Daily Health Policy Report

Friday, June 7, 2013

Last updated: Fri, Jun 7

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Public Health & Education

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Can I Stop My Health Reimbursement Account From Being Drained? (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a question from a reader about who pays first when there is coverage from two insurance plans (6/7). Watch the video or read the transcript.

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Capsules: Latinos Key To Obama’s Health Law Strategy; Study: Consumers Saved $2.1B On Individual Coverage

Now on Kaiser Health News' blog, Jenny Gold reports on the Obama administration's outreach strategy for Latinos: "President Barack Obama, who was re-elected with strong support from the Latino community, is in California today to endorse a plan that focuses on getting Latino Americans signed up for coverage under his health care law" (Gold, 6/7).

Also on Capsules, Julie Appleby reports on a new study about the costs of individual coverage: "People who bought their own health insurance last year saved $2.1 billion because of the federal health law, mainly because of a provision that limits how much of their premium can go to insurers' administration and profits, says a report out today from the Kaiser Family Foundation" (6/7). Check out what else is on the blog.

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Political Cartoon: 'But Wait, There's More!'

Kaiser Health News provides a fresh take on health policy developments with "But Wait, There's More!" by Rex May.

Meanwhile, here is today's health policy haiku:


House Republicans
have high HOAPs they can undo
Obamacare law. 

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

Obama To Tout California As Health Law Model

President Barack Obama is slated to speak in San Jose, Calif., about the implementation of the health law and point to the coordination among public and private groups there as a model for the rest of the country. Latinos -- in California and across the nation -- will be one of his target audiences.

CBS News: Obama Looks To California For Health Law Success
Republicans in most of the country are still fighting Obamacare tooth and nail, but President Obama Friday is in one state where the Affordable Care Act has escaped the GOP's obstruction tactics: California. On his second day in the Golden State (where he's attending fundraisers and meeting with Chinese President Xi Jinping), Mr. Obama on Friday morning will make a statement about the ongoing implementation of his three-year-old health law and point to California as a model for the rest of the nation (Condon, 6/7).

The Associated Press/Washington Post: Obama Pleads For Californians, Latinos, Young People To Get Coverage Under New Health Care Law
President Barack Obama is making a personal plea to Californians, Latinos and young people to sign up for coverage under the new health care law. Obama on Friday will use his visit to California to highlight how the state is implementing the Affordable Care Act. He also will discuss California's collaboration with non-government groups to promote, primarily to Hispanics, the health care exchanges that are being created to help millions of now-uninsured consumers afford coverage, White House officials said (6/7).

State Of Health: President Obama To Speak In San Jose On Health Law
President Obama is expected to deliver remarks about the ongoing implementation of his signature health law, the Affordable Care Act, Friday morning in San Jose. Last month the state’s health insurance marketplace, Covered California, released preliminary plans and premiums they expect to offer. Average premiums for these plans were lower than had been anticipated. Senior administration officials say they are "encouraged by what we see in California" in terms of "competitive choices" (Aliferis, 6/7).

The Washington Post: California Is The White House's Proof That Obamacare Is Working
President Obama will try to allay anxiety over his signature health-care law Friday during a visit to California, a state that the White House is highlighting as proof that the law is working. With the focus in recent months on the law’s shaky rollout and continuing political battles, the president wants to draw attention to a state that has embraced the law and yielded some good news: Officials in the Democrat-led state recently released figures that show insurers expect to charge lower-than-expected premiums for individual policies sold under the law (Somashekhar and Kliff, 6/6).

San Jose Mercury News: Obama Arrives In Bay Area To Raise Money For Senate Dems, Tout Obamacare
As controversy swirled in the nation's capital about the power of Big Data, President Barack Obama arrived in the heart of Silicon Valley on Thursday to raise money for Senate Democrats and speak Friday about California's success in implementing Obamacare. After Air Force One touched down at Moffett Federal Airfield at 5:40 p.m., Obama emerged from the plane about five minutes later and was greeted by NASA Ames officials and Sunnyvale Mayor Tony Spitaleri and Mountain View Mayor John Inks, among others. The president then shook hands with dozens of invited guests on a rope line, including a few kids dressed in their Sunday best, before being whisked to Palo Alto for a Democratic fundraiser (Richman, Bender, and Eslinger, 6/7).

Modern Healthcare: Obama To Spotlight Calif. Effort Promoting ACA
President Barack Obama today will promote a California effort to educate Americans about the health reform law and insurance coverage enrollment that the administration hopes will serve as a model for other states. In California on Thursday to attend events for the Democratic Senatorial Campaign Committee, the president continued his trip in the Golden State and is expected to provide a statement about the Patient Protection and Affordable Care Act at the Fairmont Hotel in San Jose around 9 a.m. Pacific Time Friday (Zigmond, 6/7).

