Daily Health Policy Report

Wednesday, July 10, 2013

Last updated: Wed, Jul 10

KHN Original Reporting & Guest Opinion

Health Reform

Women's Health

Health Information Technology

Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

How Oregon Is Getting 'Frequent Flyers' Out Of Hospital ERs

Oregon Public Broadcasting's Kristian Foden-Vencil, working in partnership with Kaiser Health News and NPR, reports: "Forty-year-old Jeremie Seals has had a tough life. He left home at 14, and he says, his health isn't good. He had a heart attack when he was 35, he has congestive heart failure and nerve pain in his legs 'real bad.' ... over the years, he says his health has deteriorated to such a degree, he can no longer hold a job. By 2011, he was sleeping in his car, and that’s when his medical problems started having a big financial impact. 'I basically lived at the emergency department,' he said. ... And that's what brought him to the attention of one of Oregon's new coordinated care organizations (CCOs)" (Foden-Vencil, 7/10). Read the story.

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Capsules: Study: Competition, Not Need, Drives Hospital Cardiac Care Investment; Medicare Advantage Plans Cut Total Cardio Procedures, But Regional Variations Remain; Community Health Centers Get Obamacare Outreach Funds

Now on Kaiser Health News' blog, Phil Galewitz reports on a study examining which hospitals are adding services for a key heart procedure: "U.S. hospitals spent up to $4 billion adding angioplasty services over a four year period, but the new services did little to improve access to timely medical care, says a study published Tuesday in the journal Circulation: Cardiovascular Quality and Outcomes. Between 2004 to 2008, some 251 hospitals added the invasive and often life-saving cardiac care, but researchers found that the new programs were mainly built near existing ones in competitive health care markets, rather than where the need for the services was greatest" (Galewitz, 7/9).

Also, Jay Hancock writes about a different study that looks at heart procedures performed on patients in the private Medicare Advantage plans: "Patients in Medicare Advantage plans got expensive balloons and stenting to clear coronary arteries at a rate 31 percent lower than patients in traditional Medicare, according to the study published in the Journal of the American Medical Association by Dr. Daniel Matlock and colleagues. ... What they didn't expect were enormous differences in utilization rates among Medicare Advantage patients from one city to another. They figured cost-control incentives would smooth out the notorious regional swings in how often procedures are administered under traditional Medicare. They didn't. In some regions" (Hancock, 7/9).

Finally, Phil Galewitz reports on new federal grants for community health centers: "The nation’s community health centers -- which treat the poor and uninsured -- apparently know a good deal when they see one. Nearly all 1,200 federally funded community health centers applied for and will be getting a piece of $150 million in federal health law money to enroll patients in new online health insurance marketplaces starting Oct.1" (Galewitz, 7/10). Check out what else is on the blog.

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Political Cartoon: 'King Of The Quill?'

Kaiser Health News provides a fresh take on health policy developments with "King Of The Quill?" By Chip Bok, Akron Beacon Journal.

Meanwhile, here is today's health policy haiku:


One mandate delayed,
House leaders seek another.
Where to draw the line?


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

House Republicans Promise New Efforts To Fight Health Law’s Individual Mandate

Speaker John Boehner vows to hold a vote this month to remove the requirement that Americans get insurance, and some in the GOP suggest they could attach the effort to bills raising the U.S. debt limit.

The New York Times: Seeing Opening, House G.O.P. Pushes Delay On Individual Mandate In Health Law
House Republican leaders on Tuesday seized on the Obama administration's one-year delay of a mandate for larger employers to offer health insurance or face penalties, demanding the same postponement for the mandate on individual insurance purchases and promising a series of showdowns aimed at dividing Democrats from the White House. ... House leaders began devising strategies that would most likely start this month with multiple votes, the first to codify the one-year delay on the employer mandate, then another to demand a delay on the individual mandate. ... Some Republicans raised the possibility that a provision to repeal the individual mandate could be attached this fall to legislation raising the government's statutory borrowing limit (Weisman and Pear, 7/9).

The Associated Press: GOP Wants Delay In Health Law's Individual Mandate
House Speaker John Boehner, R-Ohio, and other senior Republicans told Obama in a letter that his decision last week to grant a one-year delay for employers but leave in place provisions for individuals and families had created many new questions and concerns. At a Capitol Hill news conference, Boehner vowed to hold another vote this month to remove the individual mandate, arguing that it was necessary to "correct this injustice" (Alonso-Zaldivar, 7/9).

Politico: Hill GOP Eyeing Obamacare Mandate Delay Responses
House Republican leaders are hoping to take full political advantage of the White House’s delay of a key Obamacare requirement by targeting votes this summer on at least three pieces of the law — including the unpopular individual mandate. Last week, the White House gave employers another full year — until 2015 — to offer affordable health care to workers. Republicans, returning from the July 4 break, say that's more proof the law is too complicated to work and that it’s just not right to let businesses off the hook for a year but not ordinary Americans (Cunningham and Haberkorn, 7/9).

