Daily Health Policy Report

Thursday, June 6, 2013

Last updated: Thu, Jun 6

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Fraud & Abuse

Coverage & Access

Health Care Marketplace

Public Health & Education

Women's Health

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Entrepreneurs At Health 'Datapalooza' Ask Feds For More Data

Reporting for Kaiser Health News, Eric Whitney writes: "Health and Human Services Secretary Kathleen Sebelius announced the agency's latest liberation of data from its vast trove of health care information this week, making public for the first time price and quality specifics for 30 different out-patient procedures at hospitals nationwide. But this data stream is not big enough or fast enough for some entrepreneurs" (Whitney, 6/6). Read the story.

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Capsules: Of ACOs And Proton Beams: Why Hospitals 'Live In Two Worlds'

Now on Kaiser Health News' blog, Jenny Gold reports: "For the past several years, hospital CEOs have been talking a big game about accountable care—the latest health care model, which pays doctors and hospitals for quality, rather than the volume of services they provide. ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and to save money by avoiding unnecessary tests and procedures" (Gold, 6/6). Check out what else is on the blog.

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Political Cartoon: 'There's An App For That?'

Kaiser Health News provides a fresh take on health policy developments with "There's An App For That?" by Harley Schwadron.

Meanwhile, here is today's health policy haiku:


Selling the health law
is no easy task -- not when
the buyers have doubts.

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

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Health Reform

Poll: Health Law's Support Sliding

A new Wall Street Journal/NBC survey concludes that more Americans than ever before view the health law as a bad idea. Just as these numbers are rolling out, the White House is launching its own messaging effort to get people to sign up for coverage through the overhaul's new online insurance exchanges.

Wall Street Journal: Poll Finds Support Slumping For Health Law
Americans' unease with President Barack Obama's health-care law has intensified, just as the administration is gearing up to persuade people to sign up for some of its major provisions, a Wall Street Journal/NBC News survey finds. Prior Journal/NBC polls have found more people calling the health law a bad idea rather than a good one. But the number calling it a bad idea reached a high of 49% in a poll of 1,000 adults taken between May 30 and June 2, with 43% "strongly" holding that view (O’Connor and Radnofsky, 6/6).

Politico: Selling Of Obamacare Underway
The Obama administration is reaching out to Democrats and Republicans in Congress as it gears up to try to sell Obamacare to the public this summer. For the Democrats, the meetings are part of a substantial messaging effort that will get under way to encourage people to sign up for health coverage through the new Obamacare exchanges starting on Oct. 1. They’ve involved high-level officials and lawmakers. The message? Rely on the facts, not the politics, of the health law. Now is the time to give Obamacare a constituent outreach touch, à la other government programs such as Medicare and Social Security: Help people sign up, participants say (Haberkorn and Cunningham, 6/6).

Here's how the law is playing in one particular Senate race --

The Associated Press: Ad Targets Shaheen, Health Care Law
A conservative advocacy group is airing a tongue-in-cheek ad suggesting New Hampshire families would be reduced to serving their children a single potato chip as a side dish thanks to Sen. Jeanne Shaheen’s support for President Obama’s health care overhaul law…Shaheen, a Democrat who is up for re-election next year, has said that the law will help thousands of New Hampshire residents by addressing health care costs and adding stability to coverage (Ramer, 6/6).

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State Decisions On Medicaid Expansion Deepen Health Care Divide

The Fiscal Times examines how political dynamics are leading to a red state-blue state divide in the availability of health care coverage. Politico reports on how Ariz. Gov. Jan Brewer, a former foe of Obamacare, is confounding that pattern by battling lawmakers in her own party to expand Medicaid. Media outlets also report on developments in Mississippi and Ohio.

The Fiscal Times: Obamacare Creates A Two-Tiered Medicaid System
Nearly a year after the Supreme Court limited the expansion of Medicaid under President Obama's health care reform law, the federal-state health program for the poor and disabled is evolving into a disturbingly stark dual system in which the availability of health care is being determined largely by the same political divide that settled the 2012 presidential election (Pianin, 6/6).

Politico: Arizona's Jan Brewer Becomes Unlikely Ally Of Obamacare
Arizona Gov. Jan Brewer has become an unlikely warrior for Obamacare. Brewer is a conservative Republican who sued to topple the health law, refused to set up a health insurance exchange and memorably wagged her finger at President Barack Obama on a Phoenix airport tarmac. But now she's so determined to put the Obamacare Medicaid expansion in place in her state that she's vetoing any legislation that reaches her desk until the Republican Legislature caves (Cheney, 6/5).

The Associated Press: Mississippi Democrats Back Letting Poor Buy Private Insurance
Democrats in the Mississippi Legislature said Wednesday they've come up with a way to provide health coverage to about 300,000 people without expanding Medicaid. The state could use federal money to help low-income people buy private health insurance, the Democratic lawmakers said. Arkansas lawmakers approved a similar plan earlier this year and are awaiting federal approval for it (6/5).

