Daily Health Policy Report

Monday, June 30, 2014

Last updated: Mon, Jun 30

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Women's Health

Health Care Marketplace

State Watch


Editorials and Opinions

KHN Original Reporting & Guest Opinion

Retooling Hospitals, One Data Point At A Time

Kaiser Health News staff writer Julie Appleby, working in collaboration with USA Today, reports: "When a car rolls off an assembly line, the automaker knows exactly what parts, labor and facilities cost. Not so in health care, and now some health executives are trying to change that. Although U.S. hospitals account for the single largest chunk of the nation’s $2.7 trillion in health spending, few of them can say how much it actually costs them to care for every patient they admit. ... Today, the [University of] Utah health system is one of a handful in the nation with a data system that can track cost and quality for every one of its 26,000 patients. That data is shared with doctors and nurses for further input about ways to streamline cost and improve care" (Appleby, 6/30). Read the story.

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Capsules: Washington And Other States See New Insurers On Exchanges

Now on KHN's blog, Capital Public Radio’s Pauline Bartolone, working in collaboration with Kaiser Health News and NPR, reports on the expansion of Washington's online insurance marketplace: "Washington State’s health insurance exchange is looking to be an attractive marketplace for new health insurance carriers, according to an early analysis of insurer premium rate filings by McKinsey & Company. Four new insurers have applied to sell individual policies in the state’s exchange next year, making Washington among the states with the highest number of new exchange entrants of the 12 states where preliminary 2015 rates have been filed, according to McKinsey. If insurance regulators approve the new carriers, Washington will have 12 insurers on the exchange in 2015, up from eight participating this year" (Bartolone, 6/30). Check out what else is on the blog.

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Political Cartoon: 'This Is Lumbar Puncture?' By Dan Piraro

Kaiser Health News provides a fresh take on health policy developments with "This Is Lumbar Puncture?" by Dan Piraro

Meanwhile, here's today's haiku:


Ruling comes too late
For Daily Report deadline
So stay tuned for more

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Administration News

Obama To Name Former P&G Chief To Head VA

The president is expected today to nominate Bob McDonald, a West Point graduate and former CEO of Procter & Gamble. The announcement follows the release Friday of a White House report that found the Department of Veterans Affairs has a "corrosive culture" that led to the problems with care for veterans.

The Washington Post: Bob McDonald, Former P&G Chief, To Be Obama’s Nominee To Lead Veterans Affairs
President Obama on Monday will nominate Bob McDonald, a West Point graduate who served as the chief executive of Procter & Gamble, to take over as head of the troubled Department of Veterans Affairs, according to White House officials. The un­or­tho­dox pick of a retired corporate executive whose former company produces iconic household products such as Tide detergent and Charmin toilet paper — rather than a former military general — underscores the serious management problems facing the agency charged with serving more than 8 million veterans a year (Eilperin, 6/29).

The New York Times: Pick for V.A. Is Former Corporate Chief
President Obama on Monday intends to nominate Robert A. McDonald, a former chief executive of Procter & Gamble, to be the next secretary of Veterans Affairs, a White House official said Sunday, betting that a global corporate officer can turn around a government health system that has been rocked by allegations of mismanagement. ... "This is definitely a surprising pick," said Paul Rieckhoff, the chief executive and founder of Iraq and Afghanistan Veterans of America. "McDonald is not a name that was on anyone’s radar over the last few weeks. His branding background may prove helpful because there are few organizations in America with a worse reputation toward customers than the V.A. right now" (Shear and Oppel, 6/29).

The Wall Street Journal: Ex-Procter & Gamble CEO To Be Nominated As VA Secretary
Mr. McDonald, 61 years old, is a veteran and a West Point graduate, but his limited military experience is unusual for the VA post. ... While Mr. McDonald would normally be seen as an unexpected choice, a crisis at the agency over extended wait times for health care and other problems means that "right now, they need someone with management skills,'' said Bob Wallace, executive director of the Veterans of Foreign Wars. "He comes with the credentials they need at this time: management expertise and someone who has made a living making tough decisions," Mr. Wallace said. "He has no allegiance to anyone in the VA. He can do what needs to be done without offending his friends" (McCain Nelson and Kesling, 6/29).

Politico: Barack Obama Taps Ex-Procter And Gamble Exec Robert McDonald To Lead VA
A graduate of the U.S. Military Academy at West Point, McDonald rose from an entry-level job to CEO of Procter and Gamble over more than three decades at the company. He spent four years as CEO before leaving in mid-2013 amid cost-cutting at the Fortune 500 company. ... McDonald is an unusual choice for an agency that has typically been led by former military leaders, but given the agency’s bureaucratic and managerial challenges, he is seen by the White House as the kind of corporate leader the agency needs (Epstein, 6/29).

USA Today: Obama To Name New VA Chief
McDonald, 61, was with Procter & Gamble for 33 years. As CEO, he oversaw more than 120,000 employees, with operations around the world, selling products in more than 180 countries and more than 2.5 million stores, reaching more than 5 billion customers (Jackson and Zoroya, 6/29). 

Los Angeles Times: Obama Selects Former Procter & Gamble Chief To Lead Veterans Affairs
In nominating Bob McDonald as the next secretary of Veterans Affairs, President Obama is recruiting a West Point graduate with experience in running a big corporation — Procter & Gamble — to turn around a department whose failure to provide timely care to veterans has caused a political furor. If confirmed by the Senate, McDonald would succeed Eric K. Shinseki, a retired four-star Army general who stepped down last month amid a scandal in which VA employees falsified records to cover up long waits for medical appointments (Simon, 6/29).

McClatchy: Obama To Nominate Former Proctor & Gamble CEO As VA Chief
President Barack Obama on Monday will announce his choice of Bob McDonald, a West Point graduate and former CEO of Proctor & Gamble, to head up the beleagured Department of Veterans Affairs, a senior administration official said. McDonald, who retired from P&G in June 2013, will replace VA Secretary Eric Shinseki who resigned in late May amid reports of widespread problems within the Veterans Health Agency, including allegations that some veterans died while waiting for care. The White House says McDonald's 33 years at the consumer products giant "prepares him well for a huge agency with management challenges in servicing more than 8 million veterans a year” (Clark, 6/29).

Reuters: Obama To Nominate Former P&G CEO Bob McDonald As Veterans Secretary
U.S. House of Representatives Speaker John Boehner called McDonald "a good man, a veteran, and a strong leader with decades of experience in the private sector. With those traits, he's the kind of person who is capable of implementing the kind of dramatic systemic change that is badly needed and long overdue at the VA" (Holland, 6/29).

The Associated Press: Ex P&G Head Obama Choice To Lead Veterans Affairs
Senate Veterans Affairs Committee Chairman Bernie Sanders, I-Vt., said in a statement that he looked forward to meeting with McDonald next week to get his views on issues he views as important. Among them, Sanders said in a statement, "The VA needs significantly improved transparency and accountability and it needs an increased number of doctors, nurses and other medical staff so that all eligible veterans get high-quality health care in a timely manner" (Pace, 6/29). 