The Washington Post: White House Ramps Up Effort To Sell Obamacare
The White House is dramatically expanding its efforts to sell the Affordable Care Act, hiring additional staffers, formulating a public-relations strategy and reaching out to key lawmakers as the new health-insurance system prepares to launch in coming months. The administration’s push comes as Republican leaders signal their intent to focus on the law’s implementation, and any problems it encounters, in their quest to retake the Senate and maintain their House advantage in 2014 (Eilperin, 7/9).

The Hill: GOP Seeks Delay In Individual Mandate
Delaying the individual mandate would be far more dangerous for the White House. It would undermine the central mission of the healthcare law and would likely interfere with establishing new insurance marketplaces. Insurance companies are likely to oppose a delay in the individual mandate without also delaying new provisions requiring them to cover people with pre-existing conditions — one of the law's most popular elements (Baker, 7/9).

NPR: Affordable Care Act Hits More Road Bumps (Audio)
Another day, another delay of a piece of the federal health care law known as ObamaCare. The administration is having trouble setting up some of the new computer systems required by the Affordable Care Act. Last week, they announced a year-long delay in the implementation of some of the law's requirements for businesses. Today, it's smokers who are affected. Critics say this is more evidence that the administration is not ready to roll out the law, which takes effect in October (Rovner and Cornish, 7/9).

Roll Call: GOP Fired Up Over Mandate Delay
President Barack Obama's decision to delay enforcement of the employer health mandate last week had GOP leaders crying foul Tuesday and pushing for a broader repeal of the health care law. Senate Minority Leader Mitch McConnell blistered Obama for failing to follow his duty to enforce the laws passed by Congress — even those McConnell opposes, such as the Affordable Care Act (Dennis, 7/9).

Politico: Obamacare At The Crossroads (Video)
Politico Pro health care editor Joanne Kenen leads a discussion with reporters Jennifer Haberkorn, Kyle Cheney, and Jason Millman about the delayed Obamacare employer coverage rules, health law politics and the next steps for the Affordable Care Act (7/9).

Several news outlets also look at other political developments on the health law.

The Washington Post Fact Checker: A New Ad Attacking 'Obamacare'
The conservative advocacy group Americans for Prosperity is launching a $700,000 ad buy that features a mother expressing concern that her son won’t get the medical care he needs for seizures because of the Affordable Care Act, a.k.a. Obamacare. ... The AFP ad sets up a straw man — the notion that people are going to lose access to their doctor. For the vast majority of Americans, that’s not going to be the case. Under the law, millions of other Americans, for the first time, are supposed to gain access to regular health insurance. Certainly it is appropriate to ask questions about this complex law, but focusing an ad on such an emotional — and unlikely — hypothetical goes too far (Kessler, 7/9).

The Associated Press: Health-Care Plan Unites Conservative Students
A new conservatism is beginning to emerge on some college campuses, spurred in part by opposition to President Barack Obama’s signature health-care law. Modeled after The Federalist Society for Law and Public Policy, which has molded several generations of legal thinkers at the nation’s law schools, this new wave of conservative thinkers is looking to take root in graduate schools of business, medicine and foreign policy (Scherzagier, 7/9).

CQ HealthBeat: DOJ Asks Federal Courts To Stop Overhaul Lawsuits Because Of Employer Mandate Delay
Within days of the Obama administration delaying the health care law’s employer mandate, its legal team filed papers in three federal courts saying that the delay is yet another reason that challenges to the insurance requirement should be thrown out. Department of Justice lawyers have asked the U.S. District Court for the Eastern District in Oklahoma to consider the delay as more evidence that the state is not facing any imminent harm (Bunis, 7/9).

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Restaurant Owner Welcomes Delay On Law’s Insurance Requirement

The New York Times profiles the challenges that one business owner faced with the health law. Other outlets offer news on the law, including the problems the administration faces in setting up the online marketplaces, concerns about scams targeting consumers and help for Medicare beneficiaries.

The New York Times: At Restaurant, Delay Is Help On Health Law
Eric King has worked diligently to keep his family’s 35-year-old seafood restaurant [in Ellicott City, Md.] viable, most recently by expanding the menu beyond its well-loved crab cakes and other traditional dishes to draw a younger, freer-spending crowd. ... Yet the prospect of providing health insurance to every full-time worker or paying a penalty starting in January, a provision of the Obama health care law, has overshadowed the good news. ... Then came last week's announcement that the mandate would be delayed a year after business owners begged the Obama administration for more time. Mr. King ... was thrilled (Goodnough, 7/9).