Jackson, Miss., Clarion-Ledger: Bryant Opposes Dems' Medicaid Expansion Alternative
State House Democrats on Wednesday proposed an "alternative" to Medicaid expansion that would use federal money to buy insurance for 300,000 of the state’s working poor, similar to a proposal in Arkansas. But Gov. Phil Bryant and other Republicans said the Democrats’ plan is just a repackaged Medicaid expansion as called for with the Affordable Care Act, which they oppose (Gates and Pender, 6/5).

Toledo Blade: Ohio Senate Drops Medicaid Expansion
The Ohio Senate's take on a $62 billion, two-year budget is headed for a vote today, complete with $1.4 billion in tax relief for small business owners and more money for K-12 schools than either the House or Gov. John Kasich had proposed. The plan, however, lacks Mr. Kasich's controversial proposal to expand Medicaid eligibility under the federal health-care law. The expansion is not expected to make a comeback when a House-Senate conference committee meets to hammer out a compromise between the two chambers' versions. At most, Medicaid talks will continue along a parallel track (Provance, 6/6).

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No Easy Answers About Health Law's Impact On Full-Time Jobs

CQ HealthBeat parses conflicting data on whether the health law may be spurring employers to keep workers part-time. Meanwhile, Sen. Orrin Hatch, R-Utah, questions whether the projections of rising health insurance subsidy costs may be due to employers dumping coverage. News outlets also offer reports on health exchanges from Connecticut, Maryland, Colorado and California.

CQ HealthBeat: Gauging Impact Of Health Law On Part-Time Work No Simple Matter
Will the health law trap a growing number of workers in part-time jobs as employers scramble to avoid higher health insurance costs under the overhaul? And to avoid a penalty, will those workers increasingly have to get federally subsidized coverage from insurance exchanges to comply with the law’s insurance mandate that starts next year? (Reichard, 6/5).

The Hill: Hatch Probes Rising Cost Of Health Law's Subsidies
Sen. Orrin Hatch (R-Utah) wants to know why the price tag keeps rising for new insurance subsidies under President Obama's healthcare law. Hatch wrote to Cabinet officials Wednesday seeking more information about the cost of providing tax credits to help people pay for their insurance premiums (Baker, 6/5).

CT Mirror: Anthem Files Rate Proposal For Obamacare Insurance Prices
In a much-anticipated proposal, the state's largest insurer has indicated what it wants to charge people buying coverage in the new insurance marketplace being created under federal health reform. Anthem Blue Cross and Blue Shield said the average monthly premium for an individual health plan would be $440.65. The prices would vary based on each customer’s age, location and the specific health plan chosen, ranging from $101.73 to $1,259 (Becker, 6/5).

Baltimore Sun: Maryland Panel Approves Hospital Rate Increase
A state panel voted unanimously Wednesday to increase the rates hospitals can charge by 1.65 percent, but the medical institutions say the amount is inadequate and will collectively drive hospitals into the red. The Maryland Hospital Association said the decision will cause operating margins to plummet to negative 0.24 percent. The association had pushed for a rate hike of 2.43 percent, which would have also pushed down margins, but still left hospitals operating in positive territory (Walker, 6/5).

Health Policy Solutions (a Colo. news service): Rates Vary Widely, Should Promote Brisk Insurance Market
Competition among health insurance companies should be brisk in Colorado, according to an analysis by a consumer health advocacy group. “As we’ve dug more deeply, we’ve seen enough competition that we think Colorado’s going to have a really good marketplace,” said Dede de Percin, executive director of the Colorado Consumer Health Initiative (CCHI). “Despite doomsday predictions, the state is not seeing ‘rate shock,’ so many of the choices will be more affordable, especially with the subsidies.” Regulators from Colorado’s Division of Insurance (DOI) are reviewing all proposed plans and must approve or deny them by July 31. Then, they’ll be available to consumers starting on Oct. 1 on Colorado’s exchange, Connect for Health (Kerwin McCrimmon, 6/5).

California Healthline: Physicians Wary – Or Simply Unaware – Of ACA Loophole
Doctors who contract with state health insurance exchanges next year might find themselves on the hook for treatment costs resulting from what many are calling a loophole in the Affordable Care Act. Some say the provision might prompt doctors to avoid the exchanges altogether, while other experts say few health care providers are aware of the issue and likely won't know about the loophole until it's too late. Under the ACA, if families who obtain subsidized health plan coverage through the exchanges fail to pay their premiums, they have a three-month grace period before the policy is cancelled. However, insurers are responsible only for paying claims during the first month of that grace period (Wayt, 6/5).

