Daily Health Policy Report

Monday, June 9, 2014

Last updated: Mon, Jun 9

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Coast-To-Coast Health Care Woe: Cost

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: “Recently, I moved across the country, from Washington, D.C., to San Francisco. I drove the Southern route and decided to conduct an informal survey, asking folks I met along the way a question relevant to the health care reporting I've been doing for the past five years. The question: What bugs you most about your medical care?” (Gold, 6/9). Read the story.

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More Than 1.7 Million Consumers Still Wait For Medicaid Decisions

Kaiser Health News staff writer Phil Galewitz, working in collaboration with The Washington Post, reports: “While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed—with some stuck in limbo for as long as eight months, according to officials in 15 large states. The scope of the problem varies widely. California, the most populous state to implement the health law’s expansion of Medicaid, accounts for a lion’s share of the backlog with 900,000 applications still pending as of early June. The next biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all” (Galewitz, 6/9). Read the story.

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Political Cartoon: 'Micro-Managed Care?'

Kaiser Health News provides a fresh take on health policy developments with "Micro-Managed Care?" by Rex May.

Meanwhile, here's today's haiku:


In health care spending growth rate?
Revised data soon.
-Team Haiku, Altarum

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

Some Consumers In Limbo Waiting For Medicaid Applications To Be Processed

Kaiser Health News reports that most of these are people who sought coverage through the health law's Medicaid expansion. Meanwhile, the New York Times takes a look at how a state line can make all the difference in who gets Medicaid.  

Kaiser Health News: More Than 1.7 Million Consumers Still Wait For Medicaid Decisions
While an unprecedented 6 million people have gained Medicaid coverage since September, mostly as a result of the Affordable Care Act, more than 1.7 million more are still waiting for their applications to be processed—with some stuck in limbo for as long as eight months, according to officials in 15 large states. The scope of the problem varies widely. California, the most populous state to implement the health law’s expansion of Medicaid, accounts for a lion’s share of the backlog with 900,000 applications still pending as of early June. The next biggest pileup is in Illinois, with 283,000 cases, while New York has no backlog at all (Galewitz, 6/9).

The New York Times: In Texarkana, Uninsured And On The Wrong Side Of A State Line
Arkansas accepted the Medicaid expansion in the Affordable Care Act. Texas did not. That makes Texarkana perhaps the starkest example of how President Obama’s health care law is altering the economic geography of the country. The poor living in the Arkansas half of town won access to a government benefit worth thousands of dollars annually, yet nothing changed for those on the Texas side of the state line (Lowrey, 6/8).

And in Utah -

Salt Lake Tribune: S.L. County To Lobby Legislature To Accept Medicaid Funds
The Salt Lake County Council wants to let state officials know — again — that county taxpayers will end up footing a substantial bill if Utah does not go along with Medicaid expansion. So the GOP-led council is preparing to write a letter asking legislative leaders to drop their resistance to at least Gov. Gary Herbert’s compromise "Healthy Utah" proposal, which would tap public Medicaid dollars to buy private coverage for an estimated 111,000 Utahans, almost half of whom are county residents (Gorrell, 6/9). 

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Politics Continue To Swirl Around State Medicaid Expansion Debates

A group of Democratic senators has written a letter to Republican governors in states such as South Dakota, Wyoming, Wisconsin and Nebraska urging that they set politics aside and pursue the health law's expansion of the state-federal low-income insurance program. Meanwhile, the issue is also front and center in primary elections.

Sioux City Argus Leader/USA Today: Johnson Joins Other Democratic Senators To Urge Medicaid Expansion
Sen. Tim Johnson and other colleagues in the Senate have asked Republican governors in states such as South Dakota to “put politics aside and do the right thing” by expanding Medicaid coverage under the Affordable Care Act. In a letter last week, Johnson told Republican governors, including South Dakota’s Dennis Daugaard, that an estimated 6 million Americans, including almost 50,000 in South Dakota, are not getting coverage because those 18 states have failed to expand Medicaid. The letter also was sent to governors in nearby states such as Wyoming, Wisconsin and Nebraska (Doering, 6/8).

The Wall Street Journal: Tie To Obama's Health Law Proves Risky For Arkansas Republican
Arkansas legislator John Burris says he is a staunch opponent of President Barack Obama's health-care expansion. But after helping to engineer a compromise that allowed Arkansas to use dollars aimed at broadening Medicaid coverage to enroll poorer residents in private health insurance, the Republican finds himself in a tough runoff election Tuesday against an opponent who has played up his link to the Affordable Care Act (Campoy, 6/6).