Meanwhile, the White House on Friday released its report about problems at the VA.

The New York Times: Report Finds Health Unit Of V.A. Needs Overhaul
The Veterans Health Administration has a corrosive culture that has led to poor management, a history of retaliation toward employees, cumbersome and outdated technology, and a shortage of doctors, nurses and physical space to treat its patients, according to a review presented to President Obama on Friday by one of his top advisers on veterans’ issues. Mr. Obama called last month for the review of the Veterans Health Administration, a part of the Department of Veterans Affairs, just days before he accepted the resignation of the Veterans Affairs secretary, Eric Shinseki (Shear and Oppel, 6/27).

The Wall Street Journal: White House Review Of VA Finds 'Corrosive Culture,' Poor Management
A White House review of the VA health system points to a culture that has degraded the timely delivery of care and requires a restructuring to improve transparency and accountability. Acting Secretary of Veterans Affairs Sloan Gibson and Rob Nabors, White House deputy chief of staff, told President Barack Obama on Friday that significant further action was needed to address systemic problems (McCain Nelson and Kesling, 6/27). 

Politico: White House Report: Overhaul VA's 'Corrosive Culture'
The Department of Veterans Affairs' "corrosive culture" can only be fixed by a near overhaul of the system, charged a report delivered to President Barack Obama on Friday. The report, authored by a top White House official, said the department needs to be "restructured and reformed" and shared a scathing view of a corrupt and poorly-managed agency keen to protect itself over the care of veterans (French, 6/27).

Los Angeles Times: White House Report Says VA Has 'Significant' And 'Systemic Failures'
The VA suffers from "significant and chronic systemic failures" that must be addressed by department leadership, according to a White House report delivered to President Obama on Friday, giving urgency to congressional legislation aimed at reducing veterans' wait times for healthcare and holding officials more accountable. Among the problems cited are a "corrosive culture" that has led to personnel problems within the Department of Veterans Affairs, exacerbated by poor management and a history of retaliation toward employees raising issues (Simon, 6/27).

The Hill: WH Report Finds 'Corrosive Culture' At VA
The report written by Rob Nabors, the president's deputy chief of staff, paints a bleak picture of operations within the department. It says the agency needs to take "significant further action" to address "systematic problems" with providing health service for former service members. "It is clear that there are significant and chronic systemic failures that must be addressed by the leadership at the VA," Nabors says in his report, presented to President Obama on Friday (Sink, 6/27). 

Meanwhile, the Associated Press reports on new details about problems at the VA -

Associated Press:  VA Benefit Record Purse Investigated
Federal investigators are probing a whistleblower's allegations that applications for veterans seeking health care benefits may have been improperly purged from the VA's Health Eligibility Center in suburban Atlanta. Eligibility Center program specialist Scott Davis told the Atlanta Journal-Constitution that health benefit applications for more than 10,000 veterans may have been improperly purged from the Health Eligibility Center's national data system in DeKalb County. The center doesn't process all applications, but it helps manage the national enrollment computer system and offers enrollment guidance for VA hospitals across the country (6/29).

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'Pattern Of Errors' Plagues Military Medicine

The New York Times' investigation finds that on several important measures, the military system "has consistently had higher than expected rates of harm and complications."

The New York Times: In Military Care, A Pattern Of Errors But Not Scrutiny
The Zeppa case is emblematic of persistent lapses in protecting patients that emerged from an examination by The New York Times of the nation’s military hospitals, the hub of a sprawling medical network -- entirely separate from the scandal-plagued veterans system -- that cares for the 1.6 million active-duty service members and their families. ... From 2011 to 2013, medical workers reported 239 unexpected deaths, but only 100 inquiries were forwarded to the Pentagon’s patient-safety center, where analysts recommend how to improve care. Cases involving permanent harm often remained unexamined as well. At the same time, by several measures considered crucial barometers of patient safety, the military system has consistently had higher than expected rates of harm and complications in two central parts of its business -- maternity care and surgery (LaFraniere and Lehren, 6/28).

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Health Reform

Advocates And Critics Brace For High Court Decision On Contraceptive Mandate

The Supreme Court is expected to release its ruling today on a case brought by the owners of Hobby Lobby craft store and Conestoga Wood Specialties Corp., who object to being forced to offer some types of birth control.

The Hill: Sebelius: Hobby Lobby Case About More Than ObamaCare
Former Health and Human Services Secretary Kathleen Sebelius said Friday that if the Supreme Court rules against ObamaCare’s contraception mandate next week, it will have "huge" implications that go far beyond the healthcare law. Sebelius said a ruling against the law could allow employers maximum discretion to avoid following laws they say go against their religious beliefs. "I do think this issue is far beyond contraception coverage in the Affordable Care Act," she said. "This really is about whether or not employers based on religious views can pick and choose which federal laws to follow and not follow" (Al-Faruque, 6/27).

The Wall Street Journal: Religious Business Owners Brace For High Court's Contraception Ruling
Religious business owners and women's groups braced for Monday's expected Supreme Court ruling on an Affordable Care Act contraception-coverage requirement that could outline the flexibility owners of for-profit enterprises have in exercising religious beliefs. ... The contraception decision could have immediate consequences for a high-profile provision of the Affordable Care Act, two years after the court upheld the law's requirement that most Americans obtain health insurance (Radnofsky, 6/29).

Reuters: On Eve Of Court Ruling, Americans Oppose Contraceptive Ban: Reuters/Ipsos Poll
A majority of Americans oppose letting employers, based on their religious views, exclude certain contraceptives from workers’ insurance coverage, says a Reuters/Ipsos opinion poll ahead of a U.S. Supreme Court decision expected on Monday. In one of the most closely watched cases of the year, the nine-member court will weigh whether for-profit corporations may raise religious objections to a mandate in President Barack Obama's signature 2010 healthcare law that their insurance cover contraceptives. ... The Reuters/Ipsos poll of 10,693 people was conducted April 28-June 20, 2014 (Biskupic, 6/29).

Politico: Hobby Lobby Decision: Nine Justices To Watch
Shortly after 10 a.m. Monday, the Supreme Court will issue its much-anticipated decision on the religious freedom challenge businesses have brought against the Obamacare contraception mandate. ... A win for the White House would help officials ensure that employer coverage is consistent, but employers would still be able to opt out of coverage altogether by paying a fine. A win for Hobby Lobby would mean other businesses with a small number of owners could opt out of aspects of Obamacare coverage, possibly leaving employees on their own to pay for particular drugs or procedures (Gerstein, 6/30).

Associated Press: Supreme Court Poised To Decide Birth Control Dispute
The Supreme Court is poised to deliver its verdict in a case that weighs the religious rights of employers and the right of women to the birth control of their choice. The court meets for a final time Monday to release decisions in its two remaining cases before the justices take off for the summer.  The cases involve birth- control coverage under President Barack Obama's health law and fees paid to labor unions representing government employees by workers who object to being affiliated with a union (Sherman, 6/29).

