Daily Health Policy Report

Thursday, July 10, 2014

Last updated: Thu, Jul 10

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Medicare

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Will Health Reform Bring New Role, Respect To Primary Care Physicians?

Kaiser Health News staff writer Jay Hancock reports: “CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy. The company’s move to shift that balance tells a lesser-known story of The Affordable Care Act and efforts to change the health system. While much attention has focused on expanded coverage and online insurance bazaars, policymakers’ bigger challenge is improving Americans’ health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by health care’s financial boom” (Hancock, 7/10). Read the story, which also appeared in the Washington Post.

This Story: Print | Link to | Top

Putting The Home In A Nursing Home

Kaiser Health News staff writer Marissa Evans reports: “Mealtime. Naptime. Bath time. Bedtime. Everything is on a schedule for residents in a traditional nursing home, leaving little flexibility for personal decision making. But LaVrene Norton is working to change that. Norton is founder and president of Action Pact, a national consulting firm. It specializes in helping retirement communities and nursing homes train staff and design their facilities to feel and be more like living at home. Since beginning work on the 'household model' in 1984, Norton has helped design hundreds of these communities” (Evans, 7/10). Read the interview.

This Story: Print | Link to | Top

Capsules: Feds Demand Medicaid Backlog Fixes By Six States; CMS May Soften Paperwork Requirements For Home Health Care; Report: Adults With Serious Mental Illnesses Face 80% Unemployment

Now on Kaiser Health News’ blog, Phil Galewitz reports on a federal push for six states to address their Medicaid backlogs: “Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage. The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee” (Galewitz, 7/10). 

In addition, Jenny Gold reports on a new report about unemployment and mental illness: “Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 – down from 23 percent in 2003” (Gold, 7/10). 

Also on the blog, Lisa Gillespie reports on a proposed change to Medicare home health coverage rules: “Doctors may not have to write a narrative summary for patients needing home health care if a proposed rule by the Centers for Medicare and Medicaid Services is finalized.For Medicare to pay for a home health visit, which includes physical therapy, speech therapy and skilled nursing care, the patient must be seen by a doctor either 90 days prior to the start of the home health care or 30 days after the start of the services. Currently, Medicare also requires that physicians certify that these patients are under their care and that they have trouble leaving home without the help of a walker or special transportation because of an illness or injury. To do so, doctors have to fill out what’s referred to as a face-to-face document, which states when the doctor saw the patient, and includes a narrative summary stating why the patient is homebound” (Gillespie, 7/10). Check out what else is on the blog

This Story: Print | Link to | Top

Political Cartoon: 'Withdrawn?'

Kaiser Health News provides a fresh take on health policy developments with "Withdrawn?" by Dan Piraro.

Meanwhile, here's today's haiku:

PROCEEDINGS

What was that, Judge Kopf?
OMG and SMH,
just FWIW
-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.

This Story: Print | Link to | Top

Health Reform

Survey: People With New Health Law Insurance Are Happy

About 9.5 million Americans gained coverage during the health law's open enrollment period, and the uninsured rate for working-age adults fell from 20 percent to 15 percent, according to a survey by the Commonwealth Fund.  

The New York Times’ The Upshot: Newest Health Insurance Customers Are Generally Happy
We’ve known for a few months now that lots of people signed up for health insurance this year in new marketplaces. A new survey shows that the people who did so are also pretty happy with their purchases (Sanger-Katz, 7/10).

McClatchy: Survey: 9.5 Million People Gained Health Coverage In First Marketplace Enrollment Period
Some 9.5 million Americans gained health coverage during the recent marketplace enrollment period as the uninsured rate for working-age adults fell from 20 percent to 15 percent, according to a new national survey by the Commonwealth Fund. Young adults ages 19-34, whose participation in the Affordable Care Act’s coverage initiative was crucial but always uncertain, saw some of the largest coverage gains. Their uninsured rate fell from 28 percent to 18 percent. Uninsured rates for Latinos fell from 36 percent to 23 percent, the survey found. And low-income adults earning less than 138 percent of the federal poverty level saw their uninsured rate drop from 35 percent to 24 percent (Pugh, 7/10).

This Story: Print | Link to | Top

Va. Lawmakers To Take Up Medicaid Debate In September

State Republican legislative leaders who opposed expansion of the health care program for low-income residents announced that they will call the legislature into session to weigh the governor's proposal.

The Washington Post: In Va. Legislature, Republicans Plan Medicaid Debate In Late September
Republican leaders plan to call the House and Senate back into session in late September to debate Medicaid expansion, a move intended to give legislators another chance to weigh in on the issue as Gov. Terry McAuliffe (D) tries to find a way to expand the program without their approval (Vozzella, 7/9).