The Wall Street Journal: U.S. Struggles To Meet Health-Law Deadline
When Obama administration officials delayed a central plank of the new health law—requiring that big employers offer health insurance to workers—they said it was to help businesses pleading for more time. Left unsaid was the federal government hadn't written key rules guiding employers, according to current and former administration officials, and computer systems that were supposed to run the program weren't operational (Meckler, Corbett Dooren and Nicholas, 7/9).

Kaiser Health News: Community Health Centers – In Every State – Get Obamacare Outreach Funds
The nation’s community health centers — which treat the poor and uninsured– apparently know a good deal when they see one. Nearly all 1,200 federally funded community health centers applied for and will be getting a piece of $150 million in federal health law money to enroll patients in new online health insurance marketplaces starting Oct.1 (Galewitz, 7/10).

The Wall Street Journal: Prescribed: Guide To The Health Law Rollout (Interactive)
This guide explains the law and its impact on industry, consumers and states, and includes maps showing state positions on Medicaid and the insurance exchanges, a subsidy calculator and a timeline of key dates in the rollout. You can also take an interactive tour of "Obamacare," learning through your own eyes what’s covered and how the law affects you, your employer and the uninsured (7/9).

NBC News: What's To Come With Obamacare
The Obama administration is still taking a political beating for its one-year delay of one major part of health reform – the requirement that all employers with more than 50 full-time workers provide health insurance for them. That provision was going to go into effect in January. But it's not the biggest provision, and the White House says the most important reforms are still on track. The biggest, by far, is the opening of the health insurance exchanges – the online marketplaces where people can buy insurance if they don’t already get it from an employer, or from a public plan such as Medicare, Medicaid or the military (Fox, 7/10).

McClatchy: Sick: Scams Prey On 'Obamacare' Confusion
If a stranger claiming to be from the government calls to offer you an "Obamacare card" or threatens to throw you in jail unless you buy insurance, hang up the phone. It's a scam. Fraudsters are poised to take advantage of widespread confusion over the Affordable Care Act – also known as Obamacare – to steal Americans' credit cards, Social Security numbers and other personal information, consumer advocates and government officials say (Wise, 7/9).

Related, earlier KHN story: Seniors Get Hung Up In Health Care Scams (Gold, 4/22).

And finally -

USA Today: Medicare Beneficiaries Reach $5 Billion In Drug Savings
Since passage of the health care overhaul two years ago, 5.8 million Medicare patients have saved $5 billion from prescription drug discounts, and the government can now predict lower health care costs based on increased use of these cheaper drugs. The savings are a continuation of the 2010 health care law's attempt to close the "doughnut hole" — or the prescription drug coverage expenses that kick in once Medicare coverage runs out (Kennedy, 7/9).

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Catholic Hospital Group Satisfied With Contraceptive Compromise

The Catholic Health Association, which has sided with the administration before on the law, said the plan will allow employees to get birth control coverage without the hospitals paying for it.

Modern Healthcare: CHA Satisfied With Obama Administration's Contraception Solution
The Catholic Health Association, one of the Obama administration's most reliable allies in passing and promoting the healthcare reform law, has made peace with the contraception provision that distressed many of its members. After months of talks between church officials and the White House, the CHA said in a memorandum to Catholic healthcare providers ... the organization is satisfied with the administration's solution for ensuring workers have access to contraception at no out-of-pocket cost while not compelling religious employers to pay for it or arrange it (Selvam, 7/9).

NPR: Catholics Take Sides Over Health Law's Birth Control Policy (Audio) 
A trade group for Catholic hospitals says a new Obama administration policy on birth control is just fine. That's in sharp contrast to the U.S. Conference of Catholic Bishops, which continues to battle against the policy, which exempts churches, synagogues and mosques, but requires other institutions run by religious organizations to cover birth control under employees' health insurance (Rovner, 7/9).

The Associated Press: Catholic Hospitals Accept Birth Control Compromise
In a split with U.S. bishops, a trade group for Catholic hospitals said Tuesday it can accept the Obama's administration latest compromise on birth control coverage by religious employers. … Under President Barack Obama's health care law, most employers are required to cover birth control as a free preventive service for women workers. Churches and other houses of worship are fully exempt from the mandate. But religiously affiliated hospitals, universities and social service groups are not (Zoll, 7/9).

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Minn., Texas, Colo. Adapting To Health Law In Different Ways

News outlets covered how various states are ramping up health exchanges, or not, and expanding Medicaid, or not.

MPR News: Affordable Care Act Has Unique Proving Ground In Minnesota
No state is set to embrace the Affordable Care Act as thoroughly as Minnesota, the only one that will implement the "big three" components of health insurance expansion. That means Minnesota will expand the Medicaid program, develop an online insurance marketplace and offer a basic health program. It's the third component that really sets the state apart. Only Minnesota has committed to offering a basic health program, a safety net for people who have too much income to qualify for Medicaid, but not enough to afford private insurance (Richert, 7/9).