ABC News: Obama To Promote Affordable Care Act To Latinos In California
As he travels to San Jose, Calif., today, President Obama will highlight how the Affordable Care Act (ACA) will impact Latinos across the country. Obama plans to use the trip to explain how the ACA aims to expand medical coverage for all Americans, and specifically work to improve coverage among the Latino population. More than 10 million uninsured Latinos will qualify for healthcare insurance exchanges through the ACA, according to the White House (Avila, 6/7).

Kaiser Health News: Capsules: Latinos Key To Obama's Health Law Strategy
President Barack Obama, who was re-elected with strong support from the Latino community, is in California today to endorse a plan that focuses on getting Latino Americans signed up for coverage under his health care law (Gold, 6/7).

Bloomberg: Obama Targets Hispanics For Healthier Exchange Enrollees
The Affordable Care Act's initial success next year depends on President Barack Obama's ability to coax at least 2.6 million people who are young and healthy to sign up for health insurance. Hispanics may be the key. About one-third of the young and healthy people the government wants to enroll in new health exchanges live in California, Texas and Florida, a senior Obama administration official told reporters yesterday (Wayne, 6/7).

The Wall Street Journal's Washington Wire: Ohio Complains Of Higher Health-Insurance Premiums
President Barack Obama is heading to California to tout premiums for new health plans that will be sold on the state's insurance exchange. Ahead of that visit, his officials are getting early incoming fire from officials in Ohio, who say that premiums for their state have jumped dramatically because of the health-care law’s new requirements for richer benefits (Radnofsky, 6/6).

The Fiscal Times: Battles Over Obamacare Take On Campaign-Style Fervor
As President Obama prepares to deliver an address in California Friday heralding the benefits of the Affordable Care Act, a political-style campaign is taking shape between supporters who seek to sign up tens of millions of uninsured Americans for new health care insurance – and opponents working feverishly to try again to stop the program in its tracks (Pianin, 6/7).

Politico: House GOP's New Anti-ACA Group
House Republicans are planning a coordinated messaging operation against Obamacare starting this summer. They call it HOAP — the House Obamacare Accountability Project (Haberkorn and Cunningham, 6/7).

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Tech Experts Brace For Glitches When Health Exchange Websites Come Online

As planners race to finish building the online marketplaces that consumers can begin using Oct. 1 to shop for health insurance, experts expect some difficulties, according to The Wall Street Journal. Meanwhile, CQ HealthBeat examines whether the deductibles and out-of-pocket caps applied in these marketplaces will be too high.

The Wall Street Journal: Planners Expect Glitches In Health-Exchange Sites
Teams of technology experts are racing to finish building government websites that will allow people to shop and sign up for health insurance this October. People involved in the effort say to expect some problems, at least initially. The functioning of the websites—which will enable people without health insurance to enroll in plans offered through a federal or state insurance exchange—will play a major role in determining whether the Affordable Care Act is deemed a success or failure, since the 2010 law's prime objective was to bring coverage to those who lack it (Dooren, 6/6).

CQ HealthBeat: Are Deductibles And Out-Of-Pocket Caps Too High In Marketplaces?
High cost-sharing in the new marketplaces may deter some healthy people from buying coverage, the chief executive of CareFirst BlueCross BlueShield said in an interview Thursday. Chet Burrell, CareFirst president and CEO, said the plans insurers will offer that are set at the bronze level and silver level of benefits called for under the health law "have huge amounts of cost sharing for members" (Adams, 6/6).

Also in the news, state implementation developments from New Hampshire and Maryland -

The Associated Press: NH Senate Kills Health Overhaul Bill
The state Senate on Thursday killed a bill aimed at aligning state insurance rules with President Barack Obama's health care overhaul law, but the same provisions will be revisited when lawmakers negotiate over a separate bill. Opponents cast the bill as an attempt to move New Hampshire toward a state-operated marketplace, something specifically prohibited by a state law passed last session (Ramer, 6/6).

CQ HealthBeat: Maryland Outreach Groups Get a Heavy Dose Of Health Law's Complexities
Maryland officials convened a summit this week to fire up outreach groups charged with enrolling the uninsured in health coverage this fall, and the daunting size and complexity of the job quickly became apparent. It was clear from the morning-long meeting Wednesday of several hundred community, church, social services, and local health officials that even in a well organized, committed state like Maryland, expanding health coverage this fall and winter under the health law is going to be a heavy, heavy lift (Reichard, 6/6).

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Costs And Coverage: Trying To Discern Who Will Experience Health Law Gains Or Feel Its Pinch

The Wall Street Journal reports on how the law might impact small businesses that employ young and healthy workers as well as whether the measure's new coverage might be too expensive for low-paid employees. Also in the news, a report concludes that U.S. consumers who purchase health insurance on the individual market saved $2.1 billion last year due to the overhaul's rules.

