Daily Health Policy Report

Monday, July 1, 2013

Last updated: Mon, Jul 1

KHN Original Reporting & Guest Opinion

Health Reform

Medicare

Health Care Fraud & Abuse

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Thousands Of Mississippi Consumers May Not Be Offered Insurance Subsidies

Kaiser Health News staff writers Julie Appleby and Jay Hancock, working in collaboration with The Washington Post, report: "Tens of thousands of uninsured residents in the poorest and most rural parts of Mississippi may be unable to get subsidies to buy health coverage when a new online marketplace opens this fall because private insurers are avoiding a wide swath of the state. No insurer is offering to sell plans through the federal health law's marketplaces in 36 of the state's 82 counties, including some of the poorest parts of the Delta region, said Mississippi Insurance Commissioner Mike Chaney" (Appleby and Hancock, 6/29). Read the story and check out the accompanying map.

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Capsules: Mississippi Dems: We Were 'Bamboozled' On Medicaid; HHS Releases Contraception Coverage Final Rule

Now on Kaiser Health News' blog, Mississippi Public Broadcasting's Jeffrey Hess, working in partnership with KHN and NPR, reports on Mississippi's Medicaid hijinks: "With just two days to spare, and with plenty of political drama, Mississippi lawmakers approved a plan late Friday to renew Medicaid for another year. The joint federal-state program, which provides health insurance to some 700,000 poor Mississippians, was set to expire Sunday night" (Hess, 6/29).

Also on Capsules, Mary Agnes Carey reports on the Obama administration's final rule on contraception coverage: "The Obama administration issued final rules Friday governing contraception coverage in the sweeping 2010 health care law that officials said more clearly respond to concerns from religious groups that object to this requirement. But it’s unclear if the new rules will shield the administration from charges that requiring employers who oppose contraception services to pay for them for workers is a violation of employers' religious freedom" (Carey, 6/28). Check out what else is on the blog.

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Political Cartoon: 'My Way Or The Highway?'

Kaiser Health News provides a fresh take on health policy developments with "My Way Or The Highway?" by Matt Wuerker.

Meanwhile, here is today's health policy haiku:

EXPLORING NEW WORLDS?

For some Pioneers
ACO is a no go.
Bad news? Time will tell.
-Anonymous

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

What Do Moms, Librarians And Local Officials Have In Common?

News outlets report on how a range of organizations and professions could play a role in advancing the Obama administration's effort to get more people to enroll in the health insurance that will become available as a result of the health law.

Politico: Obamacare: Because Mom Said So
All those groups trying to get the "young, invincible" 20-somethings to sign up for Obamacare health insurance have identified a secret weapon. Mom. Advocacy groups from "Moms Rising" to AARP are working to reach the healthy, young adults who don’t think they need insurance -- and their mothers who think they do. The groups plan to use everything from paid advertising -- to guilt (Kenen, 6/29).

The Associated Press: Librarians To Help With Health Law
The nation's librarians will be recruited to help people get signed up for insurance under President Barack Obama's health care overhaul. Up to 17,000 U.S. libraries will be part of the effort to get information and crucial computer time to the millions of uninsured Americans who need to get coverage under the law (Johnson, 6/29).

The New York Times: Local Officials Asked To Help On Health Law
The White House is recruiting mayors, county commissioners and other local officials to promote and carry out President Obama's health care law in states like Florida and Texas, where governors are hostile to it. The effort comes as the administration is intensifying its campaign to publicize new health insurance options and to persuade consumers, especially healthy young people, to sign up for coverage when open enrollment starts on Oct. 1 (Pear, 6/29).

The Hill: Report: White House Looks to Local Officials To Promote ObamaCare
The White House is turning to local officials to help educate the public on the benefits of health care reform as the law takes effect, the New York Times is reporting. Faced with opposition from Republican governors in states like Texas and Florida, the White House is hoping that going around those officials will help educate the public on the benefits of a law that remains murky for many Americans (Jaffe, 6/29).

Politico: 5 Messaging Challenges For Obamacare
Obamacare won't have a shot at success unless millions of people sign up for insurance -- the healthy as well as the sick. For that to happen, the White House and its allies will need to make the case that coverage is worth it for the estimated 50 million people who haven't been able to afford or access insurance. Supporters are planning to spend tens of millions of dollars to persuade people to get covered under new health insurance options and explain how to sign up. ... Here are five of the messaging challenges they face (Millman and Kenen, 6/30).

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NFL Says It Has No Plans To Help With Obamacare Promotion

After receiving letters from Republican senators urging it to stay out of a political fight, the National Football League said Friday that it will not work with administration officials on the effort. HHS Secretary Kathleen Sebelius suggested earlier that the league was enthusiastic to help.

The Washington Post: NFL Says No To Promoting Obamacare
The National Football League is used to big, bruising battles. But on Friday, it announced that it was likely staying out of one of the roughest fights in Washington: the war over Obamacare (Somashekhar and Bernstein, 6/28).

CNN Money: NFL Has 'No Plans' To Promote Obamacare
The National Football League has "no plans" to work with the Obama administration in educating the public about the president's controversial health care reform, according to an NFL spokesman. ... The top two Republicans in the Senate cautioned the league against teaming up for the project, saying in a letter Friday the NFL would "risk damaging" its nonpartisan reputation by getting involved in a highly divisive issue (Killough, 6/28).

The Wall Street Journal: NFL Balks At Supporting Health Law After GOP Senators Send Warning
Health and Human Services Secretary Kathleen Sebelius told reporters at the beginning of last week that the National Football League was "enthusiastically engaged" in talks to help promote health insurance. By the week's end, the NFL had contradicted that statement, saying it "currently (has) no plans to engage in this area" after receiving a public warning from Republican Senate leaders, who also fired off letters to five other professional sports leagues suggesting they avoid promoting the Affordable Care Act. The letters were cosigned by Minority Leader Mitch McConnell of Kentucky and Texas Sen. John Cornyn (Schatz, 6/30).