The Associated Press: Republicans Announce Special Session On Medicaid
House Speaker William J. Howell and Senate Majority Leader Thomas K. Norment announced Wednesday that the General Assembly will be back in session the week of Sept. 22 for a "full and fair" debate on whether Virginia should accept federal Medicaid funds to provide health insurance for as many as 400,000 low income residents (7/9).

The Richmond Times-Dispatch: General Assembly Will Return In September To Debate Medicaid
Republican opponents of expanding Virginia’s Medicaid program want the General Assembly to debate the idea in late September, but Gov. Terry McAuliffe and Democratic legislators say they’re still waiting for the GOP’s plan to close the health coverage gap for hundreds of thousands of uninsured Virginians. House Speaker William J. Howell, R-Stafford, the leader of legislative opposition to using federal funds to expand health coverage, said Wednesday that he will call the House into session the week of Sept. 22 to debate the issue. Senate Republican leaders say they will do the same to honor their commitment to acting on the issue separately from the state budget, while blocking the governor from expanding coverage without legislative approval (Martz, 7/9).

Huffington Post: In States That Didn't Expand Medicaid, It's As If Obamacare Doesn't Even Exist For The Poor
Twenty-five states didn't take up the Obamacare Medicaid expansion at the beginning of this year, and the results speak for themselves: A new survey shows more than one-third of their lowest-income residents remain uninsured, a rate virtually unchanged from last year, even as millions gained coverage elsewhere (Young, 7/10).

Also, federal officials announce that they are seeking some states that are expanding benefits to move faster.

Kaiser Health News: Capsules: Feds Demand Medicaid Backlog Fixes By Six States
Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage. The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee (Galewitz, 7/10). 

The Tennessean: Feds Give Tennessee Ten Days To Address ACA Failures
The federal director of Medicaid programs has put Tennessee on notice that it has failed to provide services for people as required by the Affordable Care Act and is giving the state 10 days to submit a correction plan. The crux of the problem is delays with bringing a $35 million computer system online. However, Tennessee is also criticized for not providing people with face-to-face help in applying and for not setting up a program that allows hospitals to temporarily enroll people in Medicaid if they are presumed eligible. With this year's full implementation of the Affordable Care Act, Tennessee stopped providing state personnel to help people sign up for Medicaid and, instead, began directing them to use healthcare.gov, the federal health exchange (Wilemon, 7/9).

Meanwhile, Oregon is working to fix its state insurance marketplace.

The Oregonian: New Cover Oregon Executive Director Aaron Patnode Will Make $215,000 A Year
Cover Oregon's new executive director has signed a contract awarding him a base salary of $215,000 a year, more than a $30,000 raise over his predecessor. Aaron Patnode, selected by the health insurance exchange's board after a lengthy search to replace Howard "Rocky" King, starts Monday, July 14. The 36-year-old Kaiser Permanente manager will make more than twice the salary of Gov. John Kitzhaber. Patnode will also receive full state benefits as well as yearly incentive pay of $32,250 if he meets performance measures set by the Cover Oregon board (Budnick, 7/9).

This Story: Print | Link to | Top

Are Insurers Using Drug Tiers To Cherrypick Healthier Enrollees?

Critics charge that some plans continue to discriminate against sick people by putting certain drugs in the highest-cost drug tiers, requiring consumers to pay big out-of-pocket expenses. Meanwhile, critics and supporters of the law wait anxiously for a court decision on a challenge to the health law's subsidies.

The Fiscal Times: Obamacare Insurers Hit High-Cost Patients With High Drug Prices
Some insurance companies are finding ways to get around one of Obamacare’s most popular provisions that requires everyone to be covered equally -- regardless of any pre-existing condition. The anti-discrimination rule was meant to guard against insurers who historically charged higher premiums to sick people. But some insurers are still charging certain patients more by passing the extra costs on in the form of higher drug prices (Ehley, 7/10).

CQ Healthbeat: Court Watchers Click 'Refresh,' Ponder Long Wait For Halbig Ruling
It’s a long shot to succeed, but the challenge to the health law filed by the plaintiffs in the court case Halbig v Sebelius would have a devastating effect on the overhaul if it ultimately prevails. Given the stakes, it’s small wonder that opponents and supporters of the law are obsessively clicking their refresh buttons browsing the web for the federal appeals court decision in the case. The U.S. Circuit Court for the District of Columbia, customarily posts its opinions between 10:00 and 10:40 Tuesday and Friday mornings. When Halbig wasn’t among them on Tuesday, Twitter came alive, noting its absence (Reichard, 7/9).