The Wall Street Journal: How The New Health Law Could Raise Costs For Young, Healthy Employees
The younger and healthier a small business's workforce, the greater its chances of facing a big spike in health-insurance premiums next year. That is because the Affordable Care Act's impact on small employers will split largely on generational and industry lines, putting entrepreneurs like Eileen Hasson, owner of a technology-services firm with mostly male employees in their 20s and 30s, at a disadvantage (Needleman, 6/6).

The Wall Street Journal: Will New Health Insurance Be Too Expensive For America's Lowest-Paid?
For people like Salvador Martínez, a 50-year-old grounds crewman, the health-care law seems to be a potential game changer. Because of the law, his employer, a landscaping service in Santa Clarita, Calif., will begin offering coverage to him, and to its 230 other low-wage workers, next year. But Chris Angelo, a second-generation owner of the landscaping firm, Stay Green Inc., doesn't expect a groundswell of enrollments next year from lower-wage workers such as Mr. Martínez (Maltby, 6/6).

Los Angeles Times: Health Led To $2.1 Billion In Savings For Consumers, Report Says
A new report estimates that U.S. consumers who purchase their own health insurance saved $2.1 billion last year due to tougher rules in the federal healthcare law. Thursday's report by the nonpartisan Kaiser Family Foundation estimates that individual premiums would have been $1.9 billion higher in 2012 without the requirements in the federal Affordable Care Act. In addition, the nonprofit group said individual policyholders nationwide should receive $241 million in rebates this summer (Terhune, 6/6).

Kaiser Health News: Capsules: Study: Consumers Saved $2.1B On Individual Coverage
People who bought their own health insurance last year saved $2.1 billion because of the federal health law, mainly because of a provision that limits how much of their premium can go to insurers' administration and profits, says a report out today from the Kaiser Family Foundation (6/7).

The Hill: ObamaCare Rule Lowered Premiums, Analysis Finds
ObamaCare's rule that insurance companies spend no less than 80 percent to 85 percent of premiums on medical care has allowed many consumers to pay less for their coverage, according to a new analysis. The Kaiser Family Foundation studied the figure, called the medical loss ratio (MLR), and reported that it led to $1.9 billion in premium savings and $1.1 billion in consumer rebates last year (Viebeck, 6/6).

The law also sometimes leads to new jobs in some locations --

Los Angeles Times: Affordable Care Act Spurs Hiring Blitz
The nation's complicated healthcare overhaul is proving to be a surprising source of work: People are needed to explain the law's provisions to consumers. In addition to the expected demand for more nurses and doctors to treat millions of newly insured patients, the federal Affordable Care Act is feeding a cottage industry in call centers (Lopez, 6/6).

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Capitol Hill Watch

Prominent Republican Leaves Immigration Overhaul Talks Over Immigrant Health Care

On Capitol Hill, Rep. Raul Labrador says he disagreed with others in the talks about health provisions for immigrants who are here illegally now but would gain legal status under the bill. Also, CMS announces that it cannot stop sequestration cuts to Medicare's reimbursement for cancer drugs.

The New York Times: In House, Immigration Spurs Push By G.O.P.
Late Wednesday, a bipartisan group of representatives who had been meeting to write a broad immigration bill announced they had completed their negotiations. But a prominent Republican in the group, Raúl Labrador of Idaho, said he was leaving. Mr. Labrador said that he disagreed with the other lawmakers over health care provisions for illegal immigrants who would gain legal status under the measure (Parker and Preston, 6/6).

Medscape: No Stopping Sequestration Cancer Cuts, Says CMS
There is no stopping the cuts to Medicare's reimbursement of cancer drugs mandated by the federal budget sequestration, according to a June 3 letter from the Centers for Medicare and Medicaid Services (CMS) to members of the US Congress. The cuts have infamously caused cancer clinics across the country to turn away Medicare patients. The letter from CMS to members of Congress who had appealed for a workaround of the cancer-specific cuts was first reported yesterday by the Huffington Post (Mulcahy, 6/6).

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Public Health & Education

Judge's Second Ruling On Child Transplants Prompts Ethical, Political Questions

A federal judge issued a second ruling in as many days allowing another dying child onto an adult transplant list -- a move that could have ramifications for thousands of adults waiting for donated organs.

The Associated Press/Washington Post: Judge's Rulings In Heart-Wrenching Cases Raise Questions Of Fairness In U.S. Transplant Policy
It’s a life or death matter: Who gets the next scarce donated organ? In an unprecedented challenge to the nation's transplant system, a federal judge has allowed one dying child -- and a day later another -- to essentially jump the line in rulings that could have ramifications for thousands of people awaiting new organs (6/7).