Politico: Mitch McConnell Asks Pro Sports To Stay Away From Obamacare Promotion
Two top Senate Republicans have sternly warned the leaders of the NFL and other sports leagues against wading into the politically volatile waters of Obamacare. "Given the divisiveness and persistent unpopularity of the health care [law], it is difficult to understand why an organization like yours would risk damaging its inclusive and apolitical brand by lending its name to its promotion," Senate Minority Leader Mitch McConnell and Republican Whip John Cornyn wrote in letters to the commissioners of the NFL, MLB, NBA, NHL, PGA and the chairman and chief executive officer of NASCAR. A spokesman for the NFL responded Friday evening to say the league has no plans at this time to work with HHS on health law (Haberkorn, 6/28).

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Stakes Are High For Rollout Of Health Exchanges

An estimated 7 million people will shop for individual health coverage this fall in the new online health insurance marketplaces, with another 2 million seeking coverage through the law's small business program. Federal and state officials are working full tilt to have them ready in time.

Reuters: Obamacare 1.0: States Brace For Web Barrage When Reform Goes Live
About 550,000 people in Oregon do not have health insurance, and Aaron Karjala is confident the state's new online insurance exchange will be able to accommodate them when enrollment under President Barack Obama's healthcare reform begins on October 1. ... Multiply that by another 49 states and the District of Columbia, all of which will open health insurance exchanges under "Obamacare" that same day, and you get some idea of what could go publicly and disastrously wrong (Begley, 6/30).

The Hill: GOP Warns Of 'Train Wreck' Ahead Of ObamaCare Rollout
Sen. Pat Roberts (R-Kansas) warned of a coming "train wreck" when enrollment begins in ObamaCare insurance exchanges this fall in the Republican weekly address. Roberts, an outspoken opponent of President Obama's healthcare reforms, said that important questions remain before the exchanges, part of what he called a "massive federal government takeover," go into effect in October (Jaffe, 6/29).

The Wall Street Journal: Health-Insurance Costs Set For A Jolt
Healthy consumers could see insurance rates double or even triple when they look for individual coverage under the federal health law later this year, while the premiums paid by sicker people are set to become more affordable, according to a Wall Street Journal analysis of coverage to be sold on the law's new exchanges (Radnofsky, 6/30).

Medpage Today: Insurers, States Brace For Opening Of ACA Exchanges
An estimated 7 million people will shop for individual health coverage this fall under the Affordable Care Act (ACA), with another 2 million seeking coverage through the law's small business program. And by 2023, 24 million people will purchase insurance through the 2010 law's health insurance exchanges, the Congressional Budget Office estimates. With numbers like that involved, it's no secret the operation of the ACA's insurance exchanges -- sometimes called marketplaces -- is critical to the law's success. With numbers so large, it's also been a monumental task for the Obama administration and the states to get the exchanges off the ground (Pittman, 6/28).

News outlets also offer views on how the exchanges might work in specific states or regions -

Kaiser Health News: Thousands Of Mississippi Consumers May Not Be Offered Insurance Subsidies
Tens of thousands of uninsured residents in the poorest and most rural parts of Mississippi may be unable to get subsidies to buy health coverage when a new online marketplace opens this fall because private insurers are avoiding a wide swath of the state. No insurer is offering to sell plans through the federal health law's marketplaces in 36 of the state's 82 counties, including some of the poorest parts of the Delta region, said Mississippi Insurance Commissioner Mike Chaney (Appleby and Hancock, 6/29).

The Washington Post: Health-Care Setbacks Could Hit Region's Small Businesses
Some state and federal officials are falling behind setting up new health-insurance exchanges for small businesses, which could leave employers in the region waiting longer than expected for the competitive pricing they were promised under the health-care law. The Government Accountability Office has warned that federal and state officials still have a long way to go in "a relatively short amount of time” to set up the new online marketplaces, called exchanges, where small-business owners will be able to shop for health plans from various insurance providers (Harrison, 6/30).

MPR News: MNSURE Spreading The Word Via Social Media
Minnesota's new online health insurance marketplace, MNSURE, is turning to social media to inform consumers about its progress toward a launch this fall. More than a million Minnesotans are projected to obtain health insurance online through MNSURE, which will allow consumers to comparison shop for health coverage starting Oct. 1. In the meantime, consumers can turn to several social media outlets for updates (Stawicki, 6/30).

Medpage Today: California Leading From The Left In ACA Implementation
The Affordable Care Act hasn't really hit home yet for physicians in California, but the state is one of the most prepared for the next phase of implementation coming in January. … The state has the nation's largest health insurance market and 5.6 million uninsured, representing 18 percent of residents under 65, according to federal and state estimates. … California is one of only 16 states, along with the District of Columbia, that has opted to run its own ACA-mandated exchange for individuals and small businesses to purchase coverage next year. And while the federally-run exchanges are behind schedule and some states appear to be too, California's consumer insurance marketplace, called Covered California, appears to be on target for open enrollment to begin in October (Phend, 6/28).

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Nearly Half Of States Opt Not To Expand Medicaid

With most state legislative sessions coming to a close, 23 states and the District of Columbia have agreed to expand the program, as laid out under the health law. Many of the others will leave billions of federal dollars on the table, while a handful are still undecided.

CQ HealthBeat: On Medicaid: Expansion Decisions Nearing Conclusion
On the one-year anniversary of the Supreme Court ruling that says states would not lose their entire Medicaid funding if they decided not to expand the program, the nation is closely divided. With the fiscal year beginning in most states on July 1, many have decided whether or not to expand eligibility for adults starting on Jan. 1, 2014, as allowed by the health care law. So far, 23 states and the District of Columbia have announced they will expand eligibility. Another 22 have either said they will not expand or appear unlikely to expand on Jan. 1, while a handful remain unsettled (Adams, 6/28).

CNN Money: States Forgo Billions By Opting Out Of Medicaid Expansion
Nearly half the nation's states are opting not to expand Medicaid to all of their low-income residents, leaving billions of federal dollars on the table and millions of poor Americans uninsured. At least 21 states are opting out of Medicaid expansion for next year. In another six states, legislators are still weighing their options, according to the Kaiser Family Foundation, which is tracking the states' plans (Luhby, 7/1).