Health Policy Solutions (a Colo. news service): Feds Require Contingency Plans For Health Exchange
Federal health officials have required Colorado to create contingency plans in case the state’s health exchange can’t function as planned by the beginning of October. Documents that Solutions obtained show that Colorado health exchange managers are preparing for three primary problems that could undermine the planned Oct. 1 launch. … Colorado officials already had to deploy one contingency plan earlier this year. Colorado lawmakers set up the exchange as an independent public agency, not part of state government. Exchange officials and those at the state Medicaid office were planning to build a single shared IT "rules engine" to determine whether people qualify for Medicaid and are eligible for tax credits (Kerwin McCrimmon, 6/5).

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Small Businesses Continue To Mull Health Law's Implications

NPR reports that some say the health law is having a chilling effect on hiring by small businesses. In Virginia, the Governor's Small Business Summit is focusing on what might happen once the overhaul is in full force.

NPR: Is Obamacare Hurting Hiring By Small Businesses?
The Affordable Care Act, which has become known as Obamacare, will require small businesses with 50 or more employees to offer health care coverage to their workers. Some have suggested that could be discouraging hiring by small businesses (Ydstie, 6/6).

Richmond Times-Dispatch: Governor's Small Business Summit Focused On Health-Care Law
With less than seven months to go before the federal health care law goes into full effect, small businesses are still grappling with the law's implications. Most speakers at the Governor's Small Business Summit on Wednesday indicated they did not agree with the insurance reforms under the Patient Protection and Affordable Care Act, but tried to offer guidance (Gorman, 6/6).

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Capitol Hill Watch

GOP Eyes Medicare 'Doc Fix' Bill For Summer, Obamacare Replacement

House Republicans move forward on replacing Medicare's payment system for doctors with an eye on moving the measure this summer. In the meantime, a Republican readies an Obamacare replacement bill. 

CQ HealthBeat: House Medicare Payment Bill Could Be Ready This Summer
House Republicans said they are continuing to move ahead with legislation to replace Medicare's physician payment system but will wait to negotiate some of the more contentious issues. Rep. Joe Pitts, chairman of the House Energy and Commerce Health Subcommittee, said the panel remains “on track” and continues to work with Democrats and members of the Ways and Means Committee on a replacement measure (Ethridge, 6/5).

The Hill: Rep. Price To Unveil Bill To Replace ObamaCare
Rep. Tom Price (R-Ga.) on Wednesday said he was poised to unveil a wide-ranging replacement plan for the president's health care reform law. … Price said the bill is similar to one he offered in the last Congress, which had more than 80 cosponsors (Wasson, 6/5).

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Health Care Fraud & Abuse

Feds Step Up Medicare Anti-Fraud Efforts

USA Today: Policing Of Medicare Fraud Explodes Over Two Years
The government has revoked the ability of 14,663 providers and suppliers to bill Medicare over the past two years — almost two and a half times the number that had been revoked in the previous two years, new Department of Health and Human Services statistics to be released Thursday show. In some states, the number of revocations has quadrupled (Kennedy, 6/5).

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Coverage & Access

Reports Highlight Impacts Of Proposed Entitlement Changes, Reduced Health Care Spending

The Washington Post highlights a new report that finds elderly Americans are "economically vulnerable" to even modest changes in Medicare and other entitlement programs. Meanwhile, Modern Healthcare notes another report analyzing "the great debate" over health spending.

The Washington Post: Report: Entitlement Changes To Put Seniors At Financial Risk
Nearly half of the nation's elderly population is "economically vulnerable" and would be particularly hard hit by even modest changes in the Social Security and Medicare programs being considered to slow the growth of the nation's long-term debt, according to a new report (Fletcher, 6/5).

Modern Healthcare: Great Recession Spawns Great Debate Over Health Spending
Economists and policymakers are puzzling over how big an impact the Great Recession and its aftermath are having on reducing healthcare spending, whether the economic upswing will unleash pent-up demand for care, and whether the current lower spending is actually good for Americans' health. New research shows that household health spending declined even among those with private insurance and medical needs. Out-of-pocket costs for children with special medical needs declined between 2007, when the recession began, and 2009, the year the recession officially ended, a newly published study in Health Affairs says (Evans, 6/5).

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Health Care Marketplace

Health Law Provisions Spur Business Partnerships, New Opportunities

The New York Times reports that the Betty Ford Center and the Hazelden Foundation are pursuing an alliance while Kaiser Health News reports on how hospitals are sometimes caught in the middle of competing incentives.

The New York Times: Betty Ford Center And Hazelden Seek Business Partnership
With the Affordable Care Act poised to make addiction treatment available to millions of new patients, the Betty Ford Center and the Hazelden Foundation, two of the biggest names in substance abuse recovery, are pursuing a formal business alliance, the two groups said Tuesday (Quenqua, 6/5).

Kaiser Health News: Capsules: Of ACOs And Proton Beams: Why Hospitals 'Live In Two Worlds'
For the past several years, hospital CEOs have been talking a big game about accountable care—the latest health care model, which pays doctors and hospitals for quality, rather than the volume of services they provide. ACOs make providers jointly accountable for the health of their patients, giving them financial incentives to cooperate and to save money by avoiding unnecessary tests and procedures (Gold, 6/6).