Politico: Court Steps Into Second Child Lung Transplant Case
A federal judge in Philadelphia has granted a temporary restraining order in the second case involving children needing lung transplants in as many days, raising questions among ethicists about political pressure, emotional media coverage and case-by-case decision making about allocating scarce organs (Norman, 6/7).

Meanwhile, another lawmaker asks the Health and Human Services secretary to intervene in the case of a child with end-stage cystic fibrosis --

The Hill: Toomey Calls On Sebelius To Change 'Flawed' Organ Donation Policy
Sen. Pat Toomey (R-Pa.) called on Health and Human Services (HHS) Secretary Kathleen Sebelius Thursday to change an organ donation policy. … Toomey said a 10-year-old Pennsylvania girl named Sarah Murnaghan needs a lung transplant otherwise she "might only have a few weeks to live" (Cox, 6/6).

And ethicists weigh in on the issue --

USA Today: Ethicists Weigh In On Pediatric Lung Transplant Case
There are almost 1,700 people in this country on the waiting list for a lung transplant, including 31 children under age 11, according to the Organ Procurement and Transplantation Network. But none captured the public's attention like the case of Sarah Murnaghan, age 10, who suffers from end-stage cystic fibrosis (Hellmich, 6/7).

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Health Care Marketplace

FDA Panel Loosens Avandia Safety Restrictions

Despite some concern over whether the diabetes drug Avandia can increase heart problems, an FDA panel Thursday loosened restrictions on how doctors can prescribe the drug.

The New York Times: FDA Vote Is Minor Victory For Troubled Diabetes Drug
A panel of experts voted Thursday to loosen restrictions on a controversial diabetes drug, saying doctors should have more freedom to prescribe it to patients. But the decision was unlikely to improve prospects for the drug; sales have sagged since a highly publicized episode in 2007, when a doctor showed evidence that it increased the risk of heart problems (Tavernise and Thomas, 6/6).

The Associated Press/USA Today: FDA Panel Favors Easing Safety Limits On Avandia
Federal health experts are recommending changes to safety restrictions on former blockbuster diabetes pill Avandia, in light of a new analysis suggesting that the drug may not increase the risk of heart attack as much as previously thought (6/6).

Medpage Today: FDA Panel Loosens Noose On Avandia
A panel of FDA advisers thinks it is time to ease restrictions on access to Avandia (rosiglitazone), a onetime multimillion dollar blockbuster drug brought low by reports that it increased the risk of heart attacks. In a combined meeting of separate FDA advisory committees, 20 of 26 panelists voted Thursday to recommend removing or modifying rosiglitazone's highly restrictive label and distribution system. Five voted to keep the product's risk evaluation and mitigation strategy (REMS) as it is now. One panelist voted to remove the product from the market. Of the 20 panelists who voted to remove or modify the labeling and distribution system, 13 voted to modify it and seven voted to remove the REMS entirely (Pittman, 6/6).

Medpage Today: Law Weakens FDA Conflict-Of-Interest Regs
More drugs with dangerous side effects could get onto the market as the result of recent legislation that loosens conflicts of interest restrictions on experts serving on panels that advise the FDA, according to a new analysis. The analysis, published in the journal Science, reviewed a 2007 law that placed caps on the number of waivers that could be granted allowing experts with conflicts of interest and a 2012 law that removed those safeguards (Fauber, 6/6).

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'Medical Home' Experiment Reduced Costs, Improved Care Even More In Second Year

Reuters: New Health Care Model Cut Even More Costs In Year Two: Insurer
The nation's largest experiment in delivering medical care in an innovative way has reduced costs and improved the quality of care even more in its second year than in its first, according to the insurance company behind it. The nonprofit CareFirst BlueCross BlueShield launched its "Patient-Centered Medical Home" program in January 2011 among primary-care providers serving about one-third of its 3.4 million members in Maryland, Washington, D.C., and northern Virginia (Begley, 6/6).

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State Watch

State Highlights: Ore. Schools Face Insurance Exchange Choice

A selection of health policy stories from Wisconsin, Oregon, Arizona, New York, Minnesota and California.

Los Angeles Times: Wal-Mart's Wages Drive Employees Onto Public Benefits, Report Says
Wal-Mart Stores Inc. wages are so low they force many of its employees onto the public doles, creating a drag on taxpayers and the economy, according to a new report from the staff of congressional Democrats. The report analyzes data from Wisconsin's Medicaid program, estimating that a single 300-person Wal-Mart Supercenter in that state likely costs taxpayers at least $904,542 per year and could cost up to $1,744,590 per year, or roughly $5,815 per employee (Lazo, 6/7).

Lund Report: Legislators Pave The Way For School Districts To Join Cover Oregon
School districts now have a choice. Starting in 2015, they can either purchase insurance coverage from the exchange, known as Cover Oregon, or remain in the Oregon Educators Benefit Board. Earlier this week, the Senate gave districts that authority. This wasn't the first time the issue surfaced at the Legislature. Actually, lawmakers made that decision earlier and state officials have already signaled to the federal government that they want a waiver to proceed (Gray, 6/6).