The Associated Press: Arkansas State Senate Race Focuses On Medicaid Expansion 
State Rep. John Burris was among the most vocal opponents of the federal health care overhaul among the Republicans in the state House. Now running for a north Arkansas state Senate seat, however, he finds himself being portrayed as a cheerleader for the law he derides as "Obamacare" (DeMillo, 6/8).

In related news -

The Hill: Cruz: Repeal 'Every Word' Of ObamaCare
Sen. Ted Cruz (R-Texas) called for the repeal of “every blessed word of ObamaCare” in a fiery speech to a crowd of conservatives in Texas on Friday. Speaking at the Texas Republican Convention, the potential presidential contender hit on a number of conservative issues in a campaign-style speech that was punctuated by cries of, “Run, Ted!” (Jaffe, 6/7).

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Is Healthcare.gov Floating Toward The Cloud?

The Wall Street Journal reports that Amazon.com Inc.'s cloud is picking up steam in the Obama administration's attempt to revamp the federal online insurance marketplace. Meanwhile, news outlets also report on the latest developments regarding exchanges in Colorado and New Hampshire.

The Wall Street Journal: HealthCare.gov Floats To Amazon’s Cloud In Revamp
The Obama administration has turned to Amazon.com Inc. to host certain HealthCare.gov components in the latest sign that cloud is gaining traction in the government sector. The move will give the government more flexibility in the amount of computing power it uses to run its health exchange, experts say, allowing it lower costs outside of peak usage periods (Boulton, 6/6).

Denver Post:  Colorado Health Insurance Exchange Asks For Carrier Fee, Sets Budget
The board of Connect for Health Colorado will consider Monday whether to begin charging insurance carriers $1.25 a month for each policy on their books to generate more than $13 million for the state health exchange. "The carrier assessment is a big deal," Connect for Health chief executive Patty Fontneau said at a meeting of the exchange's finance committee on Thursday. Approval of the assessment on carriers will be critical as federal startup grants are exhausted and the exchange must become financially self-sufficient, Fontneau said. The exchange must generate all new revenues beginning Jan. 1 (Draper, 6/9).

Health News Colorado: Exchange Board Frustration Mounts Over Spending
Colorado’s exchange managers have triggered confusion among their own finance committee board members on the eve of a critical vote Monday over future spending and revenues. Health News Colorado on Thursday reported that board members were concerned that exchange managers had spent $10 million over the past year to sign up about 8,000 people through face-to-face enrollment centers. On Friday morning, Connect for Health Colorado managers said they actually expect to spend about $6.6 million on the assistance sites this fiscal year, which extends through the end of June (McCrimmon, 6/6).

The Associated Press:  New Hampshire Businesses Vexed By Insurance Delay
New Hampshire businesses aren't happy with the latest delay in the small group health insurance market created by the Affordable Care Act, but some are more understanding than others. Companies have been able to purchase coverage in the Small Business Health Options, or SHOP, marketplace from brokers and insurance companies since last fall, but the online enrollment portal isn't expected to launch until November. The state's insurance commissioner is seeking to delay a key feature that would allow employees to pick their coverage from a list of plans, saying he is concerned about maintaining a stable and competitive group market and wary of repeating the problems associated with the rocky rollout of the healthcare.gov portal for individual consumers (Ramer, 6/8).

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Insurers Propose Rate Hikes For Plans On The Individual Market

News reports detail the latest on insurers' efforts in Maryland and Connecticut to gain approval for increases in 2015 premiums on the state exchanges.

The Washington Post: CareFirst Seeks Price Hikes For Individual Health Plans
Maryland's dominant insurance company, CareFirst, is proposing hefty premium increases of 23 to 30 percent for consumers buying individual plans next year under the federal health-care law, according to filings released Friday. The rate proposals by CareFirst and several other carriers were posted on the Web site of the Maryland Insurance Administration and paint a mixed picture. Two other insurers, Kaiser Foundation Health Plan and Evergreen Health Cooperative, are proposing to lower rates for next year, by 12 percent and about 10 percent, respectively (Sun, 6/7).

Politico Pro: Maryland Proposed Rates Reflect Market Volatility
Five Maryland health insurers are considering dramatic changes in their rates next year, reflecting volatility that is likely to greet the second year of Obamacare coverage nationwide. CareFirst BlueChoice and CareFirst of Maryland want to raise rates by 22.8 percent and 30.2 percent, respectively. But two insurers want to make big cuts. Kaiser Foundation Health Plan is pitching a 12.1 percent cut, and Evergreen Health Cooperative wants a 10.3 percent cut (Haberkorn, 6/6).