Columbus Dispatch: Kasich Signs Budget, But Veto Keeps Alive Medicaid Expansion
Gov. John Kasich last night vetoed language attempting to block him from moving forward with Medicaid expansion, but did not touch any of the anti-abortion language before signing the new two-year, $62 billion state budget. The budget takes effect today, the first day of the new fiscal year (Siegel, 7/1).

The Associated Press: Pa. Hospitals Press Lawmakers For Medicaid Bill
Pennsylvania's top hospital lobbyists were in the state Capitol on Saturday pressing lawmakers to pass legislation to potentially expand Medicaid eligibility to hundreds of thousands of adult Pennsylvanians under the 2010 federal health care law — and shore up the bottom lines of hospitals around the state. The hospital lobbyists were among a crowd of advocates on subjects from liquor to gas drilling plying the hallways of the Capitol during an unusual weekend voting session as lawmakers scramble to pass an on-time budget and other high-priority legislation before they depart Harrisburg until fall (Levy, 6/30).

Patriot News: Pa. Senate Approves Medicaid Expansion, But It Still Faces A Battle In The House
The state Senate Sunday night approved a bill to potentially expand Medicaid eligibility to hundreds of thousands of Pennsylvanians. The bill cleared the Senate by a 40-10 vote, indicating strong bipartisan support. The language, embedded in a yearly bill filled with updates to the state's Welfare Code, now moves to the state House of Representatives, where its fate was unclear (Thompson, 6/30).

Pittsburgh Post-Gazette: Corbett Signs Nearly $29 Billion Pa. Budget Before Deadline
One of those bills was approved Sunday by the Senate with a proposal requiring the state to apply for expanded Medicaid eligibility under the federal health care law, so long as certain conditions were met. House Republicans oppose broadening eligibility. Mr. Corbett has said he will not agree to Medicaid expansion unless the federal government allows Pennsylvania to make changes to its program. He was noncommittal Sunday night on the Senate proposal, saying he would not agree to a plan without Medicaid reforms. "I don't have a bill on my desk," Mr. Corbett said (Langley and Giammarise, 7/1).

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Contraceptive Exemption For Religious Groups Finalized

The rule, issued under the health care law, attempts to quell the controversy by balancing the interests of women with the concerns of the Roman Catholic Church and other employers with religious objections to providing coverage for contraceptives. 

The New York Times: Contraceptives Stay Covered In Health Law
Despite strong resistance from religious organizations, the Obama administration said Friday that it was moving ahead with a rule requiring most employers to provide free insurance coverage of contraceptives for women, a decision that has touched off a legal and political battle likely to rage for another year. The final rule, issued under the new health care law, adopts a simplified version of an approach proposed by the government in February to balance the interests of women with the concerns of the Roman Catholic Church and other employers with religious objections to providing coverage for contraceptives (Pear, 6/28).

Los Angeles Times: Obama Administration Issues Regulations On Contraceptive Coverage
The Obama administration made a final attempt Friday to quell the controversy over a requirement in the president’s healthcare law that insurance plans offer contraceptive coverage to women, issuing regulations that exempt churches and religiously affiliated organizations from paying for the benefits (Levey, 6/28).

Kaiser Health News: Capsules: HHS Seeks To Address Religious Employers’ Concerns In Contraceptive Coverage Final Rule
The Obama administration issued final rules Friday governing contraception coverage in the sweeping 2010 health care law that officials said more clearly respond to concerns from religious groups that object to this requirement. But it' unclear if the new rules will shield the administration from charges that requiring employers who oppose contraception services to pay for them for workers is a violation of employers’ religious freedom (Carey, 6/28).

Boston Globe: Contraceptive Exemptions Issued For Religious Groups
The Obama administration on Friday released its final rule determining contraceptive coverage under the federal health care law; religious organizations can gain an exemption from this coverage, but their employees will still get coverage for birth control with no cost-sharing due to some creative loopholes. "These employers, primarily houses of worship, may exclude contraceptive coverage from their health plans for their employees and their dependents," states a press release from the Department of Health and Human Services. Other non-profit religious organizations -- such as Catholic hospitals, high schools, and universities -- also won’t have to pay for coverage for which they object to on religious grounds (Kotz, 6/28).

Politico: Obama Administration Finalizes Contraception Coverage Policy
The Obama administration on Friday finalized its health care reform policy requiring nearly all employers to provide coverage of contraceptives in their employee health insurance policy free of co-pays, digging in its heels against backlash from religious groups (Haberkorn, 6/28).

Reuters: U.S. Sets Birth Control Rule For With Religious Ties
The Obama administration on Friday made it final that employees of religiously affiliated, nonprofit institutions would receive insurance coverage for birth control amid mounting legal challenges to a rule in the recent healthcare law. The White House proposed in early 2012 an arrangement that allows universities, hospitals and other employers with a religious affiliation to avoid paying directly for contraceptives. Instead, insurance companies provide coverage and foot the bill under the law (Morgan, 6/28).

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Health Law Has Businesses, Health Systems Weighing Tough Decisions

News outlets also attempt to "demystify" the health law and report on recent poll results and news regarding accountable care organizations.

Fiscal Times: 7 Ways Businesses Can Dodge Obamacare
The countdown to Obamacare implementation is on. And owners of businesses with 50 or more employees have begun making some tough decisions on ways to minimize their long-term costs. That's because under the law, businesses with at least 50 "full-time equivalent" employees have to provide health care to their workers or pay a penalty. Recent surveys indicate that many small-and medium-sized businesses are restricting hiring and cutting hours to get under that threshold. And according to Kenneth Laks, a certified public accountant at AVZ & Company, many businesses simply aren't prepared (Francis and Pianin, 7/1).