The Associated Press: Anti-Abortion Group Pushes Clinic Inspection Law In Arizona
A powerful anti-abortion group is pushing for last-minute legislation to allow unannounced inspections at Arizona abortion clinics, saying the change is needed because they are the only medical facilities in the state that don't have such snap inspections. Cathi Herrod of the Center for Arizona Policy said Thursday that her proposal in the waning days of the legislative session isn't designed to either derail Gov. Jan Brewer's Medicaid expansion proposal or avoid public scrutiny that proposed laws normally undergo through legislative hearings beginning early each year (6/6).

The New York Times: Council Bill Would Crack Down On Proliferation Of Adult Day Care Centers
New York City officials said on Thursday that they would introduce legislation to crack down on Medicaid-supported senior day care centers that lure relatively healthy clients with enticements like free takeout food and even cash (Bernstein, 6/6).

MinnPost: The Telemedicine Tourniquet
Inside the Mayo Clinic's Center for Innovation in Rochester, a new initiative is taking shape: the development of Mayo's Center for Connected Care. … Mayo, like many other health care systems, is already engaged in virtual care on a number of fronts: in radiology, dermatology, infectious diseases, and other fields (Logeland, 6/6).

Oregonian: Senate Passes Bill Tightening Rules For Parents Who Opt Out Of Vaccines For Children
Parents could have a harder time opting out of vaccinations for their children under a bill passed Thursday by the Oregon Senate. Under Senate Bill 132, parents opting out for non-medical reasons would need to obtain the signature of a doctor or other health care practitioner certifying that the parents received immunization education, or provide a certificate confirming they'd watched an approved online educational video (Zheng, 6/6).

California Healthline: Reversing Medi-Cal Cuts Priority For Latino Lawmakers
Members of the legislative Latino Caucus on Tuesday laid out their agenda that includes some form of reversal of the 10 percent reduction in payments to Medi-Cal providers. The Legislature passed the 10 percent cut in 2011, but it was delayed until a federal appeals court ruling upheld the reduction two weeks ago. State officials said the bulk of the cutbacks will begin in September. Although the case may be appealed to the U.S. Supreme Court, the federal appeals court ruling May 24 puts pressure on the Legislature to come up with an alternative (Gorn, 6/6).

California Healthline: Another Arrow In The Quiver For Attempt To Reverse Medi-Cal Cut
The Legislature in 2011, mired in a seemingly hopeless economic morass, ordered a 10 percent across-the-board reduction in Medi-Cal provider reimbursement rates. That move is worth an estimated $458 million in general fund savings to the state in fiscal year 2013-2014, according to H.D. Palmer of the Department of Finance. That number jumps to $725 million in general fund dollars when annualized, Palmer said. Until now, cuts were in limbo awaiting court rulings in lawsuits challenging them. But that changed on May 24 when the Ninth Circuit U.S. Court of Appeals ruled that the Medi-Cal reduction was legal. Now the only legal avenue left is appeal to the U.S. Supreme Court (Gorn, 6/6).

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Health Policy Research

Research Roundup: Health Spending On Kids With Special Needs

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: Recession Led To A Decline In Out-Of-Pocket Cost Spending For Children With Special Health Care Needs – Between 2008 and 2010, the rate of growth for health care spending declined. The recession, many researchers believe, was a key contributor to this decline. In this study, researchers explored whether the recession also had an impact on health care spending for children, especially those with special health care needs. They analyzed nationally representative survey data to examine trends in out-of-pocket spending for privately insured families from 2001 to 2009. "We found that the recession of 2007-09 was not associated with a decline in out-of-pocket spending for most children. However, adults in those children's families experienced significant declines in out-of-pocket spending during the recession," suggesting that parents may have cut back their own care to continue to provide for their children,  the authors write. They  found, however, "a significant reversal in the spending trend for children with special health care needs." The authors suggests that "policy efforts to bolster coverage for families with children are needed to protect the health care use of both children and parents during times of economic hardship" (Karaca-Mandic, Yoo, Sommers, 6/2013).

American Journal Of Preventive Medicine: Menu Labeling Regulations And Calories Purchased At Chain Restaurants –The federal menu labeling law will soon require all large chain restaurants to post caloric information on menus. Currently, 21 U.S. jurisdictions have adopted similar regulations. The authors examined the impact of menu labeling on calories purchased across 50 sites from 10 chain restaurants in King County, Wash., which includes Seattle. Using survey data and receipts of purchases collected from consumers, the researchers compared the averages of calories purchased at intervals before and after restaurants adopted the regulations. They found no significant changes in calorie intake for the first six months, but after 18 months calories purchased  at some chain restaurants and among women in King County decreased. "Implementation of similar regulations nationwide could reach millions of Americans, given the large number of restaurant patrons and the high frequency of eating out," the authors conclude (Krieger et al., June, 2013).