CNN: Court Set To Rule On Obamacare Contraception Mandate
The biggest case of the Supreme Court's term involves a three-headed, hot-button appeal combining abortion rights, religious liberty, and Obamacare. It's also the last one, and a ruling is due on Monday. The legal and social pique may not reach the heights of two years ago when the justices narrowly preserved the Affordable Care Act and its key funding provision in a blockbuster ruling. But the stakes are still large, and the decision could serve as a primer for other pending challenges to the health law championed by President Barack Obama and in play as a campaign issue this midterm season (Mears, 6/30).

CNN: 5 Questions: Supreme Court And Obamacare On Contraception
The Supreme Court on Monday will rule on a politically-charged Obamacare appeal involving a requirement that certain, for-profit businesses provide contraceptive coverage to their employees. Can those employers avoid the requirement if they object on moral or religious grounds? Can they do so if they see this as a requirement that can -- in their view -- ultimately lead to abortion? That's what the justices have weighed over several months. Here are five questions to consider in advance of their decision, which incidentally is the last of the term and should come down shortly after 10 a.m. ET (Mears, 6/29).

Fox News: Decision Day: Hobby Lobby Team 'Very Confident' Ahead Of Supreme Court Ruling
Supporters of the arts-and-crafts chain Hobby Lobby -- the business at the center of one of this session's most closely watched Supreme Court cases -- are sounding a confident tone ahead of Monday's expected decision in their case challenging ObamaCare's so-called contraception mandate (6/30).

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Medical Boards Draft Plan To Allow Greater Use Of Telemedicine

Amid predictions of a growing doctor shortage, state medical boards have drafted a model law that would make it easier for physicians licensed in one state to treat patients in others, whether in person, by videoconference or online. Meanwhile, former Health and Human Services Secretary Kathleen Sebelius acknowledges she made mistakes in the health law's rollout by spending "too little time clearly on the technology side."

The New York Times: Medical Boards Draft Plan To Ease Path To Out-of-State And Online Treatment
Officials representing state medical boards across the country have drafted a model law that would make it much easier for doctors licensed in one state to treat patients in other states, whether in person, by videoconference or online. The plan, representing the biggest change in medical licensing in decades, opens the door to greater use of telemedicine and could alleviate the doctor shortage, a growing problem as millions of people gain insurance coverage under the Affordable Care Act (Pear, 6/29).

USA Today: Supply Won't Meet Growing Demand For Primary Care
Federally funded programs will add at least 2,300 new primary care practitioners by the end of 2015, but the funding for at least one of those programs is set to expire at the same time, contributing to a massive shortage of doctors available to treat patients — including those newly insured through the Affordable Care Act and Medicare. The U.S. is expected to need 52,000 more primary care physicians by 2025, according to a study by the Robert Graham Center, which does family medicine policy research. But funding for teaching hospitals that could train thousands more of these doctors expires in late 2015 (Krasselt and O'Donnell, 6/29). 

Politico: Kathleen Sebelius: I 'Made Some Mistakes'
Former Health and Human Services Secretary Kathleen Sebelius acknowledged Friday that she made mistakes leading up to the rollout of the Affordable Care Act, worrying too much about whether there'd be a market for Obamacare and spending "too little time clearly on the technology side." "I sure made some mistakes along the way in terms of focusing on some things and not on others," she said at the Aspen Ideas Festival. Instead of confirming what she was being told about HealthCare.gov’s readiness "was actually accurate and getting enough eyes and ears on that," she said she concentrated on the insurers, consumers and regulators who needed to come together in the health exchanges (Villacorta, 6/27).

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Rule Issued For Small Business Health Insurance Tax Credit

The regulation sets eligibility requirements for businesses seeking tax credits to help them buy coverage for their workers. Meanwhile, a Republican House member complains about not getting information about how the Small Business Health Options Program (SHOP) is working.

Modern Healthcare:  IRS Issues Rule On Small-Business Health Insurance Tax Credit
The Internal Revenue Service issued a final rule on tax credits intended to make it more affordable for small businesses to buy health insurance for their employees. The rule establishes eligibility requirements for a tax credit introduced by the Patient Protection and Affordable Care Act. The credit has been available since the 2010 tax year but was implemented through IRS notices rather than formal rulemaking, according to Timothy Jost, a Washington & Lee University School of Law professor.  ... Eligible small employers are defined as those with no more than 25 full-time equivalent employees who have average annual wages of no more than $50,800 each. Employers must contribute at least 50% of the premium cost on behalf of each enrolled employee and in return, they can claim a  tax credit of 50% of the premium amount paid (Dickson, 6/27).

The Hill: Lawmaker Presses HHS For Small-Business Health Insurance Data
A top GOP lawmaker pushed the administration Friday to release enrollment data measuring the success of the Small Business Health Options Program (SHOP) under ObamaCare. Rep. Sam Graves (R-Mo.), chairman of the House Small Business Committee, issued a statement expressing frustration that the Department of Health and Human Services has repeatedly failed to provide the requested data. "It's astonishing how little information has been disclosed about a law in which the taxpayers are investing billions. What is the Administration hiding?" Graves asked (Al-Faruque, 6/27).

Also, The New York Times examines one insurer's effort to find out more about customers.

The New York Times: When A Health Plan Knows How You Shop
There may be a link between your Internet use and how often you end up in the emergency room. At least that’s one of the curious connections to emerge from a health care analysis project at the insurance division of the University of Pittsburgh Medical Center. ... But the insurer recently bolstered its forecasting models with details on members’ household incomes, education levels, marital status, race or ethnicity, number of children at home, number of cars and so on. ... With the addition of these household details, the insurer turned up a few unexpected correlations: Mail-order shoppers and Internet users, for example, were likelier than some other members to use more emergency services (Singer, 6/28).

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Inaccurate Doctor Lists Hurt Access For Low-Income Californians

Meanwhile, confusion over limited providers also has led to unforeseen bills for enrollees in private plans in California, reports The Los Angeles Times. Other stories look at the growing number of insurers who want to participate in the online marketplaces and how 19 states have passed laws restricting the workers who help consumers sign up, despite a new federal rule eliminating many such restrictions.

The California Health Report: Directories Of Doctors Who Treat The Poor Are Inaccurate, Hurting Access
Directories of doctors given to low-income patients across California are highly inaccurate, making it difficult for them to get the health care they’re entitled to under state law, the California Health Report has found. More than half of the primary-care doctors in provider directories given to low-income patients in three counties in Northern, Central and Southern California are not accepting new patients with Medi-Cal, the state’s low-income health plan, or could not be reached by telephone. At one plan in Butte County, more than 95 percent of the doctors listed in the printed directory were either unavailable to new patients or could not be reached. Even in the most accurate directory, from a plan in Fresno County, reporters were able to confirm that a doctor would see a new patient at only six out of every ten offices listed (Guzik, 6/29).