This Story: Print | Link to | Top

Capitol Hill Watch

Democrats Introduce Legislation To Undo High Court's Hobby Lobby Decision

With only a limited calendar to work with, Democrats view this push as an important aspect of the  2014 congressional campaign.

Los Angeles Times: Congress Has Heavy Workload But Limited Time Before Summer Recess
And even as they face a series of time-sensitive votes, both parties continue to push symbolic legislation that has little hope of passage but appeals to their respective bases in an election year. Senate Majority Leader Harry Reid (D-Nev.), for example, told reporters Tuesday that he was committed to taking action in the Senate to address the Supreme Court's ruling in the Hobby Lobby case. That decision gave businesses owned by devout Christians the right to refuse to pay for insurance covering contraceptives for female employees (Memoli, 7/9).

Politico: Hill Democrats See Hobby Lobby Contraception Fight In 2014 Races
With an eye on the November elections, congressional Democrats on Wednesday introduced a bill that would overturn the Supreme Court’s Hobby Lobby contraception decision. Democrats and women’s health groups believe they have a powerful campaign weapon in pushing back on the Supreme Court’s 5-4 ruling that Hobby Lobby and other closely held for-profit companies don’t have to comply with the health law’s contraceptive coverage requirement if it violates the owners’ religious beliefs (Haberkorn, 7/9).

CBS News: Democrats Unveil Bill To Reverse Supreme Court's Hobby Lobby Ruling
Accusing the Supreme Court of turning a religious freedom law on its head and dragging down women's rights, a group of Democratic lawmakers on Wednesday introduced legislation that would reverse the court's recent ruling on health insurance coverage for birth control. "We are peddling back with this court as fast as they can take us to the 19th Century," Rep. Louise Slaughter, D-N.Y., said. "We don't want to go." Last week, the Supreme Court ruled that closely-held companies like Hobby Lobby don't have to follow the Obamacare mandate requiring large firms to help pay for their employees' birth control. Sens. Mark Udall, D-Colo., and Patty Murray, D-Wash., consequently introduced a bill that specifically bans for-profit employers from refusing to provide health coverage -- including contraceptive coverage -- guaranteed to their employees under federal law (Condon, 7/9).

Los Angeles Times: Sen. Mark Udall Skips Obama Colorado Visit To Focus On Women’s Issues
As Obama was on his way to deliver remarks on the economy in Denver’s Cheesman Park on Wednesday morning, Udall held a news conference in Washington with female senators and House members to announce a new bill that would bar employers from denying contraceptive coverage. In a direct appeal to women voters, who could be the most crucial swing voters in Colorado's Senate race this year, Udall has made contraceptive coverage a central issue in his campaign (Reston, 7/9).

Denver Post: Colorado Democrat Joins Fight Of Hobby Lobby Decision
On the heels of U.S. Sen. Mark Udall, another Colorado Democrat is backing legislation to combat the Supreme Court's recent Hobby Lobby decision. U.S. Rep. Diana DeGette is co-sponsoring a companion bill to one Udall announced Tuesday that would prohibit for-profit employers from citing religious beliefs to deny health coverage under the Affordable Care Act. Neither DeGette nor Udall's bills stand good chances of becoming law in the current Congress (Santus, 7/9).

This Story: Print | Link to | Top

McConnell Counters Medicare Ad With One Of His Own

Also, the Washington Post fact-checks another ad which positions Sen. Lamar Alexander, R-Tenn., as a key Obamacare opponent and claims the health law increased insurance premiums 50 percent.

Politico: Mitch McConnell Strikes Back On Medicare Ad
Mitch McConnell has decided to quickly and strongly counterpunch on Medicare. Just 24 hours after Democrat Alison Lundergan Grimes began running an attack ad about the entitlement, the Kentucky senator is firing back with a Larry McCarthy-produced spot that says it is Democrats who cut Medicare under Obamacare (Hohmann, 7/9).

The Washington Post’s The Fact Checker: Did Health Insurance Premiums Jump 50 Percent Because Of Obamacare?
This campaign ad highlights Alexander’s role as one of the chief GOP critics of President Obama’s health-care law during a nationally televised “health-care summit” held on Feb. 25, 2010. The ad shows Alexander debating the president over whether the Congressional Budget Office predicted a rise in premiums because of the Senate version of the bill. Then the ad asserts that individual premiums have gone up more than 50 percent ... Alexander may want to relive his moment in the national spotlight, but he’s misleading viewers with his math that premiums have risen more than 50 percent (Kessler, 7/10).