Medpage Today: Health Systems Face ACA Cost, Quality Pressures
When it comes to maximizing quality at the lowest cost, the Affordable Care Act (ACA) has presented both a challenge and an opportunity for health systems. It's also presented a level of uncertainty, as many states have not yet implemented changes associated with the ACA. Medicaid expansion has not yet kicked in, so not all health systems have seen the influx of new patients that next year is expected to bring, but many have seen numbers grow as a result of provisions that allow young patients to stay on their parents' insurance until age 26 (Petrochko, 6/28).

NPR: You Ask, We Answer: Demystifying The Affordable Care Act
The biggest changes in health insurance coverage under the Affordable Care Act are set to begin less than three months from now. October 1 is when people can start signing up for coverage in new state health exchanges. The policies would kick in on Jan. 1, 2014. It can all be a little confusing, we agree. So two weeks ago, we asked what you wanted to know about the health law. You weren't shy; our inbox was stuffed. Here are some answers (Rovner, 7/1).

Medpage Today: One Year Later, Readers Reverse Course On ACA
What a difference a year makes! Last year, a majority of readers were in favor of the Affordable Care Act (ACA). This year, it's a minority. In June of 2012, MedPage Today asked readers if the Supreme Court did the right thing when it ruled the ACA, in particular its individual mandate, did not violate the Constitution, but effectively left the decision to expand Medicaid up to each state. As part of our anniversary coverage of the Supreme Court's vote, we asked the same question again. The vote tallies are like peering through Alice's looking glass: nearly an eerie mirror image of each other (Kaiser, 6/28).

Modern Healthcare: Several Pioneer ACOs May Exit Program
Medicare's most ambitious test of accountable care could lose a substantial number of its participants after the first year. As many as nine of 32 Pioneer accountable care organizations—the name given to Medicare's first and highest-risk test of the payment model—may exit the program, according to the CMS, and at least four have started to notify providers (Evans, 6/28).

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Medicare

Hospitals, Doctors Consider Changes Amid Medicare Hospital Readmissions Scrutiny

Hospitals and doctors are feeling the health care law heat as officials try to reduce readmissions and increase quality of care in the Medicare program. PBS NewsHour looks at the law's hospital readmissions penalties and Medpage Today explains what the hospitals are doing.

PBS NewsHour: Health Care Law Aims To Reduce Need To Rehospitalize Medicare Patients (Video)
Every year, nearly 2 million Medicare beneficiaries are readmitted to the hospital within 30 days of being discharged, at a cost of $17.5 billion. Health correspondent Betty Ann Bowser reports on provisions in the new health care law that aim to limit the need to rehospitalize Medicare patients (6/28).

PBS NewsHour: Health Reform Brings Heavy Fines for Hospitals With High Readmissions
The federal government began fining hospitals based on how many Medicare patients were readmitted within 30 days of discharge in October. They track three specific conditions -- heart failure, congestive heart failure and pneumonia. … [W]e spoke to Kaiser Health News reporter Jordan Rau recently. He's been following the policy since the Affordable Care Act was passed in 2009 (Clune, 6/27).

Medpage Today: Hospitals Already Feeling ACA Pinch
Putting the Affordable Care Act (ACA) into practice has left some hospital-based physicians feeling trapped between two worlds. Although most care is still delivered in the fee-for-service realm, many have started to think in terms of a pay-for-performance model, with a focus on improving outcomes while simultaneously trying to make care cheaper. … A triumvirate of ACA reforms is driving most of the changes that serve an ultimate goal of improving outcomes in order to lower costs. These are reducing readmissions, diminishing hospital-acquired infections, and getting paid based on the value of service provided (Fiore, 6/28).

And Sen. Charles Grassley asks states what they're doing about problem doctors who serve Medicare patients --

ProPublica: Senator Asks States If They Alert Medicare To Problem Physicians
A key U.S. senator sent letters to all 50 states this week asking how they sanction doctors in their state health programs and whether they alert the federal government when they do.  In his letters, Sen. Charles Grassley, R-Iowa, cited examples from a ProPublica report last month that found doctors who had been kicked out of state Medicaid programs for the poor were able to continue prescribing drugs to elderly and disabled patients in Medicare (Ornstei, Weber and LaFleur, 6/28).

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Health Care Fraud & Abuse

Budget Cuts Likely To Undermine Medicare Anti-Fraud Efforts

Center For Public Integrity: Medicare Fraud Outrunning Enforcement Efforts
Citing massive budget and staff cuts, federal officials are set to scale back or drop a host of investigations into Medicare and Medicaid fraud and abuse—even though cracking down on government waste and cutting health care costs have been top priorities for the Obama administration (Schulte, 7/1).

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State Watch

Lawmakers Gird For New Abortion Fight As Texas Special Session Convenes

Texas lawmakers resume debate on proposed abortion legislation as the state legislature opens a special session Monday. Republicans say they will quickly pass new abortion restrictions despite opponents' efforts. Meanwhile, the Congressional Budget Office projected that a House bill that would ban abortions after 20 weeks would increase Medicaid costs by as much as $400 million.

Dallas Morning News: Texas Lawmakers Resume Debate Monday On Abortion Bill Derailed By Wendy Davis Filibuster
With the raucous ending to their last special session still fresh on their minds, Texas lawmakers return to the Capitol on Monday to resume debate on proposed abortion restrictions that have stirred emotions across the state and nation. Less than a week after a Democratic filibuster killed a far-reaching abortion bill on the Senate floor, the Legislature will answer Gov. Rick Perry’s call to try again to pass the GOP-backed measure over vigorous objections from Democrats and abortion rights groups. The House and Senate will begin work Monday afternoon, just after a Capitol rally sponsored by the Texas Democratic Party to oppose the abortion bill (Stutz, 6/30).

The Associated Press/USA Today: Texas Lawmakers Are Back, And So Is Abortion Fight
Round two of Texas' fierce ideological battle over abortion limits was set to begin Monday, less than a week after a Democratic filibuster and hundreds of raucous protesters threw the end of the first special session into chaos. The Legislature's Republican majority has vowed to pass wide-ranging abortion restrictions quickly and easily this time, even as opponents mobilize for more protests (7/1).