Los Angeles Times: Confusion Over Doctor Lists Is Costly For Obamacare Enrollees In State
Frustration and legal challenges over the network of doctors and hospitals for Obamacare patients have marred an otherwise successful rollout of the federal healthcare law in California. Limiting the number of medical providers was part of an effort by insurers to hold down premiums. But confusion over the new plans has led to unforeseen medical bills for some patients and prompted a state investigation. More complaints are surfacing as patients start to use their new coverage bought through Covered California, the state's health insurance exchange (Terhune, 6/28).

Kaiser Health News: Capsules: Washington And Other States See New Insurers On Exchanges
Washington State’s health insurance exchange is looking to be an attractive marketplace for new health insurance carriers, according to an early analysis of insurer premium rate filings by McKinsey & Company. Four new insurers have applied to sell individual policies in the state’s exchange next year, making Washington among the states with the highest number of new exchange entrants of the 12 states where preliminary 2015 rates have been filed, according to McKinsey. If insurance regulators approve the new carriers, Washington will have 12 insurers on the exchange in 2015, up from eight participating this year (Bartolone, 6/30).

CNN Money: Obamacare = Opportunity For Insurers
For insurers, Obamacare spells opportunity: They are flocking to sell more policies on more state exchanges for 2015. In Illinois, for example, 10 insurers are submitting proposals to state regulators to market 504 plans on the Obamacare exchange, a huge jump from the eight insurers that offered 165 plans for this year. ... UnitedHealthcare (UNH) has applied to be on the exchanges in Illinois and Washington. This year, it took a cautious approach and only provided policies in a dozen insurance exchanges. "We feel the exchange markets hold opportunity," said Tyler Mason, a spokesman for UnitedHealthcare (Luhby, 6/27).

The Washington Post: How States Are Still Limiting Obamacare’s Outreach Program
If you think back to the time before the rollout of Obamacare's coverage expansion, there was one controversy that fired up opponents and supporters of the law more than any other: the role of in-person enrollment aides. ... last month, the administration issued new rules trying to crack down on these state laws. In all, 19 states have laws placing additional requirements on navigators, and 15 of those appear to violate the new federal guidelines, according to Georgetown University Health Policy Institute researchers (Millman, 6/27).

Fox News: ObamaCare Whistleblower Claims Retaliation, Republicans Cry Foul
A political storm has erupted in Washington state involving a whistleblower who claims she was retaliated against after raising concerns about ObamaCare's implementation.  Patricia Petersen, a hearings officer in the state's Office of the Insurance Commissioner (OIC), filed a whistleblower complaint alleging coercion and corruption in the OIC, which is tasked with implementing the Affordable Care Act. She said Chief Deputy James Odiorne threatened her job if she didn’t rule the way Commissioner Mike Kreidler -- a supporter of the law – wanted (Springer, 6/28).

Pioneer Press:  Tale Of Two Health Care Websites:  Minnesota Presses On; Maryland Moves On
A year ago, Minnesota and Maryland were at a similar place in developing new websites for their health insurance exchanges. Both states were using a similar group of information technology vendors. And Minnesota and Maryland were helping each another by sharing code, according to comments from MNsure's former executive director at a June 2013 board meeting. But today, the two states seem to be charting very different courses. Maryland decided this spring to pull the plug on its health insurance exchange website and instead use a system developed by the state of Connecticut. The decision followed a judgment that the Maryland system "remains deeply flawed," according to a March report (Snowbeck, 6/29).

Meanwhile, in Connecticut, Anthem Blue Cross proposes 12.5 percent premium increases on average for individual market policies to cover rising pharmaceutical costs, and a report finds the state's small businesses pay more to cover their workers than those in other states -

The CT Mirror: Consumers Call Anthem Rate Hike Proposal 'Unaffordable'
Anthem Blue Cross and Blue Shield officials said Friday that the company needs to raise rates on its individual-market policies by an average of 12.5 percent to account for rising pharmaceutical costs, particularly costly new Hepatitis C drugs. During a public hearing at the Connecticut Insurance Department, Anthem officials also cited federal fees meant to cover the cost of subsidizing people’s premiums and reduced federal risk protection for insurers as reasons for seeking to raise rates. Customers, meanwhile, expressed outrage at the proposed rate hikes (Becker, 6/27).

The CT Mirror: GAO: CT Small Businesses Paid More Than Most Others For Health Care
Federal researchers have determined that Connecticut’s small businesses and non-profits pay more than those in every other state – except Alaska – to provide health care coverage to their workers. The Government Accountability Office studied the average premium charged by small group policy providers in all 50 states and the District of Columbia and determined it cost an average of $6,080 to cover an individual in Connecticut in the first quarter of 2013. That was just before implementation of the Affordable Care Act’s prohibition against considering the health or gender of members of a small group when determining premiums. Only Alaska, with an average annual premium of $7,691, had costlier small group health insurance plans than Connecticut (Radelat, 6/30).

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Fallout From Medicaid Expansion Fights

In Virginia, The Washington Post traces the behind-the-scenes deal-making to create a job for the Democratic state lawmaker whose resignation gave Republicans control of the chamber and the ability to block Gov. Terry McAuliffe's plan to expand Medicaid. Meanwhile, a Missouri hospital lays off 60 employees, blaming the state's failure to expand Medicaid.

The Washington Post: E-Mails Outline Turmoil At Va. Tobacco Panel Over Puckett’s Hiring
Sen. Phillip P. Puckett was about to get a good gig with the state tobacco commission, one created just for him, with a job description he was invited to write himself. Maybe even a state car. The only problem was timing. If the commission hired Puckett on the same day that the Democrat from rural Russell County stepped down from the Senate, it might look fishy. His resignation would give the Republicans control of the chamber, giving them the advantage in a budget standoff over Gov. Terry McAuliffe’s top priority: Medicaid expansion. The head of the commission warned that they should " 'decouple' those announcements for the sake of the appearance of the Commission manipulating the Senate balance of power and starting WW3 w/ the Governor’s administration" (Vozzella and Portnoy, 6/27).

Associated Press:  Missouri Hospital Lays Off 60 Employees, CEO Blames Lack Of Medicaid Expansion
Ozarks Community Hospital says it will lay off up to 60 of its employees in the Springfield area. CEO Paul Taylor said in a letter dated Wednesday that the layoffs will occur during the next 60 days. The hospital has about 800 employees, with 500 working in the Springfield area. The Springfield News-Leader reports Taylor blamed the layoffs on the Missouri Legislature's failure to expand Medicaid in the state (6/27).

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Women's Health

Abortion Issue Drives Campaigns

Senate Minority Leader Mitch McConnell (R-Ky.) promises to do more to limit abortions if Republicans take control of the U.S. Senate, while Wendy Davis, the Democratic nominee for Texas governor, tried to galvanize support a year after her marathon filibuster in the state legislature against abortion restrictions.