The CT Mirror: Healthcare Advocate Wants Hearing On Anthem Rate Request
State Healthcare Advocate Victoria Veltri has asked the Connecticut Insurance Department to hold a public hearing on Anthem Blue Cross and Blue Shield's proposal to raise premiums for its individual-market health plans by an average of 12.5 percent next year. Veltri also urged Insurance Commissioner Thomas B. Leonardi to consider holding public hearings on all rate proposals filed by insurers offering coverage through the state’s health insurance exchange. ConnectiCare Benefits requested an 11.8 percent increase in its base rates and HealthyCT proposed decreasing its premiums by an average of 8.9 percent. UnitedHealthcare also proposed rates for plans that would be sold on the exchange's individual market for the first time in 2015 (Becker, 6/6).

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Enrollees' Data May Be Compromised As A Result Of Access Health CT Breach

The Connecticut health insurance exchange data breach has been traced back to an employee of the company that runs the call center.  

The CT Mirror: Access Health CT Data Breach Traced To Call Center Vendor Employee
A data breach involving Connecticut's health insurance exchange has been traced to an employee of the company that runs the agency's call center, according to the exchange. A backpack discovered on a Hartford street Friday afternoon was found to contain four notepads with handwritten names, Social Security Numbers and birth dates for about 400 people, as well as paperwork from Access Health CT, the state's exchange, according to exchange officials. The backpack belongs to an employee of Maximus, which runs the exchange's call center, Access Health Chief Marketing Officer Jason Madrak said in a statement Sunday. The employee came forward after learning about the backpack’s discovery on television news, Madrak said (Becker, 6/8).

The Hill:  Personal Data On ACA Enrollees May Be Compromised
Connecticut's health insurance exchange acknowledged Friday that the personal information of some enrollees may have been compromised.  In a statement, Access Health CT CEO Kevin Counihan said that an individual discovered a backpack on a Hartford street containing the personal information of about 400 people.  Because the backpack contained paperwork for the exchange, "it appears as though some of that personal information may be associated with Access Health CT accounts," Counihan said (Viebeck, 6/6).

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Under Health Law, States Serve As Testing Grounds For Innovation

Media outlets report on a range of issues related to the measure's implementation, including how some states are finding opportunities in the overhaul to pursue their own health system changes. Also in the news, the latest on the roles being played by emergency rooms, faith-based non-profits and accountable care organizations.     

The Wall Street Journal: Some States See In The Health Law A Chance To Pursue Unique Solutions
The federal health-care law was intended to create a uniform standard of health coverage across the U.S. But the law also is creating opportunities for states to pursue their own solutions. For states like Vermont, that means pursuing liberal experiments that go further than the Affordable Care Act; for others, it means expanding coverage for the poor in a way that's more palatable to conservative lawmakers (Radnofsky, 6/8).

Louisville Courier Journal/USA Today: More Patients Flocking To ERs Under Obamacare
It wasn't supposed to work this way, but since the Affordable Care Act took effect in January, Norton Hospital has seen its packed emergency room become even more crowded, with about 100 more patients a month. ... Nationally, nearly half of ER doctors responding to a recent poll by the American College of Emergency Physicians said they've seen more visits since Jan. 1, and nearly nine in 10 expect those visits to rise in the next three years. Mike Rust, president of the Kentucky Hospital Association, said members statewide describe the same trend. Experts cite many reasons (Ungar, 6/8).

The Washington Post: Opponents Of Health-Care Law Turn To Faith-Based Non-Profits to Cover Medical Expenses
Susan Tucker is one of millions of Americans who dislike the health law and want nothing to do with it. But the 54-year-old Venice, Fla., homemaker took her opposition a step further: She opted out. Tucker dropped the private health plan she had carried for more than a decade and joined Christian Healthcare Ministries, a faith-based nonprofit in which members pool their money to pay for one another’s medical needs — and promise to adhere to biblical values, such as attending church and abstaining from sex outside marriage (Somashekhar, 6/5).

Los Angeles Times: Anthem, HealthCare Partners Save $4.7 Million By Coordinating Care 
Insurance giant Anthem Blue Cross and the HealthCare Partners physician group say a new effort to coordinate care among 55,000 patients helped save $4.7 million. In results released Friday, the two companies said their collaboration, known as an accountable-care organization, or ACO, cut costs by reducing hospital admissions, emergency-room visits and lab tests, particularly among patients with chronic conditions (Terhune, 6/6).