In other marketplace news --

The Associated Press/Washington Post: UnitedHealth Board Approves 32 Pct Increase In Quarterly Dividend To 28 Cents Per Share
UnitedHealth Group will raise its quarterly dividend by another 32 percent as the price of its stock hits all-time highs. The payout is being made in the face of funding cuts to a key portion of the health insurer's business starting next year (6/5).

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Public Health & Education

Judge Orders Sebelius To Put Girl Who Needs Lung On Transplant List

A federal judge intervened in the case of a 10-year-old girl with cystic fibrosis who needs a lung transplant, ordering HHS Secretary Kathleen Sebelius to provide an exception and place the girl on the adult lung transplant list.

USA Today: Judge Orders Dying Pa. Girl Put On Transplant List
The national organ-transplant network is to hold an emergency review Monday, U.S. Sen. Pat Toomey, R-Pa., said in a statement. U.S. Health and Human Services Secretary Kathleen Sebelius on Tuesday refused to intervene in the lawsuit brought by Sarah's parents, saying that medical experts should make transplant decisions. She noted that three other children in Children's Hospital of Philadelphia are also gravely ill (Winter, 6/5).

Politico: Sarah Murnaghan Lung Transplant Case: Sebelius Ordered To Make Exception On Transplant
A federal judge on Wednesday ordered HHS Secretary Kathleen Sebelius to allow 10-year-old Sarah Murnaghan to be moved to the adult lung transplant list, giving her a better chance of receiving a potentially life-saving transplant. The quick and unusual ruling, made after a hastily scheduled emergency hearing, follows a campaign by the family and some members of Congress to pressure the Obama administration to change a federal policy that puts children under age 12 at the bottom of the list of those who can receive donated adult lungs (Norman and Millman, 6/5).

Reuters: Pennsylvania Girl Eligible For Adult Organ Transplant After Ruling
A 10-year-old girl with cystic fibrosis who had been kept off an adult organ transplant list due to an age restriction will now be eligible for an adult lung transplant, a federal judge in Pennsylvania ruled on Wednesday. The family of Sarah Murnaghan, a patient at the Children's Hospital of Philadelphia, sued to prevent the U.S. Department of Health and Human Services (HHS) from enforcing a policy that prevents children under age 12 from getting adult lung transplants regardless of how ill they are (Honan, 6/5).

Bloomberg: Sebelius Sued By Dying Girl's Family Over Transplant Rule
The family of a 10-year-old Pennsylvania girl who needs a lung transplant to survive won a temporary court order making her eligible to seek an organ from an adult donor after U.S. Health and Human Services Secretary Kathleen Sebelius denied her family's request.  Janet and Francis Murnaghan, whose daughter Sarah suffers from cystic fibrosis, filed a lawsuit yesterday in federal court in Philadelphia seeking to bar Sebelius from enforcing a department rule giving adults and adolescents priority over children younger than 12 for adult lungs (Wayne and Edney, 6/6).

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Women's Health

Dems' Senate Filibuster Rule Revamp Tempered By Abortion Vote Fears

Some supporters of abortion rights fear that any current changes could be used sometime in the future to restrict the option for women. Meanwhile, an appeals court rules that some morning-after pills should be available over the counter immediately.

Politico: Abortion Emerges As An Issue In Filibuster Fight
As Democrats consider whether to use the so-called nuclear option to rewrite the Senate's filibuster rules, one issue in particular has some liberals worried: abortion. Changing the rules to make it easier to confirm President Barack Obama's executive branch or judicial appointments may help the White House in the short term, and railing against Republican filibusters plays well with the Democratic base. But privately, that base and pro-choice groups are concerned how a future GOP president and Senate could take advantage of the new setup (Everett, 6/6).

NPR: Court Says Some Morning-After Pills Must Be Available OTC Now
A federal appeals court has dealt the Obama administration yet another blow in its quest to keep at least some age restrictions on the sale of emergency contraceptive pills. In a three-paragraph order, a three-judge panel for the United States Court of Appeals for the 2nd Circuit ruled that although the government's appeal of a lower court decision removing all age restrictions on morning-after pills is still pending, at least some medications must be made available over the counter immediately (Rovner, 6/5).

The New York Times: Judge Orders All Restrictions Lifted On Some 'Morning-After' Pills
A federal appeals court in New York on Wednesday ordered that some types of emergency contraceptives be made available for now to women of all ages without a prescription, adding another layer of confusion to a complex and intensely political fight over the drug's availability (Belluck and Shear, 6/5).

The Associated Press: Court To Allow Girls To Buy Morning-After For Now
A federal appeals court has decided to permit girls of any age to buy generic versions of emergency contraception without prescriptions while the federal government appeals a judge's ruling allowing the sales. The order Wednesday was met with praise from advocates for girls' and women's rights and scorn from social conservatives and other opponents, who argue the drug's availability takes away the rights of parents of girls who could get it without their permission. It is the latest in a series of rulings in a complex back-and-forth over access to the drug (Neumeister and Neergaard, 6/6).