The Texas Tribune: DPS, Abortion Activists Preparing For Renewed Debate
Less than a week after their shouts and screams effectively derailed a vote on a restrictive new abortion law, reproductive rights advocates are already getting organized for the special session. But when proceedings begin anew on Monday, state leaders will be better prepared -- and are working with state security to prevent further disruption (Aaronson and Luthra, 6/29).

Politico: Wendy Davis: Perry, Dewhurst Advancing Abortion Bill 'To Step Up The Political Laddar'
Texas state Sen. Wendy Davis blasted Texas Gov. Rick Perry and Lt. Gov. David Dewhurst on Sunday for using the 20-week abortion ban legislation in Texas to advance their own political ambitions. "I think really what’s happening here, Bob, is politicians are using this issue to boost their own political aspirations, their own political ambitions,” she told host Bob Schieffer Sunday on CBS's "Face the Nation" (Schultheis, 6/30).

St. Louis Beacon: On The Trail: Texas Fracas Familiar For Veterans Of Missouri's Abortion Battles
Last week's spectacle in the Texas Senate got national attention, but some Missouri politicos may have experienced déjà vu while watching a livestream of Texas state Sen. Wendy Davis' filibuster against an abortion bill (Rosenbaum, 7/1).

Abortion issues in Kansas, California and Iowa also make news --

The Associated Press/Washington Post: Federal Judge In Kansas Refuses To Block Parts Of State's Sweeping New Anti-Abortion Law
The chief federal judge in Kansas refused Sunday to temporarily block parts of a new state abortion law, including a requirement that providers' websites link to a state site with information they dispute. But U.S. District Judge Kathryn Vratil’s ruling Sunday in a lawsuit filed by Planned Parenthood came after a state judge ruled Friday in a separate challenge that Kansas couldn't enforce the website requirement for now (6/30).

Los Angeles Times: Protesters Hit Home Of Hoag Doctor Who Opposed Abortion Ban
About 50 to 100 antiabortion protesters wrote messages in chalk and shouted slurs outside the home of a Newport Beach obstetrician who was one of the doctors to oppose Hoag Hospital's decision to eliminate elective abortions. The protest late Thursday outside the Dover Shores home of Dr. Richard Agnew, a Hoag Hospital-affiliated physician, was led by a group of protesters who mostly appeared to be in their early teens and wrote messages in chalk that included "neighborhood serial killer" and "This house was built from blood" (Williams and Cowen, 6/28).

Des Moines Register: Iowa Medicine Board Takes Step Toward Banning Remote Abortions
The Iowa Board of Medicine on Friday took an initial step toward enacting rules barring Iowa doctors from administering abortions via videoconference. Responding to a petition seeking new state regulations on the practice, the board voted 8-2 to initiate the state’s rule-making process. The action does not write a ban into law, but clears the way for a public comment period and ensures a final vote by the board later this year (Noble, 6/29).

Meanwhile, from Capitol Hill -

Politico: CBO: GOP Abortion Bill Would Raise Deficit
Nearly every single House Republican voted last week to increase government spending and push the nation further into debt — all to limit abortion access for some women. The official budget scorekeeper of Congress says the Pain-Capable Unborn Child Protection Act, which would ban abortions after 20 weeks, would increase Medicaid costs by as much as $400 million (Sherman, 6/28).

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State Highlights: Calif. Bill To Fine Firms With Workers On Medi-Cal Fails

A collection of health policy stories from California, Pennsylvania, Oregon, Mississippi, Massachusetts, Georgia and Iowa.

Los Angeles Times: Bill To Fine Big Firms With Workers On Medi-Cal Comes Up Short
A California proposal to fine large companies that have workers on Medi-Cal came up short in an initial vote in the Assembly amid strong business opposition. The proposed fines could reach about $5,000 per full-time employee who receives Medi-Cal, the state Medicaid program for the poor. The bill, AB 880, garnered 46 votes in the 80-member chamber Thursday, short of the 54 votes, or two-thirds majority, needed. The measure could come up for reconsideration as early as next week (Terhune, 6/27).

The Philadelphia Inquirer: Pa. 'Benevolent-Gesture' Bill For Physicians Advances
On the physician's checklist, somewhere between describing how difficult an operation was and which steps a family might want to take next, expressions of empathy may now become more prevalent. Again making its way through the Pennsylvania legislature is a bill -- "benevolent-gesture" legislation -- that would prohibit empathetic statements such as apologies and condolences from being used against medical personnel in court (Haghighat, 6/29).

The Lund Report: House Passes Bill To Help Diabetic Women; Cancer Screening Money In Influx
The House passed a bill that will require insurance companies to cover the prenatal medical needs of diabetic women at no extra cost during pregnancy. Rep. Sara Gelser, a Corvallis Democrat, sponsored the bill, saying it would not only ease the burdens that diabetic women face when they become pregnant, but also prevent devastating stays in neonatal intensive care units for newborn infants (Gray, 6/28).

Kaiser Health News: Capsules: Mississippi Dems: We Were 'Bamboozled' On Medicaid; 
With just two days to spare, and with plenty of political drama, Mississippi lawmakers approved a plan late Friday to renew Medicaid for another year. The joint federal-state program, which provides health insurance to some 700,000 poor Mississippians, was set to expire Sunday night (Hess, 6/29).

The Wall Street Journal: At Nation's Oldest Institution for the Disabled, 13 Lives in Limbo 
Michael Martin is 51 years old, but because of brain damage he lives his days like a very young and anxious child, prone to violent outbursts. He is learning to fold towels. Yet his abilities tower over a longtime neighbor, Teresa Kacinski, who can't walk, talk, see, feed herself or change positions. With help, she can strike a key on a toy piano. They are among the 13 remaining residents of the Fernald Developmental Center, the oldest [Massachusetts] state-run institution in the U.S. for people with developmental and intellectual disabilities (Ansberry, 6/28).