Meanwhile, the ACA's discount drug program faces a legal challenge -  

The New York Times: Judge Voids Expansion Of Discount Drug Program
A federal judge has struck down a new rule requiring drug companies to offer certain drugs at discounted prices, saying the Obama administration had no authority to issue the rule. Federal officials said the decision could provide a windfall to drug makers. However, the pharmaceutical industry said that the administration was stretching the Affordable Care Act to provide discounts on more drugs for more people, and that the rule was “inconsistent with the plain language of the statute” (Pear, 6/8).

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Administration News

VA To Probe Deaths Of 18 Veterans To See If Delay In Care Played A Role

Acting Secretary Sloan Gibson announces 18 more veterans kept off an appointment list have died. The department is expected to release more details Monday as officials appear before Congress.

The Associated Press: VA Head Says 18 Vets Left Off Wait List Have Died
In a new revelation in the growing Veterans Affairs' scandal, the organization's acting head says that an additional 18 veterans whose names were kept off an official electronic VA appointment list have died. Acting VA Secretary Sloan Gibson said he would ask the inspector general to see if there is any indication those deaths were related to long wait times. If so, they would reach out to those veterans' families (Tang and Daly, 6/6).

Los Angeles Times: More Details From Audit Of VA Healthcare Scandal Expected Monday 
As the acting secretary of Veterans Affairs tries to assure congressmen that he is moving to address the VA healthcare scandal, his department is preparing to release more results of a nationwide audit of scheduling practices that have been denounced as misleading and harmful to veterans. The results are expected to be released Monday, as a House committee puts VA officials through another round of grilling over findings that VA employees falsified records to conceal long waits for medical appointments (Simon, 6/7).

Reuters:  New VA Secretary Plans More 'Purchased Care' To Relieve Backlogs
The acting secretary of the Department of Veterans Affairs said on Friday the agency is putting out bids for "purchased care" that would allow veterans to be treated at other hospitals at the VA's expense while cutting backlogs at its facilities. "In far too many instances, in far too many locations, we have let our veterans down," Sloan Gibson told reporters after a tour of the sprawling Audie Murphy VA Medical Center in San Antonio. VA hospitals and clinics will be open during non-traditional hours to expand coverage, said Gibson, who was appointed acting secretary of the department on May 30 (Forsyth, 6/6).

Des Moines Register:  Push To Let Vets Use Private Care Gains Traction
Robert Hunter, like many Iowa veterans, has few qualms about the quality of care he receives from the Department of Veterans Affairs. But the system's bureaucracy and lack of resources can be aggravating, and he wishes he didn't have to drive 90 miles from Fort Madison to Iowa City for most of his appointments. He might soon get his wish, thanks to a boiling national controversy over waiting times at VA hospitals and clinics. Some members of Congress have long pushed the VA to let more veterans use their benefits for care in private hospitals and clinics. That idea is gaining traction since reports surfaced that VA administrators in Phoenix and elsewhere covered up the fact that veterans had died while waiting months for care (Leys, 6/7).

Houston Chronicle: Texas Lawmakers Meet With Acting Secretary Gibson Over VA Scandal
Acting Secretary of Veterans Affairs Sloan D. Gibson was in San Antonio Friday to address allegations regarding misconduct at local VA facilities. Rep. Lamar Smith, R-Texas, was one of the Texas lawmakers present at Audie Murphy Memorial VA Hospital to press the secretary about the recent controversy (Escalante, 6/6).

The Boston Globe: Massachusetts A Model For Veterans' Health Care
As the Obama administration and Congress wrestle with how to fix the veterans health care system, lessons are being drawn once again from an incubator of health care ideas: Massachusetts. The state boasts three of the nation's highest-rated VA hospitals and spends more per capita on veterans than any other, which has helped it avoid the long waiting lists plaguing some veterans hospitals, officials say. Massachusetts provides a series of alternative options, including contributing roughly $75 million annually to help veterans pay for private insurance. In addition, the state has encouraged philanthropic initiatives that help both physically and mentally ill veterans get care outside the VA health system (Bender, 6/9).

Denver Post:  VA Problems Extend Beyond Delayed Care, Colorado Vets Say
Two years ago, Navy veteran Michael Beckley learned that Veterans Affairs had repeatedly missed his prostate cancer. He said he got the news in a room "the size of a broom closet." In a hospital hallway, he had caught up with the urologist who tested him, and he asked for the results. The doctor took him into the closest room, told him the news was bad and said he was too busy to explain the test numbers. "Google it," he advised. Beckley, a former fighter pilot, sat on the floor and cried. The scandal rocking the VA centers on delayed care and falsified appointment records, but critics say the problems run deeper — to quality of care and patient safety at many of the department's 1,700 health care facilities (Draper and Olinger, 6/8).