Reuters: U.S. Sale Of Some 'Morning-After' Pills To All Ages Allowed
A U.S. appeals court on Wednesday said that some emergency contraception pills now can be sold over-the-counter without age restrictions while the federal government fights a lower court judge's order allowing unrestricted sales. In a brief order, the 2nd U.S. Circuit Court of Appeals allowed the two-pill version of emergency contraception to be sold without limits, including to girls under age 17, saying the U.S. Food and Drug Administration had not met the legal standard to justify limits (Stempel, 6/5).

NBC News: Court Orders FDA To Make Some Plan B Pills Available To All
An appeals court ordered the U.S. Food and Drug Administration on Wednesday to make certain forms of "morning-after" birth control pills available freely over the counter to anyone who wants to buy them. But the court said the FDA could continue to restrict access to a newer, one-pill formulation called Plan B One-Step while the agency appeals a lower court ruling. The ruling from the 2nd Circuit Court of Appeals instructs the FDA to make available two-pill versions of emergency contraception drugs that contain levonorgestrel (Fox, 6/5).

Boston Globe: Ruling Lifts Age Restrictions On Some Emergency Contraception
In a strange twist of events, a federal appeals court ruled Wednesday that two-pill generic versions of the morning after pill should be immediately made available over the counter, without any age restrictions; the court, though, denied unrestricted sales of the Plan B One-Step product until it determines whether the government’s appeal should be upheld. Last month, the federal government appealed a New York state judge's ruling ordering emergency contraception to be made available on drugstore shelves next to condoms and tampons and without any age restrictions (Kotz, 6/5).

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State Watch

Wis., Pa., Ariz. Lawmakers Seek Further Abortion Regulation

Add lawmakers in Wisconsin, Pennsylvania and Arizona to the long list of states seeking to further restrict and regulate the availability of abortions.

Milwaukee Journal Sentinel: Bill Would Require An Ultrasound Before An Abortion
An ultrasound would be required before an abortion under a bill moving through the Legislature, and clinics that perform the procedure would need admitting privileges at a nearby hospital -- a provision that has threatened to shut down clinics in other states. "The ultrasound is the gold standard of medical decision-making," Sen. Mary Lazich (R-New Berlin) said during her testimony Wednesday before the Senate Health and Human Services Committee. "The intent of the legislation is to strengthen the informed-consent law” (Phillis, 6/5). 

PA Independent/Philadelphia Inquirer: Corbett To Sign Bill Banning Abortion Coverage In Obamacare Exchanges
Women in Pennsylvania will have the right to choose insurance through the state health exchange, but it won’t extend to abortion. … The state Senate on Wednesday voted 31-19 to approve House Bill 818, which prohibits insurance policies offered through Pennsylvania’s upcoming health-care insurance exchanges from offering abortion coverage. The bill, which already passed in the House, goes to Gov. Corbett (Wilson, 6/5).

Arizona Republic: Abortion-Clinic Regulations Urged
An influential conservative advocacy group is pushing last-minute legislation to further regulate abortion clinics. The Center for Arizona Policy, which has written nearly all legislation restricting abortions in recent years, will call on lawmakers at a rally today to allow the Arizona Department of Health Services to conduct unannounced inspections of abortion clinics (Rau, 6/5).

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Medicaid Fraud Settlement Becomes Part Of Virginia Gubernatorial Campaign

Virginia Attorney General Ken Cuccinelli says he is taking on the IRS over a Medicaid fraud settlement payment from which the state is owed $125 million. But Democrats in the state's congressional delegation say they had been working on the issue for months and accused him of using his office for a campaign stunt in the gubernatorial race.

The Washington Post: Cuccinelli Takes On IRS Over Payment to Virginia
Cuccinelli is in a bitter fight with McAuliffe, a Democrat, to succeed Gov. Robert F. McDonnell (R). The attorney general called a morning news conference to announce that the IRS was refusing to release $125 million, part of the assets forfeited in a Medicaid fraud investigation that his office led. The case produced a $1.6 billion plea agreement with Abbott Laboratories for illegally promoting unapproved uses of its drug Depakote. It was the second-largest Medicaid fraud settlement in U.S. history (Vozzella, 6/5).

The Associated Press/Washington Post: After Va. Attorney General Complains Of Delay, Feds Cite Requirements For Releasing $115M
Hours after Virginia Attorney General Kenneth Cuccinelli complained that the Internal Revenue Service was blocking the release of more than $100 million owed to Virginia from a Medicaid settlement, federal officials said Wednesday that they are prepared to cut a $10 million check but need additional information before transferring the rest (6/5).

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State Highlights: N.Y. Hospital Struggles To Reopen Post-Sandy

A selection of health policy stories from New York, Georgia, Florida, Maine, Oregon and Missouri.