This Story: Print | Link to | Top

Health Care Marketplace

Insurers Test New Payment Models For Health Care Providers

The patient-centered medical homes model, which has been the hallmark of one such experiment by CareFirst BlueCross BlueShield, is among the approaches receiving attention for reducing costs and reducing hospitalizations.

The New York Times: Health Insurers Are Trying New Payment Models, Study Shows
Health insurers are experimenting with new formulas for reimbursing doctors and hospitals, slowly moving away from the traditional approach of basing payments on the numbers of tests and procedures performed, according to a survey of Blue Cross insurers, among the most dominant plans in the country (Abelson, 7/9).

Reuters: New Form Of U.S. Healthcare Saves Money, Improves Quality, One Insurer Finds
In one of the largest tests of a novel way to deliver and pay for healthcare, insurer CareFirst BlueCross BlueShield announced on Thursday that 1.1 million people receiving care through its "patient-centered medical homes" last year were hospitalized less often and stayed for fewer days compared to patients in traditional fee-for-service care. Medical homes, a centerpiece of President Barack Obama's healthcare reform, have been heralded as one of the best hopes for reducing the cost of U.S. healthcare, the highest in the world, and improving its quality, which lags that of many other wealthy countries (Begley, 7/10).

Kaiser Health News: Will Health Reform Bring New Role, Respect To Primary Care Physicians?
CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy. The company’s move to shift that balance tells a lesser-known story of the Affordable Care Act and efforts to change the health system. While much attention has focused on expanded coverage and online insurance bazaars, policymakers’ bigger challenge is improving Americans’ health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by health care’s financial boom (Hancock, 7/10).

In related news -  

Modern Healthcare: Preferred Referrals Gain Favor With ACOs
Each month, doctors at one Arizona accountable care organization get a rundown of referral patterns, including the percentage of patients who followed referrals to specialists the ACO deems preferred.  Doctors get on that list thanks to strong quality scores, efficient operations and laudable customer service. But when performance falters or patients leave dissatisfied, they're dropped (Evans, 7/9).

This Story: Print | Link to | Top

Wall Street Seeks Big Bang From Urgent Care

Urgent care has mushroomed into an estimated $14.5 billion business, as investors try to profit from changes in health care, reports The New York Times. Meanwhile, beginning in September, patients will be able to check whether their doctors have accepted gifts, payments and other services worth $10 or more from drug and medical device makers and suppliers.

The New York Times: Race Is On To Profit From Rise Of Urgent Care
For more than eight hours a day, seven days a week, 52 weeks a year, an assortment of ailments is on display at the tidy medical clinic on Main Avenue here. But all of the patients have one thing in common: No one is being treated at a traditional doctor’s office or emergency room. Instead, they have turned to one of the fastest-growing segments of American health care: urgent care, a common category of walk-in clinics with uncommon interest from Wall Street (Creswell, 7/9).

The Associated Press: Who Pays Your Doc? Coming Soon To A Site Near You
When many of us have a medical appointment we’re concerned about our finances: how much will we owe out-of-pocket? What’s our co-pay? But next time, you may also want to ask your doctors about their financial situation. That’s because nearly 95 percent of U.S. physicians accept gifts, meals, payments, travel and other services from companies that make the drugs and medical products they prescribe, according to the New England Journal of Medicine ... for the first time, patients will soon be able draw back the curtain (7/9).

This Story: Print | Link to | Top

Medicare

Medicare Providers Say They Lose Millions Due To Excessive Audits

Health care providers say they're losing millions that are tied up in appeals because of the increasing number of Medicare audits. Meanwhile, the trade group representing family physicians complains about Congress' failure to fix Medicare's outdated physician payment formula.

The Associated Press: Medicare Providers Complain Of Duplicative Audits
Health care companies say they’re losing millions of dollars that are tied up in appeals because of increasing numbers of Medicare audits. But the rise in the often duplicative audits has failed to reduce Medicare fraud, according to a report released Wednesday. In recent years, the Obama administration has added manpower to investigate cases, increase audits and analyze more data to fight fraud in the taxpayer-funded Medicare program. Yet a report from the U.S. Senate Special Committee on Aging criticized the government for not targeting its resources more effectively (7/9).