Modern Healthcare:  VA's Sun Belt Facilities Stressed As Veteran Population Shifts There
Anthony Hardie, a disabled Army veteran who served in the first Iraq War, suffers from the so-called Gulf War syndrome. He lives an hour's drive from the closest Department of Veterans Affairs medical center in Bay Pines, Fla.  So when he gets lung "flare-ups" several times a year, he uses his private health insurance and goes to a private urgent-care center close to his home in Bradenton. ... one issue that hasn't gotten as much attention is the mismatch of VA facilities to where most veterans live. Of the approximately 20.8 million veterans living in the U.S., 9.6 million live in 14 Sun Belt states. Yet only about a third of the VA's 152 hospitals are located in those states (Herman and Landen, 6/6).

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Cosgrove Withdraws His Name From Consideration For Top Job At The VA

Cleveland Clinic CEO Dr. Delos M. Cosgrove said that, though he seriously considered the position, he did not feel he could step away from his commitments at the clinic.

The New York Times: Cleveland Clinic Chief Out Of Running For V.A.
Dr. Delos M. Cosgrove, the chief executive of the Cleveland Clinic, said Saturday he had been considered by President Obama for the job of secretary of the Department of Veterans Affairs, but had withdrawn his name and would stay at the clinic (Pear, 6/7).

The Wall Street Journal: Cosgrove Takes His Name Out Of Contention For Top VA Job
A person familiar with the situation said Dr. Cosgrove was moved by the White House's pursuit of him for the job and seriously considered it. But he decided not to take it in part because he didn't feel he could walk away from his commitments at the Cleveland Clinic, including the opening of a new facility in Abu Dhabi that he personally saw through (Armour, 6/7).

In related news -

The Hill: CEO Says No To VA Post
This is the second time this week a VA contender has withdrawn. On Friday, Obama's top nominee for undersecretary of health at the agency, Jeffrey Murawsky, withdrew his name because he feared his confirmation could spiral into a long political fight. Murawsky oversaw a VA hospital that has been linked to the scandal caused by officials using secret lists to hide long waits for appointments (Al-Faruque, 6/7).

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Health Care Marketplace

Hospital Shifting Away From Billing For Individual Services

Bundled payments may be the "wave of the future," the Wall Street Journal suggests. Meanwhile, health care providers are working to get patients more involved in decisions about their care.

The Wall Street Journal: Hospitals Push Bundled Care As The Billing Plan Of The Future
Hospital bills may soon get a lot simpler. Traditionally, hospitals have charged patients separately for every service and supply they use—as anybody who has waded through pages of charges knows. Fees for surgeons, anesthesiologists and other providers come in complex bills of their own. Now, more hospitals see so-called bundled payments as the wave of the future (Beck, 6/8).

The Wall Street Journal: The Health-Care Industry Is Pushing Patients To Help Themselves
It's the last mile in the race to fix health care—getting patients more involved. Hospitals, doctors and public-health officials are pushing patients to keep track of their medical data, seek preventive care and stay on top of chronic conditions. They're measuring how motivated patients are to manage their own health and adopting a wide range of strategies to help them do better, a concept known as patient engagement (Landro, 6/8).

Los Angeles Times: Scale Of Medical Decisions Shifts To Offer Varied Balances Of Power
Doctors still make decisions sometimes, but sometimes patients make them, and sometimes doctors and patients make them together. Doctors and bioethicists are engaged in a vigorous debate about the relative merits of these various approaches. Meanwhile, you may want to consider which suits you best as a patient (Ravn, 6/6).

The Wall Street Journal: Take Your Heart Medicine—And Win A Prize!
In the Heartstrong study being conducted by the University of Pennsylvania's Center for Health Incentives and Behavioral Economics and the Penn Medicine Center for Health Care Innovation, 1,000 patients will be given pill bottles that transmit wireless alerts to researchers if the patients fail to take their medicine. The study is testing new ways to motivate people to take their medicine more consistently—including greater involvement of friends and family and the possibility, every day, for those who take their pills to win a small cash prize (Ward, 6/8).

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HHS Identifies -- But Doesn't Recover -- Overpayments To Medicare Advantage Plans

Medicare auditors found the government overpaid the plans hundreds of millions of dollars but in 2013 opted to scrap such reviews, the Center for Public Integrity writes. Meanwhile, Modern Healthcare looks at Medicare's difficult job in dealing with safety failures.