The Associated Press/Washington Post: Suburban N.Y. Hospital Damaged By Superstorm Sandy Struggles To Reopen
Officials at the last hospital still closed because of damage from Superstorm Sandy are no longer predicting when they will be able to reopen. The Long Beach Medical Center, located on a waterfront channel just east of New York City, suffered heavy flooding damage in the October storm, requiring at least $56 million in repairs, hospital officials said (6/5).

Georgia Health News: Aetna Regional Chief Sees 'Dynamic' Times Ahead
Aetna's newly named head of its Southeast region said the company plans to launch accountable care organizations in the Georgia and Florida markets in coming months. Those networks, promoted in the 2010 health reform law (the Affordable Care Act), are combinations of physicians, hospitals and insurers that seek to deliver high-quality, efficient medical care. Mark LaBorde, an Emory University graduate who worked for Aetna in Georgia for 13 years, also said Wednesday that the company's acquisition of Coventry will bring the combined companies' membership to more than 700,000 in Georgia (Miller, 6/5).

Medscape: Physician-Assisted Suicide Voted Down In Maine
The Maine House of Representatives overwhelming defeated a bill on May 31 that would have made the state the fourth in the nation to explicitly legalize physician-assisted suicide. The vote was 95 to 43 to squelch the measure. The idea of allowing physicians to help the terminally ill die on their own terms has gone before voters and lawmakers over the past 12 months with mixed results. Voters in Massachusetts last November rejected a physician-assisted suicide proposal in a referendum while Vermont lawmakers approved a similar measure on May 13 (Lowes, 6/5).

Lund Report: Public Health Budget Calls For $4 Million In Tobacco Dollars For Prevention
The Joint Ways & Means Subcommittee on Human Services voted Tuesday to approve a preliminary budget for the Oregon Health Authority’s Public Health Division, putting up $4 million from the tobacco master settlement agreement for prevention. If the figure goes forward as the Legislature enacts the budget, this would be the first time Oregon dedicated tobacco settlement dollars directly to tobacco prevention programs, but the $4 million figure is a steep drop from the $12 million asked for earlier this session by Rep. Carolyn Tomei, D-Milwaukie, and public health advocates such as Tobacco-Free Oregon.

St. Louis Beacon: Reports Link Health Disparities Among Blacks, Hispanics To Education, Economics, Lifestyle
Eduardo Crespi says he puts in long hours promoting healthy habits among blacks and Latinos in the Columbia and Joplin regions of Missouri. … The reports on medical conditions among blacks and Hispanics show that health care disparities persist in minority communities across the state, triggering generally higher rates of illness, injury and death than among Missouri's whites (Joiner, 6/5).

Health News Florida: Pharmacists, Doctors Ignore Database
Only one-third of pharmacists and 10 percent of doctors are using Florida's prescription drug database, and that's a serious problem, federal officials told the state Board of Pharmacy on Tuesday. A consumer member of the board has been working hard to get the board to require such a check, but he didn't get anywhere on Tuesday at the board's meeting in Miami (Lamendola, 6/5).

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Weekend Reading

Longer Looks: Obamacare Explained; The Dark Side Of Med School; Tattoos Removed

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

KQED/The California Report: Obamacare Explained: A Guide For Californians
Whether you love it, hate it or are just plain confused, the ACA is the law of the land. The thousand-page law covers a lot of ground and figuring out what part of it has to do with you can be a challenge. Don't panic. We're here for you. This guide explains how the health law affects you, your family or your small business, here in California. It's for people who already have insurance and people who don't — but want to get it. ... If you're concerned about the cost, we also show you what help is available (Lisa Aliferis, 6/3).

Association of Health Care Journalists: Revisit How High-Risk Insurance Pools Are Working In Your State
There are two basic kinds of high-risk pools – about 35 states have some form of high-risk pools that predate the Affordable Care Act, and all states have Pre-Existing Condition Insurance Pools created by the federal law. ... Some states administer these "PCIPs" themselves, and some let the federal government run them. "Red" states tended to hand it to the feds, "blue" states tended to run it themselves but there were enough exceptions in both directions to make this less political than the fight over the state-run health insurance exchanges going online in 2014 (Joanne Kenen, 6/4).

New York Magazine: Is Obamacare A War On Bros
The incessant drumbeat of predictions that the Affordable Care Act will wreak havoc upon the land is a long, frustrated quest to find sympathetic victims. There are, to be sure, clear losers from the new health-care law. Rich people have to pay higher taxes to fund its subsidies. Many doctors and hospitals will lose some of their income stream from the law tightening up unnecessary care. Yet neither the medical specialist nor the hospital executive nor the upper-income taxpayer quite offer the politically sympathetic face of the Everyman struggling under Obama's socialist boot conservatives are looking for. The search has instead come to focus on a new paradigmatic victim: the healthy, financially secure 25-year-old male (Jonathan Chait, 6/5).