The Hill: McConnell: I'd Fight To Limit Abortions
Senate Minority Leader Mitch McConnell (R-Ky.) promised Saturday to focus more attention on limiting abortions if Republicans take control of the Senate in November. Speaking to the National Right to Life Convention in his home state of Kentucky, the Senate's top Republican suggested Majority Leader Harry Reid (D-Nev.) has blocked the upper-chamber from voting on bills that would limit women's rights to abortion, according to conservative website Townhall.com. But McConnell said he would push abortion-limiting legislation to pressure President Obama to take a stand on the issue (Devaney, 6/28).

The New York Times: For Wendy Davis, Filibuster Goes Only So Far In Race To Be Governor of Texas
One year after bursting onto the national scene with a marathon filibuster against abortion restrictions, Wendy Davis, the Texas state senator and Democratic nominee for governor, has been doing everything she can to mark the anniversary of that speech last June, even donning the same pink Mizuno sneakers. The problem: A year after her filibuster pumped her up into the kind of galvanizing candidate Texas Democrats have not had for decades, she seems very much dragged down to earth, dwarfed by the perception that Democrats’ chances of ending the Republican domination of Texas remain slim (Fernandez, 6/28).

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Health Care Marketplace

Hospitals Take Steps To Figure Per Patient Costs

New tools rely heavily on data to figure out just what it will cost to treat a patient -- and in some cases, companies are buying additional information from "data brokers." 

Kaiser Health News: Retooling Hospitals, One Data Point At A Time
When a car rolls off an assembly line, the automaker knows exactly what parts, labor and facilities cost.  Not so in health care, and now some health executives are trying to change that. Although U.S. hospitals account for the single largest chunk of the nation's $2.7 trillion in health spending, few of them can say how much it actually costs them to care for every patient they admit. ... Today, the [University of] Utah health system is one of a handful in the nation with a data system that can track cost and quality for every one of its 26,000 patients. That data is shared with doctors and nurses for further input about ways to streamline cost and improve care (Appleby, 6/30).

PBS NewsHour: Hospitals Turning To Data Brokers For Patient Information
A new report this week describes how hospitals are buying information from data brokers to determine how likely you are to get sick and what it may cost to treat you. For more on this Shannon Pettypiece of Bloomberg News joins Hari Sreenivasan in New York (Sreenivasan, 6/29).

Elsewhere, a large Massachusetts hospital will screen all patients for substance abuse, and a bill there would mandate how many nurses would work in ICUs --

The Boston Globe: MGH To Screen All Patients For Substance Abuse
Massachusetts General Hospital will take the unusual step of questioning all patients about their use of alcohol and illegal drugs beginning this fall, whether they are checking in for knee surgery or visiting the emergency department with the flu. How often have you had six or more drinks on one occasion, caregivers will ask, or used an illegal drug in the past year? If the battery of four questions reveals a possible addiction, doctors can summon a special team to conduct a "bedside intervention" and, if needed, arrange treatment (Kowalczyk, 6/30).

Modern Healthcare: Mass. Law Would Set ICU Nurse Staffing Ratios
Massachusetts lawmakers have passed a bill to mandate how many nurses must be on duty in intensive-care units -- and hospital officials are encouraging the governor to make it law. This week both chambers of the Massachusetts Legislature unanimously approved a bill that would require every patient in a licensed intensive-care bed to have at least one nurse caring for them, except in cases where the ICU nurse determines she can care for two patients, because one of her charges is less acutely ill. Staffing in Massachusetts ICUs could never drop below one nurse for every two patients (Carlson, 6/27).

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Concerns Rise About Delays In Getting Generic Drugs To Market

PBS NewsHour explores concerns that settlements on patents for drugs sometimes delay the generic version getting to consumers.

PBS NewsHour: Are Generic Drugs Being Delayed To Market?
Are generic drugs being delayed to market by so-called "pay for delay" deals between drug companies? The deals happen after generic drug companies challenge the patents on brand-name drugs. The settlements include a date that the generic drug can enter the market, and in some cases, a payment from brand company to the generic company (Thompson, 6/28).

Also, some pharmacies are looking at ways to help consumers who have multiple prescriptions.

USA Today: Companies Help Patients Manage Multiple Medications
Customers with multiple prescriptions end up with numerous refill dates, resulting in many trips to drug stores to pick up medications. The remedy is pharmacy synchronization, which allows pharmacists like Irons to adjust refill dates so customers can pick up all their prescriptions on the same day. To adjust refill dates, pharmacists need to partially fill some prescriptions — and that takes cooperation from insurance companies. Republican state Sen. Kevin Mullin proposed legislation last winter that would have required insurance companies to cover partial refills of medications for chronic conditions when pharmacists are synchronizing prescriptions (Remsen, 6/28).

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23andMe Founder Working To Restore Firm's Business, Improve Health Care

The FDA shut down the genetic company's sales of personalized health reports, but CEO Anne Wojcicki is working to get that part of her business back up and running.

The Wall Street Journal: Anne Wojcicki's Quest For Better Health Care
Anne Wojcicki, chief executive of 23andMe, is determined to overturn the way traditional health care works in the U.S. It hasn't been easy. Last year, the Food and Drug Administration shut down sales of her genetics company's personalized health reports -- one of its main sources of revenue. But Ms. Wojcicki (pronounced wo-JIT-ski) isn't backing down. ... Her company is working with the FDA on getting its reports approved for direct delivery to consumers. Before the FDA's warning letter, 23andMe had 550,000 customers. Now it has 700,000, though growth has slowed (Wolfe, 6/27).

The Washington Post: 23andMe Co-Founder Anne Wojcicki’s Washington Charm Offensive
In early May, Anne Wojcicki flew into Washington accompanied by two other billionaire Silicon Valley wives intent on shaking up the health-care industry. Her genetic profiling start-up, 23andMe, a darling of the tech industry, had recently run into trouble with the Food and Drug Administration. It was a setback for the company, but it had given her an important lesson in the power of government. ... It was Wojcicki’s first time at the soiree, a coming out for her on the political scene, and she had a lot to say. The first is that the U.S. health-care system is broken (Cha, 6/27).

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State Watch

N.Y. Governor Unveils Plan To Fight HIV

The goal, the governor says, is to reduce new HIV infections to 750 per year by 2020 through aggressive treatment and testing.

The New York Times: Cuomo Plan Seeks To End New York's AIDS Epidemic
Borrowing an idea from leading AIDS researchers, the Cuomo administration said on Friday that it had developed a plan to aggressively identify, track and treat people with H.I.V. infection with the aim of reducing new infection to the point that by 2020, AIDS would no longer reach epidemic levels in New York State. ... The state's acting health commissioner, Dr. Howard Zucker, said on Friday that he believed that by 2020, New York could reduce its annual incidence of new H.I.V. infections to about 750 from the current 3,000, bringing the number of new cases below the number of annual deaths, or as he put it, "bending the curve" in the direction of ending the epidemic in the state (Hartocollis, 6/28).