Texas Tribune: Feds: TX Hispanics May Not Hear Health Reform
Texans, and in particular the state's Hispanic population, might remain in the dark on the benefits of the new federal health care law because outreach efforts are largely focusing on the 24 states participating in the Medicaid expansion and state-based insurance exchanges, officials with the Centers for Medicare and Medicaid Services said on Monday. Texas is not among those states; Gov. Rick Perry and Republican leaders have argued federal health reform would eventually bankrupt the state (Bacardi, 7/10).

Health Policy Solutions (a Colo. news service): Feds Brake, Colorado Hits Accelerator On Health Reform
Colorado exchange managers have no plans to tinker with the state’s small business or individual health exchange. … The Obama Administration last week postponed for one year the requirement that businesses with more than 50 employees provide health insurance across-the-board or face stiff fines. Colorado's small business exchange will serve businesses with fewer than 50 employees who are not required to provide health insurance under the Affordable Care Act. Colorado is one of 16 states building its own health exchange (Kerwin McCrimmon, 7/9).

St. Louis Beacon: At St. Louis Bill Signing, Nixon 'Hopeful' About Medicaid Committees
Gov. Jay Nixon told reporters he was "hopeful" that House and Senate committees studying changes to the state's Medicaid program would result in legislative action next year. The two chambers are holding hearings this summer on the health-care program for the poor. The Senate committee held hearings in Jefferson City, while another House committee is set to convene tomorrow in Independence (Rosenbaum, 7/9).

The Associated Press: Snyder Visits U.P. To Push Health Care Expansion
Gov. Rick Snyder took his campaign for expanded Medicaid coverage in Michigan to the Upper Peninsula on Tuesday, saying it's essential to extend care to hundreds of thousands of uninsured residents and take the pressure off overworked emergency rooms. The Republican leader met with officials at Marquette General Hospital (7/9).

The Associated Press: Medicaid Expansion Plans On Par With Implementation Date
The [North Dakota] director of the Department of Human Services said Tuesday the state should be ready Oct. 1 to help more than 20,000 North Dakotans apply for Medicaid when the application process goes online. But Maggie Anderson said officials won’t know how many will enroll until the federal mandate requiring everyone to have health care coverage kicks in Jan. 1 (Jerke, 7/9).

The Associated Press/St. Louis Post-Dispatch: Mo. Senators Hear Pleas To Expand Medicaid Access
Advocates for the mentally and physically ill urged lawmakers to expand access to Medicaid as a Senate panel began taking public testimony Tuesday on ways to improve the government-funded health care program. The plea to expand adult eligibility for Medicaid was a familiar one embraced by Democratic Gov. Jay Nixon but repeatedly rejected by the Republican-led Legislature during its annual session that ended in May (Lieb, 7/9).

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Women's Health

Texas House Lawmakers Give Initial Approval To Abortion Restrictions

Following a dramatic, last-minute Democratic filibuster late last week, Texas House lawmakers in a special session Tuesday tentatively approved controversial abortion restrictions after more contentious debate.

The New York Times: Texas Resumes Efforts At Abortion Restrictions
The restrictive abortion bill that has stirred up Texas politics in the past few weeks is once again moving its way through the Legislature during a second special session called by Gov. Rick Perry. The bill was initially stalled last month by the 11-hour filibuster of State Senator Wendy Davis, Democrat of Fort Worth. A new version was drafted, restarting the process in the Republican-controlled Texas House with a hearing on Monday and an often-angry debate on the floor on Tuesday (Schwartz, 7/9).

Texas Tribune: House Gives Early OK To Abortion Restrictions
After more than 10 hours of debate, the House voted 98-49 to tentatively approve the abortion regulations in House Bill 2, which would ban abortions at 20 weeks and add regulations to abortion providers and facilities that opponents argue would effectively eliminate access to abortion in Texas. The House must approve the bill again on another calendar day before it will be sent to the Senate (Aaronson, 7/9).

Dallas Morning News: Texas House Tentatively Approves Sweeping Abortion Restrictions
Tentative approval of the bill came just over a week after Gov. Rick Perry convened the current special session on abortion, and it left Democrats with few options to derail the measure as the House prepares to send it to a receptive, GOP-controlled Senate (Stutz, 7/9).

Fox News: Texas House Provisionally Approves Tough Abortion Restrictions
Democrats and women's rights supporters have protested the bill for weeks, but Republican leaders are intent on passing it quickly. Supporters say the bill will offer women more protection when they seek abortions, but critics say conservatives are trying to make the procedure harder to get (7/9).

The Associated Press/ABC News: Texas Abortion Bill Clears Hurdle
Activists on both sides of the issue from across the state and nation descended on the Capitol building, and the demonstrators erupted into screams, cheers and chants immediately following the vote (Tomlinson, 7/10). 