Kansas Public Radio: Kansas-Based Physicians Group Unhappy With Medicare Payment Plan
The American Academy of Family Physicians, based in Leawood, has some issues with the Centers for Medicare and Medicaid Services' recently released Medicare physician fee schedule for 2015. But the doctors' group blames Congress more than CMS. The biggest issue is the so-called sustainable growth rate formula, which Congress enacted in 1997 to hold Medicare spending at or below the U.S. economy's growth rate. To comply with the law, CMS proposes reductions in the reimbursement rate for doctors every year. And every year, Congress suspends those cuts. Next year’s reduction in physician fees would be 20.9 percent. Tennessee physician Reid Blackwelder, who serves as president of the American Academy of Family Physicians, said if that cut is allowed to take effect, some doctors may have little choice but to stop seeing Medicare patients (Thompson, 7/9).

Kaiser Health News: Capsules: CMS May Soften Paperwork Requirements For Home Health Care
Doctors may not have to write a narrative summary for patients needing home health care if a proposed rule by the Centers for Medicare and Medicaid Services is finalized. For Medicare to pay for a home health visit, which includes physical therapy, speech therapy and skilled nursing care, the patient must be seen by a doctor either 90 days prior to the start of the home health care or 30 days after the start of the services. Currently, Medicare also requires that physicians certify that these patients are under their care and that they have trouble leaving home without the help of a walker or special transportation because of an illness or injury. To do so, doctors have to fill out what’s referred to as a face-to-face document, which states when the doctor saw the patient, and includes a narrative summary stating why the patient is homebound (Gillespie, 7/10).

This Story: Print | Link to | Top

Public Health & Education

Those With Mental Illness Face 80% Unemployment

But, the report says that while 60 percent of those with mental illnesses want to work, only 2 percent of people in the public mental health system get help to find work.

Kaiser Health News: Capsules: Report: Adults With Serious Mental Illnesses Face 80% Unemployment
Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 -- down from 23 percent in 2003 (Gold, 7/10). 

USA Today: ‘Bleak Picture’ For Mentally Ill: 80% Are Jobless
About 60 percent of people with mental illness want to work. And two-thirds can successfully hold down a job, if they're given appropriate support, the report says. Yet fewer than 2 percent of people in the public mental health system receive this help, a cost-effective program called supported employment, which has been studied in 20 high-quality clinical trials over the past 25 years (Szabo, 7/10).

In other news related to mental health --

Minnesota Public Radio: 6 Ways To Improve Childhood Mental Illness Treatment
Seventeen-year-old John LaDue, planned a violent attack on his family and school in Waseca earlier this year, but was arrested before he could follow through. LaDue planned to murder his family and shoot "as many victims as [he] could get" at school, according to transcripts of his interviews with police. "I think I'm just really mentally ill," LaDue told police officers. "And no one's noticed. I've been trying to hide it." The case has once again brought to the forefront issues of mental illness in children (7/9).

The CT Mirror: Children Stuck In Crisis
You’ve probably heard stories like this before. The number of children and teens going to emergency rooms in mental health crisis, some waiting days for an inpatient bed, has been growing for more than a decade. ER staff are used to seeing a bump in patients at the end of each school year. The emergency department entrance at Connecticut Children's Medical Center in Hartford. But what happened this spring was unprecedented, say people who work at Connecticut Children's Medical Center, parents of kids with psychiatric illnesses and community mental health providers. “I don’t remember a period like that before where the volume was so high and we had so many kids where there wasn’t a place to facilitate them to, there wasn’t a place for them to go to,” said Gary Steck, CEO of Wellmore Behavioral Health, based in Waterbury (Becker, 7/10).

This Story: Print | Link to | Top

State Watch

Prisons Cut Health Care Costs, But Aging Inmate Population Threatens Budgets

Elsewhere, a lawsuit alleging bad medical care at a Virginia women's prison is delayed by institution of a new provider to give that care.

Marketplace: Aging Prisoners Bring Health Care Cost Headache
Health care for prisoners has long taken a bite out of state budgets, but a new report from the Pew Charitable Trusts says prisons have cut back on those costs. They’ve outsourced some health services, used tele-medicine, and simply incarcerated fewer people. But the aging of the inmate population threatens to drive those costs right back up (Gorenstein, 7/9).

The Associated Press: Va. Prison Health Provider Change Could Delay Suit
A lawsuit alleging deficient medical services at a Virginia women’s prison could be delayed by a change in health care providers. The Department of Corrections announced Tuesday that it has hired Armor Correctional Health Services Inc. to provide medical care at the state’s prisons starting Oct. 1 (7/9).

This Story: Print | Link to | Top

State Highlights: Fight Over New Ga. Trauma Center; San Francisco Premiums Expected To Drop

A selection of health policy stories from New York, Georgia, California, Iowa, Colorado and North Carolina.