The Wall Street Journal: Cuomo Unveils New Effort To Reduce HIV/AIDS Cases
The plan calls for more aggressive testing, treatment and tracking of the disease. "The state of New York was ground zero of HIV/AIDS when the crisis hit 30 years ago," Mr. Cuomo said in remarks before walking in New York City's gay-pride parade. "It's fitting that New York could be the state that is the most aggressive in eradicating the disease" (Vilensky, 6/30).

The Associated Press: Cuomo: Boost HIV Tests, Treatment To End Epidemic
New York state can end its three-decade HIV crisis by the year 2020, Gov. Andrew Cuomo said Sunday as he announced an ambitious plan to deliver a knockout blow to the epidemic by boosting testing, reducing new infections and expanding treatment. The governor said the state is aiming to reduce new HIV diagnoses to 750 by the end of the decade -- about the same number of tuberculosis cases seen in New York City each year -- down from 3,000 expected this year and 14,000 new cases of the disease in 1993 (Klepper, 6/29).

In the meantime, ex-inmates with the virus struggle to rejoin society --

The Associated Press: Many Challenges Face Ex-Inmates Living With HIV
Several times each month, a white bus picks up newly released ex-inmates at New York's Rikers Island jail complex and drives into Harlem, where helping hands await at a transition program run by a nonprofit called the Fortune Society. These new arrivals face the myriad challenges confronting anyone leaving jail or prison -- and a daunting additional one. They have HIV (Crary, 6/28).

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State Highlights: Caring For Texans Injured On-The-Job; Heroin Deaths In Md.; Pertussis In Calif.

Texas Tribune: Behind Texas Miracle, A Broken System For Broken Workers 
In formerly depressed South Texas, gas flares from the fracking boom can be seen from outer space. While Texas has a Division of Workers' Compensation, it is the only state that doesn’t require any private employer to carry workers’ compensation insurance or a private equivalent, so more than 500,000 people have no occupational benefits when they get injured at work. That means they often rely on charities or taxpayers to pay for their care (Root, 6/29).

Texas Tribune:  After Catastrophic Fall, The Fight Of One Worker’s Life 
While Texas has created more jobs than any other state over the last decade, it also leads the nation in the number of worker deaths, according to the federal Bureau of Labor Statistics. The problem is particularly acute in the Texas construction industry, where 60 percent of the workforce has never received basic safety training and one in five workers reports sustaining an injury that required medical attention, according to the report “Build A Better Texas,” compiled last year by the Worker’s Defense Project and researchers from the University of Texas at Austin. About 40 percent of employers in the construction business offer workers' compensation insurance, the report found (Root, 6/30).

The Washington Post: Heroin Deaths Spike In Maryland 
Heroin-related deaths in Maryland spiked 88 percent from 2011 to 2013, according to figures released Friday by the state’s Department of Health and Mental Hygiene, and intoxication overdoses of all types now outnumber homicides in the state (Svrluga, 6/27).

Baltimore Sun:  Maryland Heroin Overdose Deaths Jump
An alarming spike in heroin and other drug overdose deaths in Maryland has prompted what the state's health secretary calls an "all hands on deck" effort to investigate and treat addiction. The number of drug- and alcohol-related deaths in Maryland rose to 858 in 2013 from 799 the previous year, according to data released by the Maryland Department of Health and Mental Hygiene on Friday. Much of the increase is due to heroin, particularly when it is laced with fentanyl, a powerful prescription painkiller used by cancer and other patients, now being illicitly manufactured in drug labs, said Dr. Joshua Sharfstein, the department's secretary (Marbella, 6/27).

Los Angeles Times: California's Pertussis Epidemic Escalates, Health Officials Report 
California's pertussis epidemic has escalated, state health officials said Friday, with 4,558 cases reported this year as of Tuesday -- 1,100 of those in the last two weeks. "We are off to a really bad start in 2014," Dr. Gil Chavez, state epidemiologist with the California Department of Public Health, said during a phone call with reporters Friday (Brown, 6/27).

The New York Times: Rations Reduced As Demand Grows For Soup Kitchens 
The New York City Coalition Against Hunger has estimated that one in six city residents are “food insecure,” or living in homes where there is not enough money to put enough food on the table. In a 2013 survey, the group reported that 254 food pantries and soup kitchens had seen demand increase 10 percent, on average, over the previous year. “The hunger crisis in New York is the worst that it’s been in decades,” said Joel Berg, the group’s executive director, adding that people had already been struggling in a tough economy before their food stamps were reduced last fall, when federal cuts were made to the Supplemental Nutrition Assistance Program (Hu, 6/27).

The Wall Street Journal: A Place To Care For Children 
It is one of the saddest corners of the health-care field -- hospice care for children -- and it has been relatively neglected. Now, a Brooklyn health-care organization hopes to change that. MJHS, formerly known as Metropolitan Jewish Health System, plans to open what it says is the city's first residence for dying children and their families on 10 acres of property on the water in Manhattan Beach (Kusisto, 6/29).

Denver Post: Mental Health Crisis Hotline Ready To Go Statewide In August
In just a matter of weeks, the approximately 100 calls received every day at a local crisis center -- everything from people who feel suicidal to those who are grieving or stressed -- are expected to jump to about 500 daily. Metro Crisis Services, a nonprofit local hotline, won a $3 million state contract to expand its call center into the first statewide mental health crisis hotline. It's part of a larger, $20 million plan to change the way people going through a mental health crisis can access help. The plan was proposed by Gov. John Hickenlooper after the Aurora theater shooting and the Newtown, Conn., school shooting (Robles, 6/28).

Denver Post: Lawmakers In 11 States Approve Low-THC Medical Marijuana Bills 
Spurred by the stories of epileptic children being treated in Colorado with cannabis oil, lawmakers across the country this year have made a dramatic change in how they talk about marijuana. Thus far, nine states have passed laws legalizing either the use of non-psychoactive marijuana extracts for medical treatment or the study of such products. The slate of states -- Alabama, Florida, Iowa, Kentucky, Mississippi, South Carolina, Tennessee, Utah and Wisconsin -- reads in part like a list of states previously most resistant to changes in marijuana laws (Ingold, 6/30).

Sioux Falls Argus Leader: Online Medical Records Increase Privacy Risks 
Every year, thousands of small claims and civil court cases are filed in South Dakota to collect medical debts. Many of those cases contain an itemized list of the medical procedures for which a hospital, doctor or clinic is seeking payment, and that list is a public record. That means that once confidential medical information becomes part of a lawsuit, that information no longer is strictly confidential. The type of procedure, date or dates performed and the treatment -- which doctors would be legally liable for releasing to the public under other circumstances -- all become public and available for scrutiny once a case goes to collections (Hult, 6/30).