Oregonian: Oregon Health Reforms Start Up In Portland Area With New Ideas, Urgency
On a recent Tuesday in a Providence clinic in the Laurelhurst neighborhood, Corey Whitcomb and three other soon-to-be mothers sit in a circle and hold ice cubes in their hand, an exercise in managing the pain of childbirth. …  Elsewhere in the city, unemployed 24-year-old Amanda Skowronski jots down carb content in the foods she is about to eat. She's kicked her daily two-liter cola habit, and has lost nearly 10 pounds as she tries to get off insulin with the help of a caseworker. Similar subtle shifts are under way statewide to improve health care. Last year, lawmakers approved changes to the Oregon Health Plan to try and save money while improving care The changes harness $1.9 billion in federal reform funds and a waiver from federal Medicaid rules to reorganize providers and spend on prevention and keeping people healthier. Intended to make Oregon a petri dish for health reforms, the federal funds have people around the country watching to see if the investment pays off (Budnick, 6/29).

Georgia Health News: Phoebe Putney, FTC Could Reach Settlement
The Federal Trade Commission and Phoebe Putney Health System may be heading toward a settlement in their two-year antitrust battle. The federal agency has fought the merger of Phoebe Putney Hospital and its only competitor in the Albany area, Palmyra Medical Center, since the deal was announced (Miller, 6/28).

Georgia Health News: An Innovative Idea That's Crossing Boundaries
Last fall, members of the Athens Health Network invited the founders of an unusual alternative to conventional health insurance to visit this northeast Georgia college town and explain how their system works. The Athens group members, who includes hospital and clinic executives as well as public health officials and physicians, were so impressed that they vowed to try and copy the model founded more than 2,400 miles away, in Reno, Nev. (Zhang, 6/28).

Des Moines Register: Does State Still Offer 'Placement Of Last Resort'?
The Wapello County sheriff places much of the blame for Doug Newby's long jail stay on the refusal of the state-run Mount Pleasant Mental Health Institute to accept him as a patient. Law enforcement and health professionals interviewed by the Register regard the state's four mental health institutes as the last resort for people who need long-term, secure placements because they can't safely stay in unlocked community facilities (Leys, 6/29).

Reuters: Pennsylvania Hospital's Ban On Hiring Smokers Prompts Debate
With just days to go before two of the city's most prestigious hospitals refuse to hire smokers, the ban has relit a debate about the wisdom of regulating workers' behavior away from the workplace. Both the highly rated University of Pennsylvania Health System, which includes the Hospital of the University of Pennsylvania, as well as the Children's Hospital of Philadelphia, named by US News and World Report as America's top children's hospital this year, will join dozens of hospitals across the country when they implement their policy on Monday, July 1 (Warner, 6/28).

California Healthline: Health Committee Moves Mental Health Bill
The Assembly Committee on Health this week approved a bill aiming to ensure mental health needs are treated with the same concern as physical conditions by ramping up legislative oversight and enforcement efforts. Summer recess begins July 3, so the bill likely will remain in Assembly Appropriations until the Legislature reconvenes in August. SB 22 by Sen. Jim Beall (D-San Jose) would require health plans and health insurers to submit annual reports to the Department of Managed Health Care and the California Department of Insurance, respectively, to certify they are complying with state and federal mental health parity laws (Hart, 6/28).

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Health Policy Research

Research Roundup: 'Welcome-Mat' Effect Of Medicaid Expansion; Calif.'s Transition To Medicaid Managed Care

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

Health Affairs: Medicaid 'Welcome-Mat' Effect Of Affordable Care Act Implementation Could Be Substantial – The number of people eligible for Medicaid who remain uninsured varies from state to state, according to the authors. But the federal health law is likely to increase the rate of enrollment for this group. The potential impact of this increase in Medicaid enrollment, also known as the 'welcome-mat' effect, is unclear. Analyzing low-income parents in Massachusetts who had been eligible but did not join Medicaid until the state implemented it own health overhaul in 2006, researchers from the University of Minnesota  sought to predict that impact nationally.  They found that the state’s overall Medicaid participation increased more than 19 percentage points and the "enrollment rate among previously eligible low-income parents in Massachusetts increased by 16.3 percentage points." They add, however, the experiences of other states are likely to differ from the effects they observed in Massachusetts and will also depend on various factors such as current enrollment rates and outreach efforts (Sonier, Boudreaux and Blewett, 6/26).

The Urban Institute/Robert Wood Johnson Foundation: Implementation Of Small Business Exchanges In Six States – Under the federal health law, the Small Businesses Health Options Program, also known as the SHOP exchange, aims to provide small employers with an opportunity to pool their purchasing power to get more affordable health coverage options and to provide administrative relief for them in offering more options to workers. SHOP will exist in both federally and state-run health exchanges, and this report provides an overview of the program and its development in New York, Oregon, Rhode Island, Colorado, Maryland and New Mexico. "Policy decision-making varied state to state and appears to be rooted in specific market dynamics that exist in each individual state," the authors found. Their report also highlights several other major findings including the role of brokers in educating small employers about the new market places (Blumberg and Rifkin, 6/27).

The Kaiser Family Foundation/University of California, Berkeley/University of California, Los Angeles: Transitioning Beneficiaries With Complex Care Needs To Medicaid Managed Care: Insights From California – According to the report, California's Medicaid program for low-income individuals, known as Medi-Cal, transitioned close to 240,000 seniors and people with disabilities into Medicaid Managed Care between June 2011 and May 2012. This transition from a fee-for-service to managed care program, the authors add, did not include seniors and people with disabilities who were dually eligible for both Medi-Cal and Medicare, the federal health program for those 65 years and older. The researchers examined how health service providers, plan administrators and community-based organizations in Contra Costa, Kern, and Los Angeles Counties handled this transition. "Even when steps are taken to mitigate anticipated issues and concerns prior to the transition, as was the case with California, unanticipated challenges are likely to arise," the authors write. Their findings, the authors highlight in this report, may serve as guide to inform similar transitions elsewhere (Graham et al., 6/25).