The Kaiser Family Foundation: Key Lessons From Medicaid And CHIP For Outreach And Enrollment Under The Affordable Care Act -- The authors of this issue brief review five lessons learned through past enrollment campaigns for Medicaid and CHIP to help give perspective for the outreach and enrollment challenge for the online insurance marketplaces created by the federal health law. Those lessons are: Individuals want coverage and value Medicaid as a choice; outreach campaigns must combine both broad-based messaging and targeted efforts to eligible families; enrollment procedures must be simple and accessible; one-on-one assistance needs to be available; simplifying renewals and extending eligibility or lengthening the time between renewals will help cut costly drop-offs in coverage. "The Affordable Care Act (ACA) will significantly increase coverage options through an expansion of Medicaid and the creation of new health insurance exchange marketplaces," the authors write. "However, effective outreach and enrollment efforts will be key to ensuring these new coverage opportunities translate into increased coverage. ... it is important to recognize that enrollment into new coverage options will likely be a long-term effort. As such, it will be important for there to be adequate resources for outreach and enrollment over time to identify and utilize lessons learned as new enrollment efforts and experiences unfold (Stephens and Artiga, 6/4).

The Heritage Foundation: The Obama Medicare Agenda: Why Seniors Will Fare Worse – Current seniors are already facing high Medicare costs, according to the authors of this brief. They add that these costs will only grow over the next five years as a result of the federal health law. "Through the enactment of the Patient Protection and Affordable Care Act (PPACA), the Obama Administration and its allies in Congress have already committed to increasing seniors' out-of-pocket costs," the authors write. They add that the 2012 Medicare trustees report suggests seniors' standard Medicare Part B monthly premiums will increase from $99.90 to $128.20 between 2012 and 2017. In this brief, they also raise concerns regarding President Barack Obama's latest budget proposal for the 2014 fiscal year. "It does not substantially reform the financially desperate Medicare program; it simply shift costs to seniors," the authors assert. "America needs a sound Medicare policy. The Obama Administration's agency for increase costs for Medicare beneficiaries, plus the latest budget tweaks to administrative payments, will not reverse the troubled program’s unsustainable course," they conclude (Moffit and Senger, 5/23).  

JAMA Pediatrics: Reducing Racial/Ethnic Disparities In Childhood Obesity – In this study, researchers aimed to determine the extent to which racial/ethnic disparities in obesity and overweight are explained by differences in risk factors during pregnancy, infancy, and early childhood. The researchers recruited women during early pregnancy from a Massachusetts hospital and garnered data regarding their children through interviews and surveys. They found that black and Hispanic children by the age of 7 were twice as likely as whites to be overweight or obese. "Our findings suggest that racial/ethnic disparities in childhood obesity may be explained by factors operating in infancy and early childhood and that eliminating these factors could eliminate the disparities in childhood obesity," they wrote. "These factors include differences in modifiable early feeding behaviors, such as breastfeeding and timing of the introduction of solid foods, accelerated infant weight gain, and early childhood obesity-related risk factors, including insufficient sleep, the presence of a television set in the room where the child sleeps, and consumption of sugar-sweetened beverages and fast food, all of which have been found previously to be more prevalent among blacks and Hispanics than among whites" (Taveras et al., 6/1).

Here is a selection of news coverage of other recent research:

MedPage Today: Just 1 Doc In 10 Meets Meaningful Use Criteria
More physicians are using electronic health records (EHRs), but a significantly smaller proportion of eligible physicians say they have met the first stage of meaningful use criteria, a study found. In a national survey, 43.5% of physicians in March 2012 reported having a basic EHR -- up from 34% in 2011 -- but only 9.8% said they met meaningful use criteria, reported Catherine M. DesRoches, PhD, of Mathematica Policy Research in Cambridge, Mass., and colleagues (Struck, 6/5).

Reuters: Quit-Smoking Treatments Safe, Effective: Review
Popular smoking cessation treatments - such as nicotine replacements and antidepressants - improve people's chances of kicking the habit without much risk, according to a review of past research. "It seems very clear that medications can help. They're not the magic bullet but you do improve your chances of quitting -- generally -- if you try them. And as far as we can tell, they're safe to use," said Kate Cahill, who led the study (Seaman, 5/30).

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Editorials and Opinions

Debate Over A Dying Child And A Lack Of Transplant Organs

Several columnists explore the difficult questions raised by the case of Sarah Murnaghan, a 10-year-old with cystic fibrosis who needs a lung transplant to survive.