Forbes: Rate Shock: In California, Obamacare To Increase Individual Health Insurance Premiums By 64-146%
Last week, the state of California claimed that its version of Obamacare's health insurance exchange would actually reduce premiums. "These rates are way below the worst-case gloom-and-doom scenarios we have heard," boasted Peter Lee, executive director of the California exchange. But the data that Lee released tells a different story: Obamacare, in fact, will increase individual-market premiums in California by as much as 146 percent (Avik Roy, 5/30).

Forbes: Closing Racial And Ethnic Disparity Gaps: Implications Of The Affordable Care Act
For all intents and purposes, the Affordable Care Act (ACA), the President's signature piece of legislation, will provide more health care coverage to poor and underserved populations. Persistently disadvantaged communities have much further to go than those with insurance, and new means of accessing and paying for care will benefit them disproportionately. Nevertheless, with more than 20 percent of the nation's Black population uninsured, more than 30 percent of Hispanics uninsured and a country still grappling with understanding and properly addressing disparities, just how far does the ACA take us (Nicole Fisher, 5/28)?

The New York Times Magazine: Deeda Blair's Elegance Of Conviction
Whether she's tackling the complexities of science or style, the medical philanthropist, fashion icon and social mover Deeda Blair approaches all facets of life with quiet but unwavering discipline. Most scientists are astonished by Deeda Blair's style, and the style mavens are surprised by her scientific expertise. That is obvious to even the most casual observer of her life. If one penetrates those disparate worlds, however, one soon finds that neurobiologists credit her with helping them think through difficult questions, and that fashionistas must employ metaphors from 18th-century France to describe the impeccable way she dresses and entertains (Andrew Solomon, 5/31).

Slate: The Darkest Year Of Medical School
Next month, your future doctor will take the first steps into clinical medicine. I am not talking about the first day of internship (though that also happens on July 1), but the monumental transition that medical students make at the halfway point of medical school from the classroom years to the clinical years. … However, there is a darker side of this transition to clinical medicine. Many of the qualities that students entered medical school with—altruism, empathy, generosity of spirit, love of learning, high ethical standards—are eroded by the end of medical training (Danielle Ofri, 6/4).

The Boston Globe: Nondoctors Enter World Of Tattoo Removal
Rob Harris is an avid rock climber and "gym rat" at a climbing wall in Everett. It's a place with a lot of young people, a lot of strong people — and "a lot of skin showing," he said. And a lot of tattoos, which puzzled him. "I'd see them on wrists and necks, and places where it seemed people would regret it," said Harris, 42. So last fall when he was laid off, he knew what his next career move would be: He'd remove tattoos. … Harris joins a growing number of entrepreneurs who are starting businesses specializing in laser tattoo removal, a procedure that was once the exclusive domain of physicians. As more practitioners do it, and as the technology evolves, tattoos no longer seem to be forever (Linda Matchan, 5/31).

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Editorials and Opinions

Viewpoints: 'Reasonable' Debate About Health Law's 'Rate Shock;' 'Absurdity' Of Sebelius' Account Of Fund Raising; Obama Killed The Grand Bargain

The New Republic: Un-Rigging The Rate-Shock Debate
Many of us have been wondering whether it's possible to have an honest, reasonable debate about Obamacare. To my pleasant surprise, one may finally be starting. It's about the same subject that got me all worked up early this week: Whether Obamacare will cause "rate shock" among people buying insurance coverage on their own, through the new insurance exchanges. And if you pay attention to the right people, you'll discern a basic consensus about the facts. The consensus goes like this: Some people buying coverage on the exchanges will pay more for insurance than they do today. Some people will pay less. The benefits will be better and the policies will be more widely available, but those changes require their own trade-offs, like forcing some people to get more coverage than they want. The insurance offerings from California—the announcement that set off this debate—were better than most of us were expecting. But the numbers in other states could look a lot worse (Jonathan Cohen, 6/5). 

The Washington Post's The Plum Line: Obamacare And Collective Action
There's been a big debate going on over the last two weeks about the Affordable Care Act and "young healthies" — people who don't really need much health insurance, and who (conservatives have discovered) may pay more when the ACA fully kicks in. As Jonathan Cohn and Sarah Kliff point out in detail, the point is severely overstated, because Obamacare won't just tend to raise premiums for those who don't use much insurance, but also gives subsidies for lots of people, so that the overall outcome for many is actually better than the old status quo (Jonathan Bernstein, 6/5).

The New York Times: The Split Between The States
Wisconsin and Minnesota are neighboring states with long traditions of caring for the least fortunate, but, at the moment, only one of them is concerned about the health of the poor and uninsured (6/5).

Los Angeles Times: Divvying Up California Healthcare Funds
The 2010 federal healthcare law will make health coverage available to millions of the uninsured, but it won't reach all of them. In California, county health officials and the Brown administration are now tussling over how much to spend on the remaining uninsured, and on county health programs in general. Gov. Jerry Brown wants to reclaim some of the state tax dollars that counties have been spending because there will be fewer uninsured to care for, and that's not unreasonable. But the state should be careful not to undermine the counties' efforts to protect public health, nor should it deny them the ability to care for more people in a more cost-effective way, if they choose (6/6).