In North Carolina, a new abortion fight takes stage over legislation that would restrict where and when abortions are available --

The Wall Street Journal: Abortion Fight Flares In North Carolina 
North Carolina is considering new laws that would restrict the circumstances and types of places in which a woman could obtain an abortion, drawing protests and illustrating the recent rightward shift of a generally centrist state. The GOP-led state Senate approved a proposal just before the July Fourth weekend that the state health department said could close some of North Carolina's two dozen abortion clinics and require a doctor's presence for hours after a woman takes pills to induce an abortion (Bauerlein, 7/9).

North Carolina Health News: Tighter Abortion Clinic Standards Questioned During House Committee Meeting
As lawmakers debate putting restrictions on clinics that provide abortions across North Carolina, opponents caution that abortion providers in other states have found that when new regulations come into effect, the devil is in the details (Hoban, 7/10).

Similar fights rage across the nation --

CBS News: As More States Restrict Abortions, Fights Rage On (Video)
According to research released this week by the Guttmacher Institute, a research organization that supports abortion rights, state legislatures this year have passed 43 measures that restrict access to abortion -- the second-highest number ever at the midyear mark (Condon, 7/10).

The Washington Post: Fairfax City Council Votes To Require Abortion Clinics To Get Special Permit, Council Approval 
The Fairfax City council voted Tuesday night to create a new term in its zoning law, "medical care facility," delete the term "clinic" from the current definition of a doctor's office, and require all medical care facilities to obtain a special use permit at a cost of $4,800, along with a detailed approval process and a final vote by the city council. Pro-choice activists said the move was aimed at keeping abortion clinics out of Fairfax City, including an existing clinic in the city which was trying to relocate to meet Virginia's new hospital-style zoning standards for abortion clinics (Jackman, 7/9).

And new research could affect the debate --

Los Angeles Times: Abortion And Preterm Births Studied
In a finding likely to reignite debate over proposed new limits on abortion, British researchers have found that years ago, women who terminated a pregnancy increased their risk of giving birth prematurely in subsequent pregnancies, but that with modern procedures the danger has all but vanished. The researchers suggest the shift is the result of a growing use of oral medication to induce or aid in abortion, and a decline in surgical abortions that may injure a woman's cervix (Healy, 7/9).

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Health Information Technology

More Doctors Adopt Electronic Health Records

The nation's top Health IT official is lauding the nation's doctors for more widely adopting electronic health records in the past few years, but he and new studies say more work is needed to help the systems communicate with each other.

CQ HealthBeat: Mostashari: It's Crunch Time For Health IT Adoption
Farzad Mostashari, the nation's top health IT official, said Tuesday that policymakers, doctors and hospitals should take a bit of a victory lap because of the widespread adoption of electronic medical records that has occurred in their industry since the 2009 economic stimulus law. But he warned that even though they are passing significant milestones, they have a long way to go (Reichard, 7/10).

Medpage Today: EHR Adoption Steady, But More Work Needed
Physicians are continuing to adopt electronic health records at a steady clip, but more work is needed to have those systems communicate with each other, according to two studies published Tuesday. In 2012, 72 percent of physicians had adopted some type of EHR system and 38.2 percent had capabilities required for a basic system, a review by the CDC's National Center for Health Statistics in Hyattsville, Md., found. The number of basic EHR adopters was up from just over 25 percent in 2010, Chun-Ju Hsiao, PhD, and colleagues reported in a study that appeared online in Health Affairs (Pittman, 7/9).

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Health Care Marketplace

Office Nurses' Role Evolves In Marketplace; Studies Look At Heart Procedures

The Wall Street Journal examines how companies, facing higher insurance costs, are using office nurses to "nudge employees about long-term, expensive conditions." Meanwhile, heart studies probe where hospitals are building new angioplasty centers and how Medicare Advantage handles cardiac treatment.

The Wall Street Journal: The Office Nurse Now Treats Diabetes, Not Headaches
Workplace health clinics used to be a lot like the school nurse's office, dispensing Band-Aids, treating occupational injuries, and serving as a first stop for emergencies like asthma attacks. But as companies face rising insurance costs and an aging workforce, they're turning clinics into something new: A place to aggressively nudge employees about long-term, expensive conditions such as diabetes, hypertension and high cholesterol (Weber, 7/9).

Kaiser Health News: Study: Competition, Not Need, Drives Hospital Cardiac Care Investment;
U.S. hospitals spent up to $4 billion adding angioplasty services over a four year period, but the new services did little to improve access to timely medical care, says a study published Tuesday in the journal Circulation: Cardiovascular Quality and Outcomes. Between 2004 to 2008, some 251 hospitals added the invasive and often life-saving cardiac care, but researchers found that the new programs were mainly built near existing ones in competitive health care markets, rather than where the need for the services was greatest (Galewitz, 7/9).