Center for Public Integrity: Health Insurers Have Their Way With Regulators
Four years ago, Medicare auditors came to an alarming conclusion: the federal government shouldn’t have paid a half-dozen insurance plans hundreds of millions of dollars to treat seniors in especially poor health. ... It took years for the Department of Health and Human Services (HHS) inspector general to publish those findings, and government officials have yet to pry back more than a tiny fraction of the disputed money, the Center for Public Integrity has learned. And despite the bundle of taxpayer dollars on the line, the HHS inspector general didn't do any more audits, and decided in 2013 to scrap similar future reviews as part of a budget cut (Schulte, 6/9).

Modern Healthcare: Cleveland Clinic Cases Highlight Safety Oversight Flaws
Nearly four years ago, government inspectors investigating a complaint by retired Air Force Col. David Antoon threatened to cut off Cleveland Clinic from receiving Medicare payments after being stonewalled by hospital officials. The Vietnam combat veteran had accused the hospital of failing to fully investigate his charge that someone other than his authorized surgeon had performed prostate cancer surgery and left him gravely injured. Hospital officials refused to show the inspectors all of the notes in Antoon's complaint file, and the doctor who claimed to have done the procedure declined to talk to surveyors .... Antoon, a commercial 747 pilot in civilian life until the operation left him incontinent, is baffled that medicine has no organization like the National Transportation Safety Board to address safety failures (Carlson, 6/7).

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State Watch

State Highlights: Improving Chronic Care In Las Vegas; Standoff Over N.C. Medicaid

A selection of health policy stories from Arizona, Georgia, Massachusetts, Missouri, Nevada, North Carolina, Ohio, Oregon, Texas and Washington

Los Angeles Times: Unequal Treatment: Las Vegas Tries New Tactic To Improve City's Notorious Healthcare
Now, Las Vegas is emerging as a test of how much a community can improve chronically poor health by expanding insurance coverage and using models of medical care pioneered in healthier places. "We are a prime example of what people see as problematic about the American healthcare system," said Larry Matheis, the former longtime head of the Nevada State Medical Assn. "That makes a lot of the ideas in health reform very attractive. … The challenge is going to be figuring out how to make it all work" (Levey, 6/7).

WRAL: NC Leaders Still At Odds Over Future Of Costly Medicaid Program
State Senate leaders don't just dislike Gov. Pat McCrory's plan to remake the Medicaid health insurance program for the poor and disabled. Their budget would legally bar the Department of Health and Human Services from working on it anymore (Binker, 6/8). 

North Carolina Health News: How Do You Solve A Problem Like Medicaid?
Leaders at the state’s Department of Health and Human Services believe they have a good idea in their Medicaid reform plan. And they’re sticking to their guns, despite the displeasure of the North Carolina Senate (Hoban, 6/9).

NPR: Hospitals Put Pharmacists In the ER To Cut Medication Errors
In the emergency department at Children's Medical Center in Dallas, pharmacists who specialize in emergency medicine review each medication to make sure it's the right one in the right dose. It's part of the hospital's efforts to cut down on medication errors and dangerous drug interactions, which contribute to more than 7,000 deaths across the country each year (Silverman, 6/9).

The Boston Globe: UnitedHealthcare To Cut Doctors For Mass. Seniors
National insurance giant UnitedHealthcare plans to cut up to 700 Massachusetts doctors from its physician network for seniors enrolled in its private Medicare plan as a way to control costs, according to company officials. For elderly patients enrolled in the plan, the cuts mean they will have to find a new doctor or eventually switch to a new health plan that covers their current doctor. The move, effective Sept. 1, follows similar cuts made by the insurer to its Medicare Advantage provider networks in 11 other states, including in Rhode Island and Connecticut, where the reductions drew outrage from patients, doctors, and lawmakers earlier this year (Jan. 6/8). 

The Wall Street Journal’s CIO Journal: Hospital Giant Uses Data To Vet Treatment Options
University of Pittsburgh Medical Center has found a way to improve health outcomes at lower cost thanks to a new data analytics program in which the hospital-and-insurance behemoth invested $105 million last year. UPMC says a pilot program that directed patients to a centralized care facility helped save $15 million in medical costs over the course of a year. These clinics, known as patient centered medical homes, centralize all of a patient’s various care and medical services under the auspices of a single physician, and are assigned to patients once they’ve been released from the hospital (Hickins, 6/6).

The Associated Press: Medical Situation Grows Dire As State Holds Migrant Kids
Mattresses, portable toilets and showers were brought in Saturday for 700 unaccompanied migrant minors who spent the night sleeping on plastic cots inside an Arizona warehouse, a federal official said. The Homeland Security official told The Associated Press that about 2,000 mattresses have been ordered for the makeshift holding center — a warehouse that has not been used to shelter people in years. [Arizona] Gov. Jan Brewer's spokesman, Andrew Wilder, said Friday that conditions at the center are so dire that federal officials have asked the state to immediately ship medical supplies to the center in Nogales (Skoloff and Spagat, 6/7).