Los Angeles Times: The Rules Of Organ Transplant Vs. A Dying Little Girl
Was U.S. Health and Human Services Secretary Kathleen Sebelius being rigid and cruel when she refused an exception to the rules so a 10-year-old girl could receive a lung transplant from an adult? The girl, Sarah Murnaghan, was placed on the adult transplant list — she also remains a priority patient on the pediatric transplant list — after a judge ordered the change to be made. As much as transplants save lives that half a decade ago couldn’t be saved, the world of transplants is also a heartbreaking one, and one that often seems heartless to outsiders. There are never enough organs for all the need, so doctors and medical ethicists lay down rules intended to do the most good with what’s available (Karin Klein, 6/6).

USA Today: Letting A Child Die For A Voluntary Ideal
And this brings us to the most wrenching question of all: what about the people who will die to save Sarah? Think about it: If adult lungs become available within the next ten days – the extent of Judge Baylson's suspension – and Sarah's doctors surgically reduce them so that they fit, will another person, say a young woman whose 21 year-old life is also hanging by a thread, now die instead? That's an agonizing question to pose. ... The answer, of course, is to increase the organ supply. But with annual voluntary donations falling far behind demand, we need to give people an incentive to donate. Sarah's ordeal should force a re-examination of the 1984 National Organ Transplant Act (NOTA), the law that makes it illegal for anyone to give or acquire an organ for material gain (Sally Satel, 6/6).

Bloomberg: Sick Girl May Get A Lung But It's Not A Happy Ending
The case points up the tragic and, despite efforts to the contrary, inherently arbitrary nature of organ allocation. As long as there is an absolute shortage of organs, giving one person a transplant means denying it to someone else. Contrary to what many people assume, merely signing an organ donor card doesn't mean your organs will be transplanted when you die. You have to die in exactly the right way, and very few people do. The shortages are especially acute for pediatric organs since, fortunately, relatively few children die from massive brain trauma. The separate pediatric and adult lists reflect the need to make sure those rare organs go to children who can't tolerate transplants from adults (Virginia Postrel, 6/6).

National Review: A Lung For Sarah Murnaghan
Talk radio and TV have been ringing with strident and even hysterical accusations that HHS Secretary Kathleen Sebelius is "letting this little girl die," or "choosing who will live and who will die." Some are linking Sebelius's supposed callousness to the terrible, politicized rationing of health care that Obamacare will inaugurate. This is all backwards. The people calling upon Sebelius to intervene and grant a waiver from the usual rules regarding children and transplants are the ones urging the politicization of medical care — at least in this case. They would be the ones responsible for setting a terrible precedent. The lesson would be this: If you can muster public pressure through social media, the press, and politicians, your loved one can get an advantage over others waiting for a lung or kidney or liver. Photogenic patients or those with media-savvy or even politically well-connected relatives would go to the head of the line. That is exactly what conservatives ought to fear (Mona Charen, 6/7).

Philly.com: Needed: A Conversation On Organ Donation
A national debate on organ transplant waiting list rules would draw attention to what is really at issue here—that the demand for organs in the United States far outpaces the supply. ... even though polls show that the vast majority of Americans are willing to donate organs, in practice, fewer than half are willing to donate a family member's organs upon request by a doctor. Possible solutions include shifting to an opt-out system, whereby individuals would be presumed to be donors unless they, at the time of applying for or renewing a driver's license or state ID card specifically opted out of being a donor (Michael Yudell, 6/6).

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Viewpoints: Will 'Rate Shock' Grow?; Krugman Says GOP Spite Is Driving Opposition To Medicaid Expansion; Determining Who Owns Genes

The New York Times: Why Rate Shock Might Matter
Any plausible health care reform, the various conservative alternatives to Obamacare included, would necessarily have losers as well as winners, and as far as potential losers go single young men with above-average incomes are not precisely the country's most disadvantaged demographic. If you think the current system is flawless, then I suppose any rate increase anywhere is a strike against health care reform. But conservative and libertarian wonks don’t think the system is flawless. ... The unanswered question, though, is whether that "a little more" will actually be — or gradually become — a lot. And that's what's getting left out of some of the liberal brush-offs ... of the "rate shock" issue (Ross Douthat, 6/6). 

The New York Times: The Spite Club
Sure enough, a number of Republican-dominated states seem set to reject Medicaid expansion, at least at first. And why would they do this? They won't save money. On the contrary, they will hurt their own budgets and damage their own economies. Nor will Medicaid rejectionism serve any clear political purpose. As I'll explain later, it will probably hurt Republicans for years to come. No, the only way to understand the refusal to expand Medicaid is as an act of sheer spite. And the cost of that spite won't just come in the form of lost dollars; it will also come in the form of gratuitous hardship for some of our most vulnerable citizens (Paul Krugman, 6/6). 

