and whole grains and less sodium and fat. ... Now, four years later, the [School Nutrition Association] has changed its tune and is lobbying Congress to gut the new nutritional requirements by letting districts effectively opt out of them altogether. Judging from a House Appropriations Committee vote last week, Republicans look eager to push through the lobby’s demands. Rest assured, the School Nutrition Association says this alimentary about-face has absolutely nothing to do with the fact that half its revenue now comes from industry sources, as its spokeswoman recently told The Post (Catherine Rampell, 6/2). 

The Wall Street Journal’s Washington Wire: What’s Missing From Supporters' 'Fixes' For The Health-Care Law
A front-page story in Saturday's Washington Post discussing Republican candidates’ positions on the Affordable Care Act included a curious quote from Rep. Steve Israel, chairman of House Democrats’ campaign committee, who said that Republicans are "promising fixes but won't be specific." Actually, many conservatives have outlined numerous alternatives to Obamacare. Republicans in the House have written at least 200 separate bills showing their ideas on health care, large and small. My own organization, America Next, released its blueprint for health reform earlier this year (Chris Jacobs, 6/2). 

Bloomberg: Polls On Obamacare Tell Us Instead About Politics
This isn't a law similar to Medicare, with easily identified benefits and costs. Many Obamacare benefits -- for example, those derived from regulations on insurance companies -- are practically invisible to most policy holders. So are most of the costs, such as the tax on medical devices. That tax is mostly passed along to consumers, yet consumers rarely know what specific charges their insurance pays for, or how those charges affect premiums. Moreover, since almost everyone has some interaction with health care and health insurance, it’s easy for people to attribute -- correctly or not -- personal experiences to Obamacare (Jonathan Bernstein, 6/2). 

Deseret News: Medicaid Campaign Supports Gap Coverage Initiatives By Bringing Forward Utahn Perspectives
Gov. Gary Herbert's efforts to seek flexibility in crafting a Utah-based solution for Medicaid expansion needs to be encouraged. Utahns' justifiable skepticism over the Affordable Care Act shouldn't blind policy-makers to practical solutions for the needs of more than 50,000 of the state's poorest adults (6/3). 

The Hill: Health Insurance Model Must Evolve
In 1964, only 34 percent of cancer patients were surviving five or more years beyond diagnosis. Today, 66 percent are. The reason for such progress? In large part, new medicines. Yet despite the revolution in treating many forms of cancer over the past 50 years, patients are still stuck with an insurance model from the 1960s that discourages the use of innovative medicines to treat and cure disease while encouraging more costly hospitalizations and physician services. This needs to change (John J. Castellani, 5/30).

The Wall Street Journal: An Opportunity Amid The VA Problems
The president has made a real and very personal commitment to veterans. To turn crisis to opportunity and add to that legacy, it will be important to assemble recommendations and begin to implement them while the media and the political world are paying close attention and are motivated to act (Drew Altman, 5/30).

JAMA Internal Medicine: Physicians And Politics
A new health care system that provides universal access and is affordable and efficient will be difficult to achieve. The private insurers and all the other businesses that profit from the current commercial system will resist it. Major reform will need wide public support, which in turn will rely on advocacy by the medical profession. ... Physicians have unique power to reshape the medical care system. They are what makes it work and are best qualified to use and evaluate its resources. But if they never unite to press for major reform, the future of health care in the United States will indeed be bleak (Dr. Arnold S. Relman, 6/2).

JAMA Internal Medicine: The Role Of Copy-and-Paste In The Hospital Electronic Health Record
After a slow start, hospitals in the United States have rapidly adopted electronic health records .... Yet the application of electronic health records can be a double-edged sword. Their use can increase efficiency, facilitate information sharing, standardize hospital processes, and improve patient care. But their use can also have unintended consequences and be subject to abuse, such as when data are duplicated or templates and checkboxes are used to generate standardized text without a good medical reason. ... In September 2012, federal officials warned about "the misuse of electronic health records to bill for services never provided," and that law enforcement agencies "will take action where warranted" (Ann M. Sheehy, Daniel J. Weissburg and Shannon M. Dean, 6/2). 

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Stephanie Stapleton

Andrew Villegas

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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.