The Seattle Times: Longtime Leader Mike Kreidler Plunges Into Political Storms
On the steps of the Insurance Building on the state Capitol campus, Insurance Commissioner Mike Kreidler pauses to ponder a question about his motivations. With his moves watched by policymakers, insurance regulators and companies across the country, this affable 70-year-old politician has had anything but a predictable life in the past few years. Consumer advocates say he may be the most respected insurance regulator in the country, but some state legislators tried to have his office abolished in the last session (Ostrom, 6/8).

St. Louis Post-Dispatch: Missouri Health Planners Discard Legislator’s Idea On Nursing Homes
A state health planning board on Thursday defeated a proposal that would have given a small subcommittee dominated by legislators control over whether new nursing homes or assisted living facilities are built in Missouri. The proposal, championed by Sen. Mike Parson, R-Bolivar, had drawn strenuous criticism from some long-term care groups, particularly those affiliated with nonprofit homes. They said it would have made the state’s approval process more political (Young, 6/6).

Los Angeles Times: Feds Step Up Pressure For L.A. County Jail Reforms
Citing a dramatic increase in jail suicides, the U.S. Department of Justice announced Friday that it was seeking court oversight of how the Los Angeles County Sheriff's Department treats mentally ill inmates. The move marks a significant expansion of the federal government's efforts to improve the "deplorable" living conditions and care of the mentally ill in the nation's largest jail system (Chang and Sewell, 6/6). 

The Oregonian: Oregon Researchers Reviewed 58,000 Death Records To Check On State's End-Of-Life Planning Program
Three years ago, after an ambulance rushed Betty Lou Hutchens to Oregon Health & Science University for care of her malfunctioning heart, she was glad her three children didn't have to make tough choices on how much medical treatment she should receive to keep her alive. Now 92, the Lake Oswego retirement community resident had spelled out her wishes clearly using a pioneering Oregon program launched more than a decade ago. It set up a registry that all providers and emergency medical technicians can use to check patient's wishes. "It gives me peace of mind to know that that was taken care of," said Hutchens (Budnick, 6/8).

Georgia Health News: Georgia Still A National Leader In Health IT
An industry magazine’s list of top U.S. health care IT companies again shows a heavy Georgia presence. Healthcare Informatics Magazine lists eight Georgia-based companies in its top 100 health IT companies in 2014, based on revenues from the previous year…During the years 2008 through 2013, the state’s health IT sector added 17.2 percent more technology workers, according to the Technology Association of Georgia. “Georgia is at the forefront of the health information technology sector with more than 225 health IT companies based in the state,” said Tino Mantella, TAG president and CEO (Miller, 6/7).

The Cincinnati Enquirer/USA Today: The Doctor Will See You Now – Virtually
Advances in telehealth are changing the way health care is delivered in the Cincinnati area. ... At St. Elizabeth Healthcare in Northern Kentucky, seeing your primary doctor may soon be as easy as logging onto your computer. And in Cincinnati's West End, formerly homeless veterans and recovering drug addicts at the Talbert House now have access to free, live online doctor's visits thanks to a first-of-its kind telehealth video console donated by Anthem Blue Cross and Blue Shield (Bernard-Kuhn, 6/7).

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Editorials and Opinions

Viewpoints: 'Triage' At The VA; GOP Can't 'Fix' Health Law; Mental Health Problems In L.A. Jail

The Wall Street Journal: Political Triage At The VA
Washington's attention span on the Veterans Affairs scandal seems to be expiring. Though 42 of the VA's 152 major campuses (27%) are still under investigation for falsifying wait-time records, the Senate is converging on a bipartisan deal that claims to solve the problem. The pity is that the price of so little reform is another layer of political enamel on the VA status quo (6/8).

Bloomberg: A Two-Fisted Fix For The VA
There are two theories on what the Department of Veterans Affairs needs to fix its sprawling health-care system: Better management or more money. The beauty of the deal struck by Senators Bernie Sanders of Vermont and John McCain of Arizona is that it tries both strategies at once (6/8).

The Washington Post: I'm An Army Veteran, And My Benefits Are Too Generous
Simply put, I'm getting more than I gave. Tricare for military retirees and their families is so underpriced that it's more of a gift than a benefit. A fourfold increase in premiums would leave Tricare safely on the side of hearty largesse, yet the Pentagon's attempts to raise premiums by as little as 10 percent have had shelf lives shorter than ice cubes (Tom Slear, 6/6).