The Center Of Excellence In Public Health Workforce Studies/Robert Wood Johnson Foundation: Enumeration And Characterization Of The Public Health Nurse Workforce – Although public health nurses play a vital role in health care, "little is known about the size, composition, and educational/training background" of this workforce, the authors write.  They analyzed survey and local- and state-level data to assess the current workforce. Among many of the findings highlighted in this report is the lack of racial and ethnic diversity among public health nurses in local and state departments and the need to strengthen the workforce’s education and training. The findings highlight "the need for ongoing systematic monitoring of the workforce in order to better address issues of supply and demand, inform competency compliance and credentialing efforts, permit better alignment of academic resources with workforce needs, and allow for a better understanding between workforce infrastructure and its relationship to specific health outcomes," the report’s authors conclude (Boulton and Beck, 6/26).

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

Medscape Today: Image Test Orders Shaped By Patient And Visit Factors
Physician-level factors do not appear to greatly affect the use of low- and high-cost imaging modalities in the emergency department (ED), according to the findings of a retrospective cohort study. Hannah J. Wong, PhD, from York University in Toronto, Ontario, Canada, and colleagues published their findings online June 25 in Radiology (Barber, 6/26).

Medscape Today: Cancer Clinics Closing: Community Oncology 'Near Crisis'
The community cancer care landscape in the United States continues to evolve, and not for the better, according to a report released by the Community Oncology Alliance (COA). Since their previous report, issued in April 2012, there has been a 20% increase in clinic closings and in consolidation into hospitals. "Community oncology is very much under fire. With the coming of the budget cuts that were made to Medicare," said Ted Okon, executive director of COA, "we are nearing crisis" (Nelson, 6/27).

Medscape Today: Pediatric Scan Rates High Despite Risk
One quarter of children presenting with isolated headache undergo at least a single computed tomography (CT) scan, according to the results of a study published online June 24 in Pediatrics. "Use of CT scans to diagnose pediatric headache remains high despite existing guidelines, low diagnostic yield, and high potential risk," write Andrea DeVries, PhD, from HealthCore Inc, Wilmington, Delaware, and colleagues, noting that less than 1% of pediatric brain abnormalities present with headache as the only symptom (Waknine, 6/27).

Reuters: New Labels Tied To Fewer Child Poisonings By OTC Meds
Fewer small children have been sickened or died from accidentally taking cough and cold medicines meant only for older ages, according to a new study of the effects of recent label changes on these over the counter products. High doses of antihistamines can cause coma, seizure and abnormal heart rhythms in kids, and an overdose of the pain reliever acetaminophen can cause liver failure, according to the study's lead author Dr. Maryann Mazer-Amirshahi of the department of emergency medicine at The George Washington University in Washington, D.C. (Doyle, 6/28).

Reuters: Many Cancer Patients Expect Palliative Care To Cure
In a survey of patients with terminal lung cancer, nearly two-thirds did not understand that radiation treatments intended only to ease their symptoms would not cure their disease. Among the nationwide sample of patients with advanced lung cancers, four out of five thought the radiation would help them live longer and two in five believed it might cure their cancers (Doyle, 6/26).

Medicare Newsgroup: Traditional Medicare Makes Gains But Lags Behind Medicare Advantage in Chronic Illness Treatment -- On television, older Americans look healthy. We see them in commercials riding bicycles, jogging and playing basketball with their grandchildren. Sometimes they’re even surfing. The doctor’s office tells a different story. Dana E. King, MD, a family physician at the Sleeth Family Medicine Center, said he’s seeing an increasing burden of chronic illnesses such as diabetes obesity and hypertension in younger, baby boom-aged patients. … Turns out that baby boomers, the 78 million Americans born from 1946 through 1964, were more chronically ill, more disabled and had lower self-rated health than the previous generation did at the same age, according to their study, published in JAMA Internal Medicine. More than half of baby boomers reported no regular physical activity (Sjoerdsma, 6/27).

Medpage: ACA Coverage Affected By DOMA Ruling
Legally married same-sex couples will now be considered a family in calculating federal medical benefits after Wednesday's landmark Supreme Court ruling striking down part of the Defense of Marriage Act (DOMA). The ruling in United States v. Windsor forces the federal government to recognize same-sex marriages that have taken place in 12 states and the District of Columbia -- jurisdictions in which such marriages are legal. That means gay and lesbian spouses will now be counted as couples for such things as tax credits to purchase insurance under the Affordable Care Act (ACA) (Pittman, 6/27).

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Editorials and Opinions

Views On Abortion: USA Today Offers Contrasting Points On Effort To Set Ban After 20 Weeks; Democrats Can Fight Back Against Inroads Made By Abortion Opponents

USA Today: 20-Week Abortion Ban Too Soon: Our View
The 20-week bans are the latest front in the abortion wars that have raged ever since the Supreme Court's decision 40 years ago in Roe v. Wade. In addition to the state bans, the U.S. House passed a 20-week limit in June, using the atrocities by Philadelphia abortion doctor Kermit Gosnell as a rallying cry. Preventing murders like the ones Gosnell committed is certainly an urgent goal. But 20-week bans won't do it and could, in fact, create more tragedies than they prevent (6/30). 

USA Today: Halt Arbitrary Fetal Euthanasia: Opposing View
The trial of Philadelphia doctor Kermit Gosnell brought the gruesome nature of late-term abortion to the forefront of the national consciousness. A recent Gallup poll indicates that Americans overwhelmingly support banning later abortions. The difference between Gosnell's actions in killing the child after it is born alive and aborting the child in the womb is merely a matter of location (Anna Higgins, 6/30). 

The New York Times: No Letup On The Right To Choose
Wendy Davis, a Texas state senator, got national attention last week for her marathon filibuster against an extremist package of abortion restrictions. Ms. Davis's dramatic gesture is unlikely to stop the hard-right Texas Legislature from passing the bill, and there are many similar measures around the country that are part of a nonstop attack on women's reproductive rights by Republican lawmakers and anti-abortion groups. But her uprising, which shot around the country on Twitter and the rest of the social Web, showed that Democrats can fight back against the anti-abortion-rights campaign (6/29).