The Wall Street Journal: Michigan's Medicaid Maelstrom
The Wolverine State is one of several still sitting on the fence when it comes to the ObamaCare expansion of Medicaid. Michael Reitz of the Mackinac Center, a conservative think tank, tells us that he is increasingly worried that "Republicans may be on the brink of caving on Medicaid." ... An idea gaining traction is to accept the Medicaid dollars but place a four-year lifetime cap on eligibility for able-bodied adults. After four years on the program, Michigan residents would be cut off from any further benefits. Another Republican reform would allow health savings accounts for Medicaid patients as a way to save money. Some Republicans are also demanding a "cancellation" policy that would allow the state to take the money now but opt out of the Medicaid expansion later if costs escalate out of control. Until 2017, the federal government covers 100 percent of the costs (Stephen Moore, 6/6).

Bangor Daily News: Medicaid Expansion In Hands Of Seven GOP Lawmakers
We have tried to present reasonable arguments to Maine's Republican lawmakers to urge them to accept federal funding to expand Medicaid. We have emphasized the good financial deal Maine is projected to get, according to independent, outside analyses. We have highlighted the obvious, practical health reasons why tens of thousands more Mainers should have access to care. We criticized lawmakers when they blocked a previous Medicaid expansion proposal. ... There is still a little time, however, for a few Republicans to stand up for their communities' poorest — on whose doors they've knocked and asked for votes. It will take only 12 Republicans in the House and Senate for the bill to be veto-proof; five are already on board (6/5).

USA Today: Retiree Benefits And ObamaCare Collide
Oct. 1, 2013 is a focus of increasing anxiety in this country. That's the date when enrollments begin for the federally run health insurance exchanges, created under the Affordable Care Act (ACA). No one really knows what to expect, but it could be far worse than advertised — and for a reason that has more to do with the federal deficit than health care. ... Amid all these concerns and speculations, almost no attention is being paid to the opportunity that the ACA's insurance exchanges could represent for state and local governments' retiree health care programs. It's time to think about it because the consequences could be far-reaching (David Walker, 6/6).

Fox News: Is America Prepared For The Coming ObamaCare Disaster?
For years I have been writing about the failures of the UK's National Health Service (NHS) as a warning for what the Affordable Care Act (aka ObamaCare) will do to health care here in the U.S. London's Daily Mail has chronicled the growing problems with the NHS, which include declining quality of care and availability of services coupled with increased costs. This is what is in store for us, if Congress does not repeal ObamaCare (Cal Thomas, 6/6).

National Journal: Separate And Unequal Access To Health Care?
Segregation is still real. Although black-white segregation has, overall, declined steadily since the 1970s, major American metros remain split into black and white areas. … One of those consequences is the disparity when it comes to health care between blacks and whites. The fact that black patients have poorer outcomes in surgery has been well documented. ... Recently, researchers at the University of Michigan sought a more-rounded answer to the problem. Their results, published in the journal Health Affairs, highlights a frustrating contradiction. While black patients live closer to high-quality facilities, they are still more likely to get care in low-quality facilities (Brian Resnick, 6/5).

The New York Times Room For Debate: Can The Human Blueprint Have Owners?
The Supreme Court is expected to decide soon whether human genes can be patented. The case involves patents by Myriad Genetics on the BRCA1 and BRCA2 genes, which, when mutated, heighten a woman's risk of getting cancer. Because of the patents on these genes, which Myriad isolated, the company controls all testing for the mutations. ... Should companies be allowed to patent genes? Read the discussion (6/6).

Tampa Bay Times: Paying Too Much For Too Little Health Care
Exotic prescription drugs and extraordinary end-of-life efforts are not the only factors driving up the cost of health care. It turns out that routine procedures such as colonoscopies cost far more in the United States than in other countries, and vary widely in price. In Tampa, for example, patients pay from $980 to $3,496 in out-of-pocket and insurance costs for a colonoscopy. There is no legitimate reason for such wide differences, and bringing health care costs under control will require increased efforts by consumers and government to demand more openness about pricing and to comparative shop (6/6).

JAMA: Eliminating Wasteful, Unnecessary Care Is The Best Way To Preserve Medicare
The release this past week of the Medicare Trustees' report was met with widespread enthusiasm among health economists and supporters of the federal health reforms in the Affordable Care Act (ACA). … Reduced Medicare spending might be a small silver lining of the recession, but it is not a strategy anyone would pursue to preserve the program (Andrew Bindman, 6/6).

Roll Call: Message To Congress: Immigrants Pay More Than Their 'Fair Share' Of Medicare
Immigrants don't just pick our fruit, deliver our take-out food and design our computers — they pay for our medical care. As Congress debates immigration reform, some would have us believe that immigrants are draining the Treasury. But it turns out that closing the borders would deplete Medicare's trust fund (Steffie Woolhander and David U. Himmelstein, 6/6). 

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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.