Santa Fe New Mexican: N.M. Paid Arizona Firm Ahead Of Provider Shake-Up
Gov. Susana Martinez’s administration shook up the state’s mental health system last June when it said an audit had revealed 15 nonprofit groups that provided treatment to the poor had overbilled Medicaid by as much as $36 million. The groups were stripped of their contracts, and a handful of companies from Arizona were brought in to replace them. But months before the audit was even complete, the Martinez administration was already paying at least one of the Arizona companies for salaries, travel and legal fees, state records show. At least one payment to the company, Agave Health Inc., was made before the audit had even begun, according to the records (Malone, 6/28).

Miami Herald: Mayo Clinic Left Out Of State Plan For More Cancer Research Dollars 
Gov. Rick Scott’s plan to spend tax dollars on boosting the national prominence of Florida’s top cancer centers came as a pleasant surprise to the Mayo Clinic. ... Mayo Jacksonville officials figured they -- and the 14,000 cancer patients seen at the Florida site -- would benefit from Scott’s plan. But Mayo, nestled in a forest of pine trees in suburban Jacksonville, has learned that being “Florida’s best-kept secret,” as its leaders like to say, has political consequences. As this year’s legislative session wore on, it became clear that Mayo would be snubbed in favor of centers that enjoy more support in Tallahassee (Mitchell, 6/29).

The News Journal:  Teledoctors Save Delaware Families Time, Miles 
Nicole Tolosa had rearranged her family's life so they could shuttle her 6-year-old son, Ezekiel, upstate for treatment and therapy for his hearing problems. ... So when Nemours doctors asked Tolosa if she wanted to try a new way of getting Ezekiel the help he needed, by conducting appointments via a webcam set up at a Nemours' office in Seaford, she leapt at the chance. ... More recently, the hospital started making those video-call connections even within its own departments, from one end of the hospital to the other (Fisher, 6/29).

Associated Press: Chiropractic College Must Accommodate Blind, Court Rules 
The Iowa Supreme Court ordered the nation's leading chiropractic college on Friday to make accommodations to allow blind students to complete degrees, in an important victory for the rights of the disabled. The court rejected Palmer College of Chiropractic's contention that eyesight is a requirement for the profession, which involves adjusting patients' spines to treat back pain. The Davenport, Iowa-based college argued that chiropractors must be able to read X-rays to deliver safe and effective adjustments and that allowing blind students to rely on assistants for that information wasn't feasible (Foley, 6/27).

Detroit Free Press: Michigan Bills That Would Ban Minors From Buying E-Cigarettes Cause Concern 
Keeping e-cigarettes out of the hands of minors is the intent, but some fear that a package of three bills awaiting Gov. Rick Snyder’s signature could establish the vapor-making cigarette alternative as something other than a tobacco product. And that, in turn, could mean less regulation over a product for which the dangers -- or benefits -- are still not clear, they say (Erb, 6/30).

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Special Enrollment Periods Could Help Medicare Advantage Members With Dropped Doctors

In the meantime, for-profit hospices are scrutinized for how they bill Medicare.

St. Louis Post-Dispatch:  Experts Provide Options, Hope For UnitedHealthcare Medicare Patients 
For more than 40 years, Mary Anne Catalano and her family have gone to Dermatological Care Inc., a practice in St. Louis County. ... Now, at 68 and in the middle of her contract term, UnitedHealthcare is kicking the entire Dermatological Care staff out of her Medicare Advantage network. ... At the beginning of June, UnitedHealthcare notified almost 10 percent of Missouri physicians in its Advantage network that they will be terminated -- almost 1,000 doctors. The insurer gave no clear reason for the cuts, and patients may feel forced to switch doctors in the middle of their policy term or pay high out-of-pocket costs. But some experts say there are other options, and maybe even some hope. At the patient level, Medicare provides 17 special enrollment periods that allow consumers to switch coverage and find a plan that carries their doctors (Kulash, 6/28).

WBUR: Weekend Listening: For-Profit Hospice Care As Big Business
The for-profit hospice care is a growth industry in this country. But taxpayer beware. (And it is the taxpayer who is footing the bill, big-time.) … Too many of these for-profit hospices are gaming U.S. law and cherry-picking patients, finding ways to reap big profits from the Medicare system, taking people who will take longer to die -- and sending them home if they take too long to die, so they can maximize profits. And some of them -- including big, national corporations -- have been sued repeatedly by the federal government for their practices. Patient for patient, the for-profits cost the U.S. Treasury a lot more money (Kotsonis, 6/27).

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Editorials and Opinions

Viewpoints: Nothing In Health Care Is Free; Obamacare Opponents Lack Facts; 'Nurse Jackie' And The ER

Los Angeles Times: Mandating Preventive Care Without Co-Pays Is Good, But It's Not 'Free'
The Department of Health and Human Services released a report Friday declaring that 76 million Americans with private insurance became eligible for more preventive services with no out-of-pocket fees as a result of the 2010 healthcare law, the Patient Protection and Affordable Care Act (a.k.a. Obamacare). Because Democrats are counting on female voters to help them at the polls in November, the report highlighted how women had been helped by that aspect of Obamacare. "Altogether, a total of 48.5 million women are estimated to benefit from free preventive services," it stated. But as new HHS Secretary Sylvia Burwell surely knows, given her time as deputy director of President Clinton's Office of Management and Budget, there is no such thing as "free" services, particularly not in the world of healthcare (By Jon Healey, 6/27).

The New York Times: The Eggs And Us
Both Hobby Lobby and the personhood movement mark a turning point in our long, grueling national battle over reproductive rights. Many Americans are repelled by late-term abortion, but they don’t necessarily feel the same emotional affinity for a fertilized egg. The fact that this is actually a debate about theological dogma gets a lot clearer when you're closer to the start of the gestational saga (Gail Collins, 6/27).

Los Angeles Times: Healthcare Debate Lacks Factual Arguments Against Obamacare
Americans have always been a politically contentious lot. But one topic seems to produce more pure vitriol than any other: the Affordable Care Act. I posted an item on my Times blog, the Economy Hub, citing new statistics indicating that the act has materially reduced the ranks of the uninsured, kept premiums moderate and seemed likely to keep rate increases modest next year. I sought agreement that, given these developments, "Obamacare is working." I didn't get it. What I got instead was an unexampled outpouring of angry, vulgar and bitter emails, almost none of them bearing even the slightest attempt to counter my statistics with alternative facts. ... What accounts for the pungent rancor? Here's a rundown (Michael Hiltzik, 6/27).

Los Angeles Times: I Doubted Heritage Could Run A 'Straight' News Site. I Was Right.
And this week, [the Heritage Foundation's news website] the Daily Signal proudly unburdened itself of a major investigation of the Affordable Care Act that proves our point. It's chock-full of bogus numbers, basic misunderstandings and tendentious verbiage. The piece is headlined "Obamacare Exchanges are 'Disappointing' With Fewer than 4 Million Newly Insured. The Government Hoped for 26 Million." Misleading on both counts (Michael Hiltzik, 6/27).