Bloomberg: Wendy Davis' Argument And The Future Of Abortion Rights
The forces gathered to undermine abortion rights -- including many who entered state legislatures in the 2010 elections -- are impressively thorough and dangerously extreme. Davis's lone, passionate voice, even speaking for 10-plus hours, was never going to prevail against such a national juggernaut. Yet the two sides are not as unequally matched as it might seem (6/30).

The New York Times: Room For Debate: Coming Out On Abortion
For years, conservatives rallied support around opposition to abortion and same-sex marriage. Support for same-sex marriage has grown, in part, because opponents have realized that friends and relatives are gay. But Republicans have continued to press for tougher laws against abortion. The Guttmacher Institute says 30 percent of American women have had an abortion by age 40. Would support for abortion rights grow if more women discussed their abortions? (6/30). 

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Viewpoints: A 'Clever' Fix For Contraception Coverage; Sanjay Gupta Warns Doctors To Pay Attention To Health Overhaul

Los Angeles Times: Obama Administration's Clever Contraception Fix
Many nonprofit religious organizations have balked at having to insure their employees' birth control -- because they don't believe in artificial contraception -- under the Affordable Care Act. On Friday, the Obama administration announced a solution to this problem. The new health care law guarantees access to preventive services, and contraception falls, appropriately, into that category (Carla Hill, 6/28).

The New York Times: Sex And the H.I.V. Morning-After Pill
More than 30 years since AIDS emerged, and two decades since antiretroviral drugs transformed that epidemic into a chronic but manageable disease, conversations about H.I.V. remain awkward, especially for gay men. ... Two recent developments could make these conversations less awkward, or even render them moot. But they also raise troubling questions about promiscuity and responsibility that are reminiscent of debates from the 1980s. The first development was the approval, last summer, by the Food and Drug Administration of an over-the-counter rapid-response at-home H.I.V. test kit. The test, called OraQuick and available nationwide since October, gives results 20 minutes after a cheek swab. The second is the increasing availability of (post-exposure prophylaxis) PEP and of pre-exposure prophylaxis, or PrEP (Richard Morgan, 6/28).

The New York Times: Why Healthy Eaters Fall For Fries
Such is the puzzle of the food industry: American consumers, even otherwise healthy ones, keep choosing caloric indulgences rather than healthy foods at fast-food restaurants. Public health officials have been pushing fast-food restaurants to offer more nutritious foods to help combat excess weight in the United States, where more than one-third of American adults are obese. And restaurants have obliged by adding healthy menu items. But it's the sugary, fatty items that are flying -- or waddling -- out the door (Stephanie Clifford, 6/29). 

Medpage Today: Health Care Professionals Not Ready For ACA
It is the most extensive overhaul of health care in this country in half a century, and it's about to make itself felt in a big way. But many of us who provide health care are paying little attention to what it will mean for our profession or our patients. That's partly because this has been a slow-moving train that seemed like it might be pushed off the rails at many turns. It was easy to ignore (Dr. Sanjay Gupta, 6/28).

Fox News: ObamaCare Turns One -- Here's What America Still Needs To Know
When the Supreme Court deemed the Affordable Care Act constitutional one year ago, it was a monumental moment in our nation’s history.  It meant that essential, historic reform of the American health care system would move forward. It meant guaranteed health care access for millions of Americans who hadn't had access before. It meant a re-energized focus on medical quality and the development of a more efficient health care delivery system. Twelve months after the court's decision, though, there are still more questions than answers (Dr. Toby Crosgrove, 6/28).

Los Angeles Times: The Budget Vs. Medi-Cal
Gov. Jerry Brown signed the state's budget for the coming fiscal year into law Thursday, marking the third consecutive year that this particular task has been accomplished on time -- a sharp contrast to the prior decade's routinely late budgets. And to their credit, Brown and the Legislature relied on comparatively few gimmicks to make ends meet. ... But one of the biggest initiatives in the budget -- the expansion of Medi-Cal, the health insurance program for the impoverished -- could be undermined by some of the cuts lawmakers did not undo (6/28). 

Roanoke Times: Virginia Can Control Its Destiny With Medicaid Expansion 
We can accept expansion with the understanding that we have the option to reverse course if the federal government does not honor its commitment. Yes, Medicaid needs reform, and the impetus for reform is one of the main reasons that I am a proponent for strategic expansion. We have delineated an aggressive agenda for reform, and the administration is already making a lot of progress to achieve our goals. We have already agreed to expand Medicaid if these goals are met and to suspend our program if the federal government does not honor its commitment. Savings attributed to the revised program would be placed in a special fund in case there are shortfalls in future years (Republican State Sen. Emmett Hanger, 6/30).

Roanoke Times: Virginia Could Get Stuck With A Large Bill
Proponents of expansion have argued that "it would be foolish" for Virginia to turn down "free" federal money appropriated for expansion. But as the saying goes, there is no such thing as a free lunch. ... When a state chooses not to expand Medicaid, that money does not get spent somewhere else. It simply does not get borrowed and spent at all. A study recently quoted in the Wall Street Journal estimated if only half the states reject expansion, the federal deficit could be reduced by more than $500 billion (Republican State Del. Steve Landes, 6/30).

CNN: Find Out What Your Doctor Really Thinks About You
I was sitting in a wheelchair in an elevator of a hospital when the aide pushing me lay a binder on my lap. My medical record! It was heavy, hundreds of pages charting all I had endured since a runaway truck in Jerusalem broke my neck months before on May 16, 1990. I knew that medical charts were off-limits to patients. But I was 19 and hemiplegic (the left half of me paralyzed) and curious. And so, I opened it with my one good hand and read what a droll psychologist at Mount Sinai had somehow gleaned from our occasional games of chess: "Joshua appears compliant and motivated and expressed good insight into the nature and course of his disability." I closed the binder quickly, my mind at ease. Patients no longer have to resort to stolen glances. Ever since 1996, when Congress passed the Health Insurance Portability and Accountability Act, all of us (save a small number of people with severe mental health disorders) have had the right to read our records (Joshua Prager, 7/1).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.