The Associated Press: N.Y. Awards $462M To Help Hospitals Keep Services
New York health officials have awarded $462 million to help 22 hospitals and five large public hospital systems statewide continue key services. The funds followed a federal agreement in April for New York to reinvest $8 billion in Medicaid savings to support hospital overhauls and expand primary medical care over five years. The goal is to reduce avoidable hospital use by 25 percent while helping financially struggling institutions shift to more primary and outpatient care (7/9). 

Georgia Health News: Plan For New Trauma Center Not Welcomed By All
Hospital chain HCA’s push to have its Augusta hospital designated as a trauma center has unsettled leaders in the state’s hospital industry. A trauma center is a medical facility that’s specially equipped and staffed to treat seriously injured people. Georgia authorizes four levels of such centers, depending on their capabilities. The critics of the HCA effort point to the trauma center growth in the Florida market. Such centers in the Sunshine State are charging a “response fee” – essentially an entry fee into the hospital – for each trauma case that averages more than $10,000 per patient, according to a Tampa Bay Times investigation in March (Miller, 7/9).

The San Francisco Chronicle: San Francisco Health Care Premiums Expected To Drop
A year ago, dozens of angry city workers packed a City Hall hearing where San Francisco supervisors threatened to reject proposed 2014 health premiums for city employees, saying that Kaiser Permanente had failed to justify a 5.25 percent rate increase and that they were fed up with the provider's lack of transparency. On Wednesday, in nearly empty chambers, the same budget committee easily approved the city's proposed rates for 2015 -- a package that will slash Kaiser premiums by 2 percent, a rate the insurer has agreed to hold steady through 2016. "It's quite remarkable that you were able to negotiate these rates," Supervisor John Avalos - who last year led the opposition to the rates - told Health Service System Director Catherine Dodd (Lagos, 7/9).

Los Angeles Times: Anthem Blue Cross Faces Another Suit Over Obamacare Doctor Networks
Amid growing scrutiny statewide, insurance giant Anthem Blue Cross faces another consumer lawsuit over its use of narrow networks in Obamacare coverage. A group of Anthem policyholders sued California's largest for-profit health insurer Tuesday in state court, accusing the company of misrepresenting the size of its physician networks and the insurance benefits provided (Terhune, 7/9).

Des Moines Register: Feds Give Iowa Hospitals $10M To Improve Rural Care
Twenty-five small Iowa hospitals will soon join efforts to track and coordinate care of chronically ill patients, thanks to a $10 million federal grant to the Mercy hospital system, hospital leaders said Wednesday. The three-year grant was part of $26 million in new Iowa grants made under the Affordable Care Act (Leys, 7/9).

Denver Post: Colorado Food Bank Gets Grant For Staff Helping Clients With Medicaid
When Arvada Community Food Bank director Sandy Martin wrote a grant proposal seeking U.S. Department of Agriculture funds to expand services, she knew there was a pent-up need for her organization to provide more than just food. What she didn't anticipate was just how great that need was. The food bank got the three-year grant of $187,500 for Bridges to Opportunity. It's one of several nationwide pilot programs supporting food bank clients as they move toward self-sufficiency. Instead of just providing food, the Arvada Food Bank has now hired a full-time staff member to help clients tie into assistance programs such as Medicaid and the Supplemental Nutritional Assistance Program (Briggs, 7/10).

The Associated Press: One Year Later, No New Abortion Rules In NC
Abortion rights advocates in North Carolina say they are in the dark about new rules required by a year-old law that they fear could effectively shut down many of the state's clinics. Broadly speaking, the law requires that clinics be regulated in the same way as outpatient surgical centers. But exactly how those rules will take shape and what the state's 15 abortion clinics will need to do to comply remain unknown. The state's health department says it is committed to maintaining access to the procedure and is still drafting the rules. There is no deadline for drafting the rules (Ferral, 7/9).

This Story: Print | Link to | Top

Weekend Reading

Longer Looks: Doctors' Misunderstanding Of Test Results; The Medical Facts About Birth Control

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

BBC News: Do Doctors Understand Test Results?
[Gerd] Gigerenzer, director of the Harding Center for Risk Literacy in Berlin, is an expert in uncertainty and decision-making. His new book, Risk Savvy, takes aim at health professionals for not giving patients the information they need to make choices about healthcare. But it's not just that doctors and dentists can't reel off the relevant stats for every treatment option. Even when the information is placed in front of them, Gigerenzer says, they often can't make sense of it (William Kremer, 7/6). 