Kaiser Health News: Medicare Advantage Plans Cut Total Cardio Procedures, But Regional Variations Remain
Patients in Medicare Advantage plans got expensive balloons and stenting to clear coronary arteries at a rate 31 percent lower than patients in traditional Medicare, according to the study published in the Journal of the American Medical Association by Dr. Daniel Matlock and colleagues. ... What they didn't expect were enormous differences in utilization rates among Medicare Advantage patients from one city to another. They figured cost-control incentives would smooth out the notorious regional swings in how often procedures are administered under traditional Medicare. They didn't (Hancock, 7/9).

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Pharmaceutical Companies Race For New Cholesterol Drugs

A discovery of a rare mutation that affects cholesterol has ignited hopes of a prescription that can help prevent heart attacks. In the meantime, an announcement by Roche could pose more questions about controversial diabetes medicines. Also a federal report warns Americans of using some Internet pharmacies.

The New York Times: Rare Mutation Ignites Race For Cholesterol Drug
She was a 32-year-old aerobics instructor from a Dallas suburb -- healthy, college educated, with two young children. Nothing out of the ordinary, except one thing. Her cholesterol was astoundingly low. ... The discovery of the mutation and of the two women with their dazzlingly low LDL levels has set off one of the greatest medical chases ever. It is a fevered race among three pharmaceutical companies, Amgen, Pfizer and Sanofi, to test and win approval for a drug that mimics the effects of the mutation, drives LDL levels to new lows and prevents heart attacks. All three companies have drugs in clinical trials and report that their results, so far, are exciting (Kolata, 7/9).

The New York Times: Roche Abandons New Diabetes Drug
Roche, the Swiss pharmaceutical giant, has discontinued development of a potentially important diabetes drug, a move that could raise new safety questions about the entire category of drugs, which includes the controversial diabetes medicine Avandia (Pollack, 7/9).

Stateline: Rogue Internet Pharmacies Dangerous Says Federal Report
In their search for cheaper prescription drugs, Americans are increasingly turning to Internet pharmacies, many of which federal investigators say skirt U.S. and state regulations and sell misbranded, adulterated and counterfeit drugs. These transactions -- often without a legitimate prescription -- put consumers at risk, the U.S. Government Accountability Office said in a new report released Monday (Ollove, 7/9).

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Medicare To Propose New Doctor Payment For Managing Multiple Chronic Conditions

Medicare is proposing paying doctors for managing Medicare patients with multiple chronic conditions starting in 2015. In the meantime, a Medicare plan to deny an Eli Lily diagnostic test to patients unless they are enrolled in a clinical trial is decried by some Alzheimer's treatment advocates.

Medscape: CMS Proposes New Fee For Chronic Care Management
In a nod toward primary care, the Centers for Medicare & Medicaid Services (CMS) has proposed paying physicians a new fee -- beginning in 2015 -- for managing Medicare patients with 2 or more chronic conditions apart from face-to-face office visits. Right now, the details are sketchy: CMS has yet to set the amount of the fee, and the agency is asking the medical profession to help it develop standards for earning the extra cash (Lowes, 7/9).

Reuters: Medicare Plan On Alzheimer's Test Dismays Advocates
Alzheimer's experts plan to protest proposed Medicare guidelines that would deny coverage of an Eli Lilly diagnostic test for the disease unless patients are taking part one of several clinical trials in which the $3,000 test is being used. Eli Lilly and Co and the Alzheimer's Association have objected to the draft guidelines, issued last week by the U.S. Centers for Medicare & Medicaid Services, the agency that runs Medicare (Steenhuysen, 7/9).

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State Watch

State Highlights: Disabled At Risk At Calif. Facilities, Audit Finds; Ga. Maternal Mortality

Los Angeles Times: California Facilities Put Disabled At Risk, Audit Finds 
Californians with developmental disabilities who are cared for at state facilities are being put at risk by outdated policies and inadequate investigations of abuse, the state auditor's office said Tuesday. Allegations that residents have been raped, shot with stun guns and otherwise abused have not been acted on satisfactorily, auditors found. The California Department of Developmental Services cares for 1,480 severely disabled people in five facilities throughout the state (McGreevy, 7/9).

Sacramento Bee: Children's Advocates Say New Dental Plans Not That Filling After All
Filling cavities in children's teeth is designated by law as one of 10 "essential benefits" in next year's federal health care overhaul. But children's advocates say that the fine print shows that it's not all that essential after all. … The bottom line is that low-income families buying pediatric dental insurance through the state's online exchange, Covered California, will pay an extra monthly premium and potentially more out-of-pocket expenses. Children's advocacy groups are pushing the state exchange to switch gears and embed medical care and kids' dental care into a single policy, with premiums cut by charging the same price to families with children and without (Sanders, 7/10).