Virginia Pilot: Expand Medicaid, Save Money, Lives
Virginia lawmakers established a commission this year to determine whether to expand Medicaid, a move that allowed General Assembly Republicans and Gov. Bob McDonnell to defer a decision until federal officials accept a series of cost-cutting reforms. The strategy is just as misguided as outright refusal. Virginia, previous analyses have shown, would get back nearly all of the tax dollars its residents pay over the next several years if the commonwealth expands Medicaid (6/6).

Sacramento Bee: Should State Close 'Loophole' In Health Care Law? Yes
Unfortunately, a small number of large corporations are skirting their responsibility to provide health care or pay a penalty by cutting hours and wages so low that workers end up on taxpayer-funded Medi-Cal. Why Medi-Cal? Because on Medi-Cal there is currently no penalty or cost to the employers. Due to this loophole in the ACA, these big companies can avoid paying their fair share, and taxpayers pick up the tab instead. This loophole will have devastating consequences on the state budget if it is not closed (Jimmy Gomez, 6/6). 

Sacramento Bee: Should State Close 'Loophole' In Health Care Law? No
While sponsors of Assembly Bill 880 suggest it would affect only a few large and profitable companies, the facts are quite different. This legislation would have a broad and devastating impact on organizations in nearly every industry in this state, including nonprofits such as the Community College Foundation. The Community College Foundation serves at-risk youths to improve communities through education. We can employ more than 500 tutors to work with thousands of K-12 youths who are one to three grade levels behind. ... Most of our good work for those most at risk could screech to a halt if AB 880 passes (Rick Fowler, 6/6).

Bloomberg: Sebelius' Absurd Excuses On Obamacare Fundraising
Kathleen Sebelius, secretary of the Department of Health and Human Services, told a House committee yesterday that she did nothing wrong by suggesting to companies she regulates that they support a group publicizing the Affordable Care Act. Let's consider the absurdity of that position by looking at the arguments behind it (Christopher Flavelle, 6/5).

National Review: How Obama Killed The Grand Bargain
Prospects for a "grand bargain" on the budget finally seem dead, and, we’re told, the reason is the improved budget outlook. While it is certainly true that the Congressional Budget Office’s latest projections of federal deficits over the coming decade are less dismal than they were previously, that’s not the main reason Washington has lost interest in a bipartisan compromise on the budget. The chances of such a compromise have been low all year, and are due to the tactical choices made by the one person with the most to gain from a deal — the president (James C. Capretta, 6/6).

Los Angeles Times: Get Rid Of Those Outdated HIV Laws
A bipartisan bill introduced in the House calls for a review of state laws that criminalize behavior by people with HIV, including many laws that seem anachronistic or inappropriate given what has been learned during the last three decades about the transmission and treatment of the virus that causes AIDS. The bill should be passed (6/6).

Roll Call: Cancer Patients Are Being Left Behind
Just when we all thought Congress was gridlocked beyond hope, it successfully pushed through a legislative change that would improve the daily lives of millions of Americans. It didn't improve funding for poor children whose programs had been cut by the federal sequester, and it didn't work to make changes that would safeguard public health or safety initiatives. Working together and reaching across the aisle, the members quickly and decisively made changes that ensured their flights to and from Washington, D.C., would not be delayed as a result of cuts from the sequester. If only cancer patients could be so fortunate (Nancy Davenport-Ennis, 6/5).

The New England Journal of Medicine: In Support of SUPPORT — A View From The NIH
The Surfactant, Positive Pressure, and Oxygenation Randomized Trial (SUPPORT), carried out at more than 20 sites between 2004 and 2009, sought to identify, in infants born very prematurely at 24 to 27 weeks' gestation, the oxygen-saturation level within the range considered the standard of care that would minimize the risk of retinopathy of prematurity (ROP), a complication of oxygen therapy that can result in vision loss. ... The circumstances surrounding the SUPPORT study have unquestionably created controversy in the research community, but the situation has created an opportunity for a better understanding of the scientific and ethical issues that must be addressed when designing such studies in the future (Kathy L. Hudson, Drs. Alan E. Guttmacher and Francis S. Collins, 6/5).

The New England Journal of Medicine: How AIDS Invented Global Health
[T]he progress made in addressing this pandemic and its effects on science, medicine, and public health have been far-reaching. The changes wrought by HIV have not only affected the course of the epidemic: they have had powerful effects on research and science, clinical practices, and broader policy. AIDS has reshaped conventional wisdoms in public health, research practice, cultural attitudes, and social behaviors. Most notably, the AIDS epidemic has provided the foundation for a revolution that upended traditional approaches to "international health," replacing them with innovative global approaches to disease (Allan Brandt, 6/5).

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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.