Reuters: How To Fix A Broken Market In Antibiotics
The drugs don't work - and neither does the market, when it comes to antibiotics. When sophisticated bugs that medicines used to kill within days start to fight back and win, all of healthcare, and the people it keeps alive, is in trouble. ... It's a glimpse of what Britain's chief medical officer Sally Davies calls the "apocalyptic scenario" of a post-antibiotic era, which the World Health Organisation says will be upon us this century unless something drastic is done. Waking up to the threat, governments and health officials are getting serious about trying to neutralize it. It may seem like a question of science, microbes and drugs - but in truth it is a global issue of economics and national security (Ben Hirschler and Kate Kelland, 7/6).

The New Republic: The Medical Facts About Birth Control and Hobby Lobby—From An OB/GYN
If you’ve read the Supreme Court’s ruling in Hobby Lobby or the reaction to it, then you know what sparked the lawsuit. The Affordable Care Act says that employer-provided insurance must include essential health benefits, including all medically authorized forms of contraception. The owners of Hobby Lobby objected to this requirement, because they believe that four common forms of birth control—two versions of the "morning-after pill" and two kinds of intrauterine devices (IUDs)—are "abortifacients." In other words, the owners of Hobby Lobby think these contraceptives end pregnancies rather than prevent them. And they believe that is tantamount to ending a life. The claim, which you can find on virtually any conservative website, has been making the rounds for a long time. It’s stuck because the science on how these particular drugs and devices work wasn’t that great (Jen Gunter, 7/6). 

MedPage Today: Profiles In Medicine: Mystery In The Delta
It's not unusual for physicians to encounter a slew of memorable characters in the early days of their career -- the overbearing attending who compensates for insecurity by eliminating the competition, the aggressive trial lawyer, the scalpel-happy surgeon who's potentially more dangerous than helpful -- all of which make for good tales to share at the dinner table. But for one Mississippi physician those characters furnished plot lines for novels. Darden H. North, MD, partner in a 16-member ob-gyn group practice in Jackson, Miss., has published four novels in the last 9 years, and is now hard at work on a fifth. The books' characters all hail from those early days of his career. They are his stories' backbone, he says (Suz Redfearn, 7/6). 

The Atlantic: Should We 'Fix' Intersex Children?
M was born with genitals that were not clearly male or female. Also known as disorders of sex development (DSDs), the best guess by researchers is that intersex conditions affect one in 2,000 children. The response by doctors is often to carry out largely unregulated and controversial surgeries that aim to make an infant’s genitals and reproductive organs more normal but can often have unintended consequences, according to intersex adults, advocates and some doctors. A long and gut-wrenching list of damaging side effects—painful scarring, reduced sexual sensitivity, torn genital tissue, removal of natural hormones and possible sterilization—combined with the chance of assigning children a gender they don’t feel comfortable with has left many calling for the surgeries to be heavily restricted (Charlotte Greenfield, 7/8).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Turning To New Legal Challenges To ACA; Is The Law Working?; Medicaid Problems In N.C.

The Washington Post: Courts Won't Void The Affordable Care Act Over Semantics
The Supreme Court’s term ended in June with another Affordable Care Act ruling, and the ACA survived largely unscathed. Burwell v. Hobby Lobby has important ramifications for women’s health and religious freedom but does not invalidate a single section of the law. There are, however, a number of ACA lawsuits percolating up through the courts that could be much more destructive (Timothy Jost, 7/9). 

The New York Times' Taking Note: Democrats Will Vote To Undo The Hobby Lobby Decision
The Supreme Court’s ruling last week in the Hobby Lobby case wasn’t based on a fundamental right found in the First Amendment or anywhere else in the Constitution. When the justices said that closely held corporations have religious rights that let them refuse to pay for insurance plans that cover contraceptives, they based their decision on a 1993 law passed by Congress, the Religious Freedom Restoration Act. That means Congress has the ability to rewrite federal law to overrule the court’s decision, and Senate Democrats have wasted little time coming up with a bill to do just that (David Firestone, 7/9).

The Fiscal Times: Harry Reid's Crafty Ploy To Fight The Hobby Lobby Ruling
Senate Majority Leader Harry Reid plans to rebut the Supreme Court by amending the (Religious Freedom Restoration Act). Democrats in both chambers of Congress began working on bills that would exempt Obamacare from the bill passed in 1993 and signed by then-President Bill Clinton in an attempt to circumvent the Hobby Lobby decision and force employers to provide free contraception and sterilization to their employees. Reid announced the effort on Tuesday by announcing that Democrats wouldn’t allow women’s lives to be "determined by virtue of five white men," which must have come as a shock to Justice Clarence Thomas, one of the five justices to support the majority in the Hobby Lobby decision. That, however, was just the start of the insanity. Let’s start with a refresher course on the RFRA (Edward Morrissey, 7/10).