Related, earlier Kaiser Health News story: Health Law Provisions To Expand Kids' Dental Coverage May Fall Short, Advocates Say (Carey, 6/19)

Georgia Health News: State Reviewing Why More Women Die In Childbirth
Georgia has improved its infant mortality rate but has seen a jump in its maternal mortality rates. The rates were included in a series of health statistics presented at a Department of Public Health board meeting Tuesday (Miller, 7/9).

Kaiser Health News: How Oregon Is Getting 'Frequent Flyers' Out Of Hospital ERs
Forty-year-old Jeremie Seals has had a tough life. He left home at 14, and he says, his health isn't good. He had a heart attack when he was 35, he has congestive heart failure and nerve pain in his legs 'real bad.' ... [O]ver the years, he says his health has deteriorated to such a degree, he can no longer hold a job. By 2011, he was sleeping in his car, and that’s when his medical problems started having a big financial impact. 'I basically lived at the emergency department,' he said. ... And that's what brought him to the attention of one of Oregon's new coordinated care organizations (Foden-Vencil, 7/10).

Modern Healthcare: Docs, Ala. System Accused In $522M Kickback Case
Cardiologists and the Infirmary Health System in Mobile, Ala., are accused of needlessly exposing patients to radiation in a nine-year-running kickback scheme tainting an estimated $522 million in Medicare, Medicaid and Tricare reimbursements since 2004. The U.S. Justice Department announced it will join a whistle-blower's lawsuit against Infirmary and the independent Diagnostic Physicians Group, making it at least the third ongoing government False Claims case against a hospital seeking more than $100 million (Carlson, 7/9). 

Health News Florida: DOH Cancels Studies In Mid-Stream
Medical researchers across Florida say they fear a state bureaucratic decision will strip them of up to $10 million in grants and prematurely shut down ongoing studies involving thousands of patients. The Department of Health has told 18 university and institute scientists that a state rule on grants forbids the state from funding the final two years of five-year grants the researchers received in 2010 (Lamendola, 7/9).

California Healthline: Medical Home Bill Closer To Passage
The Senate Committee on Health last week passed a bill to establish a medical home system in California. AB 361, by Assembly member Holly Mitchell (D-Los Angeles,) already won approval in the Assembly and appears headed for a Senate floor vote when the full Legislature reconvenes in August. "This bill brings federal resources to California to address frequent users in the Medi-Cal system because of chronic medical conditions," according to Assembly member Ken Cooley (D-Rancho Cordova), who introduced the bill last week for Mitchell. … In fact, Cooley said, setting up the medical home program has no cost to the state, since 90 percent of it is federally funded under the Affordable Care Act, and the remaining 10 percent tab will be picked up by the California Endowment (Gorn, 7/9).

Kansas Health Institute: Public Comment Sessions Scheduled On Proposed Kansas Medicaid Changes
State health officials have scheduled public comment sessions next week in Wichita and Topeka to collect input on their plan to modify the state's Medicaid program so that long-term supports for the developmentally disabled can be included in KanCare. Pending federal approval of the plan, Kansas officials aim to expand KanCare effective Jan. 1, 2014 (7/9).

Oregonian: Oregon Legislature Mandates Midwife Licensing
The Oregon Legislature passed a bill this weekend that would require mandatory licensing of midwives. The stipulations of House Bill 2997 apply to direct-entry midwives, who enter into midwifery without training from a nursing program. The bill makes exceptions for midwives that are part of a traditional religious community (Karlamangla, 7/9).  

The Lund Report: Bill Banning Toxic Chemicals In Toys Dies In Oregon Senate
This is how the legislative session ends; not with a bang, but with a whimper. The Toxics Disclosure for Health Kids Act died on the session's last day, Monday, with no vote ever taken in the Senate. Instead, Senate Majority Leader Diane Rosenbaum, D-Portland, sent House Bill 3162 to the Senate Rules Committee after a brief speech: "This is an important bill disclosing toxics in children's products but unfortunately it does not have the votes at this time," Rosenbaum lamented as she signaled the bill's defeat (Gray, 7/9).

The Lund Report: Women's Cancer Screening In Oregon Gets Funds Along With Junction City Hospital
The Legislature found extra funding in its final budget for breast and cervical cancer screening, rural ambulance services, and dental fluoride programs for school children as it passed its budget resolution, House Bill 5008, before adjourning on Monday. HB 5008 is known informally among Capitol insiders as the "Christmas tree" bill, as last-minute negotiations and deals in the Legislature leave advocates and special interests vying for presents (Gray, 7/9).

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Editorials and Opinions

Viewpoints: USA Today Says 'GOP Poisons' Obamacare; McConnell Calls For Repeal

USA Today: GOP Poisons Obamacare, Then Claims It's Sick: Our View
Making Obamacare work was always going to be hard, which is exactly what you'd expect for a complex new program that affects one-sixth of the U.S. economy. ... That explains — but hardly excuses — Republicans' latest assault on Obamacare. Having lost in Congress and in court, they're now using the most cynical of tactics: trying to make the law fail. Never mind the public inconvenience and human misery that will result. Their assault is under way on several fronts (7/9).