Bloomberg: Why Obamacare Can't Be 'Fixed'
Monica Wehby, the Republican Senate candidate in Oregon, has fallen prey to a common delusion: that Obamacare can be "fixed." On her campaign website, Wehby, a surgeon, runs through a list of changes she wants made to the president's health-care overhaul. She would, among other things, get rid of the individual mandate to buy health insurance, offer more catastrophic insurance options on the exchanges and make it easier for people to buy insurance across state lines. But she also wants to keep several Affordable Care Act provisions, including the one that bans insurers from discriminating against people with pre-existing health conditions (Ramesh Ponnuru, 6/6).

Vox: Virginia Is Having An Insane Fight Over Medicaid Expansion
There is a tense and increasingly unbelievable fight over Medicaid expansion happening in Virginia. It now involves a huge political fight, a potential government shutdown and one apparent bribe to get a legislator out of office — and that's only the beginning (Sarah Kliff, 6/8).

The Star Tribune: Business Forum: Will Obamacare Die A Natural Death?
Minnesotans are almost palpably relieved that MNsure finally appears to be stabilized, past its rocky launch and two-hour holds on phone calls. More than 200,000 people have now signed up for health coverage through the state's online marketplace, along with 8 million others who signed up in the other 49 states for the first full implementation of the Affordable Care Act (ACA), or Obamacare. Count me among those pulling for MNsure’s success. I find the specter of working people unable to afford access to health care for themselves and their families tragic and disgraceful. But the logistics hurdles in setting up MNsure pale before this one: What if the ACA and MNsure carry the seeds of their own demise? (Michael Showalter, 6/8).

The New York Times: Shifts In Charity Health Care
Health care reform was supposed to relieve the financial strain on hospitals that have provided a lot of free charity care to poor and uninsured patients. The reform law, known as the Affordable Care Act, was expected to insure most of those patients either through expanded state Medicaid programs for the poor or through subsidized private insurance for middle-income patients, thereby funneling new revenues to hospitals that had previously absorbed the costs of uncompensated care (6/8).

The New York Times' The Upshot: How To Pay For Only The Health Care You Want
One reason health insurance is expensive is that most plans cover just about every medical technology — not just the ones that work, or the ones that are worth the price. This not only drives up costs, but also forces many Americans into purchasing coverage for therapies they may not value. But there's no reason things couldn’t be different, and better for consumers (Austin Frakt and Amitabh Chandra, 6/9).

Los Angeles Times: L.A. Has Run Out Of Time To Fix Its Own Jails
It should come as no surprise that Los Angeles County's treatment of mentally ill jail inmates falls so short of acceptable standards that the U.S. Department of Justice is seeking federal court oversight. County officials did too little for too long to correct egregious problems. Recent efforts to improve jail management and to identify and better serve mentally ill and suicidal inmates came too late (6/8).

NPR: A Doctor Takes A Look In The Medicare Mirror
As a teacher and a practicing physician, I was curious to learn what I could about my own Medicare billing from the public data. So I plugged my name into both The New York Times' Medicare database tool and ProPublica's Medicare Treatment Tracker to see where I stood. What did I find? In 2012, Medicare reimbursed the university where I work $45,994 for my services. Not much compared with the $21 million paid to a Florida eye doctor who specializes in treating macular degeneration. No doubt he's looked at a lot of eyeballs. A lot of eyeballs! (John Henning Schumann, 6/8). 

The Boston Globe: Martha Coakley’s Deal With Partners Will Help Contain Health Costs
After long negotiations, Attorney General Martha Coakley and Partners HealthCare System have arrived at a reasonable deal to let the hospital network acquire South Shore Hospital in exchange for significant restrictions on short-term rates and bargaining power. This agreement should be healthy for Massachusetts and good for Partners itself, which considers the acquisition of the Weymouth hospital vital to its efforts to deliver care in the most cost-effective setting. The multi-part pact is complicated, but the most significant pieces aren't (6/9). 

USA Today: GOP Takes Bite Out Of Healthy Meals
A few years ago, I took a group of kids to a farmers market in New York City. It was an eye-opening experience. Most of them had never seen, much less tasted, many of the vegetables on display. One 11-year-old mentioned it was her first time eating a raw carrot. That experience made me realize the sorry state of our food environment. The most obvious place to roll up our sleeves and start making improvements would be in schools. But sadly, a congressional panel just severely weakened a nutrition overhaul to the school lunch program, which taxpayers fund to the tune of $11 billion a year (Katie Couric, 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.