The Washington Post: Terry McAuliffe, Virginia Democrats Should Learn Lessons From Defeat On Medicaid
Virginia Democrats are right to be furious that Republicans used a sleazy job offer and a parliamentary gimmick to block Gov. Terry McAuliffe’s top goal of expanding medical insurance for the state’s working poor. Rejecting both compassion and common sense, the GOP went to extraordinary lengths to ensure that Virginia would refuse $2 billion a year in federal funding just because the money was tainted by association with dreaded Obamacare. But after the Democrats have finished gnashing their teeth, they should study the lessons from this major defeat and figure out how to win the contest in the end (Robert McCartney, 6/28). 

The Wall Street Journal: On Medicaid Expansion, Red States Will Be Watching Red States
Since the Supreme Court made expanding Medicaid optional for states under the Affordable Care Act, 26 states have expanded Medicaid. Three of the 24 states that have not–Indiana, Utah and Pennsylvania–are considering expanding via federal waivers that they are negotiating with the Obama administration. ... If Indiana, Pennsylvania and Utah reach agreement with the administration and move ahead, that would bring to 10 the number of states with Republican governors that have expanded Medicaid. ... Republican governors and legislators will be watching the red states that have expanded Medicaid especially closely. They will want to know if those states are benefiting economically from their new federal funding; how the expansion has affected their state budgets; if their hospitals and counties are less stressed with the federal government paying more of their bills for serving the uninsured; and if Republican elected officials have been hurt or helped politically by their decision to expand (Drew Altman, 6/30).

And on other health topics -

USA Today: Can former P&G CEO Clean Up VA? Our View
On Friday, the White House issued a broadly damning report on the VA, all the more remarkable considering that the administration has been in charge of the agency for the past six years. And today, President Obama will nominate a man to clean up the mess. Robert "Bob" McDonald, a West Point graduate and the former chief executive of Procter & Gamble, lacks experience in health care, which surely will slow him down. But his experience running a sprawling, private-sector institution should give him an edge over the succession of military commanders and career bureaucrats who have headed the troubled agency. If confirmed by the Senate, McDonald will need every ounce of his reputed managerial abilities to turn around the VA's vast national network of 1,700 hospitals, clinics and other facilities (6/29).

USA Today: Return VA To Its Core Mission: Another View
If there's one thing all Americans can agree on, it's that we owe our veterans the care they need to treat injuries suffered while serving their county. But Congress and the organized veterans groups have stretched that vital mission into massive bureaucracy that builds and owns hospitals, hires doctors and provides care directly to millions of veterans, regardless of whether their illnesses are service-related. In the wake of the Veterans Affairs scandal, we may be tempted to believe that the system can be fixed by changing leaders or simply spending more money. But spending for the VA health system has risen eight times faster since 2007 than the number of unique patients. And the problems go back decades (Michael Tanner, 6/29).

The New York Times: Anthrax? That’s Not The Real Worry
Officials at the Centers for Disease Control and Prevention recently discovered that at least 75 workers there had been exposed to possible anthrax infection. We should be glad that it was only anthrax. Anthrax is a dangerous but noncontagious bacterium; the risk to the exposed workers is real, but there is no danger of transmission to others. Much more troubling would be an accidental exposure to a dangerous, contagious pathogen. And unfortunately, that’s also quite possible (Marc Lipstitch, 6/29). 

The New York Times: House Hypocrisy On Insider Trading
[A] federal judge in New York has ordered a hearing this week for an explanation from the [House Ways and Means] committee and the staff member suspected of leaking to a lobbyist nonpublic information he heard last year about pending Medicare rate increases. According to the commission, the lobbyist passed this valuable word along to a health care brokerage firm that quickly issued a private alert to clients. A suspicious spike in trading of shares profitable to the clients occurred before the government made its Medicare decision public. This is clearly a case worth pursuing if the law known as the Stock (Stop Trading on Congressional Knowledge) Act is to be a credible tool against corruption on Capitol Hill and in numerous executive agencies also covered (6/29).

The New York Times: Pushback On Home Care
The salvos keep coming from opponents of a new federal rule to ensure that home care workers are paid at least the minimum wage and time and a half for overtime. The rule, many years in the making, reverses a misguided policy from 1974 that has long denied home care workers those basic wage protections. ... Now comes another challenge: Three groups that represent home care agencies have filed a lawsuit in federal court to stop the new rule on the grounds that the department exceeded its authority and did not follow proper procedures. That’s a stretch (6/29).

The New York Times: What 'Nurse Jackie' Gets Right About The E.R.
Despite the fact that Jackie is a seriously flawed human being, the show itself is a standout portrayal of nursing, when TV almost always gets nursing wrong. Nurse Jackie, played by the gifted Edie Falco, has enviable clinical judgment and an unshakable commitment to patients. But, like many addicts, she lies and sometimes steals to maintain her habit. ... But I praise the show because its clinical portrayals of nursing are realistic and mostly positive, in contrast to almost every other medical program on television. TV hospitals are almost exclusively staffed by doctors. ... In real hospitals, those jobs are almost always done by nurses, and "Nurse Jackie," true to its name, shows that (Theresa Brown, 6/28).

The New York Times: The Trauma Of Parenthood
This is the ideology of modern parenting, and it can lead to unnecessary feelings of guilt and shame, for it ignores an inconvenient truth: that many women and men experience significant psychological distress in response to becoming a parent and that much of this distress isn't caused by a hormonal epiphenomenon of the birth process. It is driven instead in large measure by the objectively bleak circumstances new parents often face. That you love your child is not always sufficient to counteract this reality (Finkel, 6/27).

The Wall Street Journal: Life Lessons From Dad: Caring For An Elderly Parent
My father was born and died at home. Nearly 91 years separated those two days, as did a lifetime of significant experiences, including one Great Depression, one World War, one wife, three children, and one year at my house, where he, accompanied by my mother, went through hospice during his struggle with dementia. Our family's experience was hardly unique. ... As our population ages, tens of millions of Americans will be called on to care for stricken parents. Over 15 million nonprofessionals are estimated to provide Alzheimer's care alone. What can families expect? (Dave Shiflett, 6/27).

The New York Times' Motherlode blog: The Battle Over Vaccinating Grandparents
Our midwife recommended that because of a resurgence in cases of whooping cough, I get vaccinated during pregnancy. In addition, she suggested I ask family members who were going to be in frequent contact with our baby, including my husband and our parents, to make sure their shots were up-to-date. My request sparked a firestorm in my family. My in-laws and my mother agreed to the vaccine. But my dad? He refused (Kim Conte, 6/29).

The Washington Post: West Africa Can't Manage The Ebola Outbreak
An alarming report released last week by Doctors Without Borders said that West Africa’s current Ebola outbreak is "out of control." That should shock the governments of Guinea, Sierra Leone and Liberia into action. It marks a frightening moment for a disease that has been contained numerous times before (6/29).

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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.