USA Today: Sen. Mitch McConnell: Obamacare Hikes Costs, Kill Jobs
With the Obama administration's decision last week to delay significant provisions of Obamacare, the White House seems to be finally, if slowly, admitting what Americans already know: Obamacare costs too much and isn't working as promised. And yet, the administration's solution isn't to fix the problem by replacing the law with common sense reforms that could actually lower costs for Americans — but rather to get a better spokesperson (Senate Minority Leader Mitch McConnell, R-Ky., 7/9). 

Politico: Sen. Mitch McConnell: Repeal Health-Care Law 
But just as Washington Democrats should never have taken over health care in the first place, the administration shouldn’t now be in the business of picking who gets a break from Obamacare and who doesn’t. In the face of escalating complaints, the Obama administration has clearly embraced a policy of quick fixes aimed at placating the loudest voices in the bunch. But this will never work as a long-term strategy. The answer isn’t to help some and ignore others. It’s to liberate all Americans from the burdens of this terrible law. What’s needed is a permanent delay — for everyone (Senate Minority Leader Mitch McConnell, 7/9). 

The New York Times: The Koch Brothers' Advertising Campaign
David and Charles Koch, the immensely rich industrialists, presumably have health insurance, though they don’t really need it. More than 25 million Americans don’t have it and really do need it, however, and the Koch brothers are working hard to make sure the government doesn’t give it to them. The advocacy group backed by the Kochs, Americans for Prosperity, is spending more than $1 million on an advertising campaign to (yet again) discredit President Obama’s health care reform law (David Firestone, 7/9). 

The New York Times: Could Employers Use Immigrants To Avoid The Health Mandate?
In a bid to win conservatives over to the cause of immigration reform, the authors of the Senate bill included a provision that would deny health benefits to illegal immigrants seeking to become legal. Now there is an argument making the rounds that this provision will encourage companies to replace American workers with those newly legalized immigrants. ... But how realistic is this? (Robb Mandelbaum, 7/9).

The New York Times: Taxing Employers And Employees
The delay of the Affordable Care Act’s employer mandate is a favorable development for the labor market, but the employer mandate is only the tip of the iceberg in terms of the labor-market distortions that the law has scheduled to come on line next year (Casey B. Mulligan, 7/9).

Los Angeles Times: It's Time To Fix California's Outdated Medical Malpractice Law
The Medical Injury Compensation Reform Act of 1975 has destroyed the ability of large segments of California patients to file malpractice lawsuits (Michael Hiltzik, 7/9).

Sacramento Bee: Raising Cap On Malpractice Law Will Increase Health Care Costs
The Consumer Attorneys of California, a trade association representing trial lawyers, and their allies are "declaring war" on physicians, according to a story last month in The Bee. Their coalition has committed to spend $1 million for a political and public relations campaign to pass legislation that would increase lawyer payouts in lawsuits against doctors, hospitals, nurses, community clinics, firefighters, EMTs and other health workers who provide care for patients (Dr. Paul Phinney and Jonathan Porteus, 7/10).

Los Angeles Times: Obamacare Glitch May Cost Young Smokers, Spare Older Ones
No matter how small a surcharge they impose on young smokers, their premiums are still going to be higher than the ones for bare-bones policies available today. They're also going to be considerably more expensive than the tax penalty imposed for not obtaining coverage, at least in 2014 (Jon Healey, 7/9).

WBUR: How Much Should We Pay Our Health Care Leaders? (Audio)
Despite its sports-crazed citizenry, in Massachusetts the public employee with the highest salary isn’t a university coach but the chancellor of the University of Massachusetts Medical School, Michael F. Collins, who earns about $785,000 a year. Carrie Goldberg, co-host of WBUR’s Commonhealth blog, wrote about this and raised the question, how much should we pay our health care leaders, and how much is too much? (7/9).

Fox News: Planned Parenthood, Big Abortion And The Battle To Saves Lives In Texas
If you’re befuddled by the loud uproar and tense debate over this bill that we witnessed last week in the national media – or why the press is focusing on one woman’s pink sneakers – know you’re not alone. Texas’s pro-life bill is not a radical bill. ... Because America’s women are watching, waiting and praying that the Texas legislature will follow the ethical sentiments of their citizens and the entire country and take this minimal step to protect the lives of women and children (Penny Young Nance, 7/9).

The Denver Post: Chronic Mismanagement On VA Hospital Projects
It's unclear why the under-construction Veterans Affairs hospital in Aurora, which has already ballooned in cost multiple times, is now another nearly $200 million, or 34 percent, over budget. Regardless, one thing is abundantly clear: The VA has a troubling pattern of mismanaging the construction of its hospitals (7/10).

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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.