The New York Times: Reading Hobby Lobby In Context
To grasp the full implications of the Supreme Court's Hobby Lobby decision, it helps to read it not in isolation but alongside the court's other major religion case of the term, Town of Greece v. Galloway. Issued eight weeks before Hobby Lobby and decided by the same 5 to 4 division, Town of Greece rejected a challenge to a town board's practice of beginning its public sessions with a Christian prayer. A federal appeals court found the practice unconstitutional, concluding that it violated the First Amendment's Establishment Clause by conveying an official endorsement of one particular religion (Linda Greenhouse, 7/9). 

Los Angeles Times: What Do The Hobby Lobby Backers Want Women To Be?
In the fallout surrounding last week's Supreme Court Hobby Lobby decision, a lot of people have been wondering exactly what role the Christian right thinks women should play in society and how birth control detracts from it (Meghan Daum, 7/9). 

The Wall Street Journal’s Washington Wire: How Proposals For Obamacare Subsidies In 2015 Could Cost Taxpayers
In a Think Tank post last week, I explained why the number of unresolved inconsistencies in applications on the federal insurance exchanges probably exceeds the 2.9 million cited in two recent Department of Health and Human Services reports. Recent HHS proposals could allow many income-related inconsistencies to persist in 2015–potentially risking taxpayer funds (Chris Jacobs, 7/9). 

JAMA: How Well Is The Affordable Care Act Working?
The American people are still divided in their views of the Affordable Care Act (ACA), which is perhaps not surprising given how partisan the debate has been and the fundamental ideological differences in the country about the appropriate role for government in health care, as in other spheres. There are legitimate differences of opinion about the law, just as there are about any important policy issue. But the politics of the ACA often get confused with the question of whether the law is working as intended, whatever one may think of the wisdom of those intentions. That is largely a factual question, though facts about the ACA are often blurred when looked at through ideologically tinted lenses (Larry Levitt, 7/9).

Bloomberg: Obamacare Is Working. Unless You're Black.
A new survey shows that Obamacare has done a fantastic job of reducing the uninsurance rate -- for everybody except blacks. The share of Americans age 19 to 64 without health insurance fell from 20 percent last summer to 15 percent this spring, according to a telephone survey of 4,425 people from the Commonwealth Fund, a nonprofit health-care research group. ... When the Commonwealth Fund conducted a survey from July to September last year, 21 percent of blacks reported being uninsured. This year, in a similar survey conducted from April to June, that level was effectively unchanged, at 20 percent. Blacks were about half as likely as Latinos to be uninsured a year ago; now the rates for the two groups are almost the same (Christopher Flavelle, 7/9).

Forbes: Intervention: Will North Carolina Clean Up Its Medicaid Program?
What started out as a pro forma session to pass North Carolina’s budget has turned into an intervention over the state Medicaid program’s big-spending, poor-performing ways. And it’s about time—North Carolina spends more than $14 billion per year on its Medicaid program, has run over budget the last four years, and, perhaps most shocking, the Medicaid agency doesn’t even know how many people are currently enrolled (Josh Archambault, Jonathan Ingram and Christie Herrera, 7/10). 

Arizona Republic: Brewer Was Right On Medicaid Expansion (We Have Proof)
Gov. Jan Brewer's victory in the fight for Medicaid expansion paid off. Big time. A survey by the Arizona Hospital and Healthcare Association found a 31 percent reduction in the amount of uncompensated care in the first four months of this year compared to the same period last year. We're talking real money. Responses from 75 percent of the state's hospitals showed they wrote off $170 million in uncompensated care through April this year. During those same months in 2013, the cost of uncompensated care was $246 million (7/8).

Georgia Health News: To Help Struggling Hospitals, Replace Georgia's Malpractice System
A panel of health care and political leaders appointed by Gov. Nathan Deal kicked off its work this summer to address the ongoing crisis in rural medical care. Its focus: the very survival of hospitals outside metropolitan communities through the state. ... Four rural Georgia hospitals have closed in the past two years. ... While some continue to urge the governor to expand the state’s Medicaid rolls as a solution to the hospitals’ financial challenges, there is a healthier avenue to create revenue to sustain these hospitals. Under the proposed Patients’ Compensation System (PCS) before the General Assembly, state taxpayers could save $6.9 billion over the next decade. That state revenue could be reinvested in rural hospitals that are barely surviving and others losing these federal grants (Wayne Oliver, 7/9).

This Story: Print | Link to | Top


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.