Daily Health Policy Report

Thursday, July 11, 2013

Last updated: Thu, Jul 11

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

Women's Health

Public Health & Education

State Watch

Quality

Medicare

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: GOP Has 'Really Busy Month' Ahead On Health Care

Kaiser Health News' Mary Agnes Carey talks with Politico Pro's Paige Winfield Cunningham about the latest Republican efforts to delay or repeal Obamacare provisions, including postponing a mandate on individuals to carry health insurance. Watch the video or read the transcript

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Capsules: Some States Are Pushing "Employee Choice" For Small Business Insurance; Tax Break Can Help With Health Coverage, But There’s A Catch

Now on Kaiser Health News' blog, Julie Appleby reports on a choice some workers will have on a few online health insurance marketplaces: "Small business workers in at least 15 states and the District of Columbia may have a menu of health insurance choices next year, something that didn’t seem likely a few months ago. Back in April, federal officials concerned about the potential for major glitches put off until 2015 a provision that would offer small businesses owners a way to allow their employees to choose from among a variety of competing plans in the new online marketplace being overseen by the Obama administration" (Appleby, 7/11).
 
Also, insurance columnist Michelle Andrews examines a key distinction between the premium subsidy and the cost-sharing subsidies offered to lower income people on the new  marketplaces: "There are two kinds of financial help for people planning to enroll in the online health insurance marketplaces that will open this fall. One could put people at risk of having to pay some of the money back, while the other won’t. That’s one big difference between tax credits and subsidies, both of which are intended to help people with lower incomes pay for health insurance through the new health care law" (Andrews, 7/10). Check out what else is on the blog.

 

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Educating Florida About Health Care Reform Starts With Conversation

The Miami Herald's Patricia Borns, in partnership with Kaiser Health News, reports: "Enroll America, a Washington, D.C.-based nonprofit whose mission is to educate Americans about their healthcare options under the Affordable Care Act, kicked off its Florida campaign Wednesday in Miami with a training session for more than 25 newly hired organizers who will be reaching out to residents statewide" (Borns, 7/10). Read the story.

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Political Cartoon: 'Gloving Up?' By Clay Bennett, Chattanooga Times Free Press

Kaiser Health News provides a fresh take on health policy developments with 'Gloving Up?' By Clay Bennett, Chattanooga Times Free Press.

Meanwhile, here is today's health policy haiku:

IT'S HARD OUT THERE FOR AN INTERN 

Sleep deprivation
Or training deprivation
Which one would you choose

-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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Capitol Hill Watch

Senate GOP Petitioning For 'Permanent Delay' Of Obamacare

Encouraged by the administration's delay of the employer mandate provision by one year, Republicans were active on both sides of Capitol Hill Tuesday, renewing their calls for repeal.

The New York Times: Democrats Shrug Off Delays And Affirm Support For Health Law
Congressional Democrats said Wednesday that they expected to see more delays and snags in President Obama's efforts to carry out the new health care law, but they affirmed their strong support for the overarching goal of expanded coverage. The comments came in a hearing of a House Ways and Means subcommittee held to investigate the president’s decision last week to delay until 2015 a major provision of the law. It requires employers with more than 50 full-time workers to offer health coverage to them (Pear, 7/10).

Kaiser Health News: Health On The Hill: GOP Has 'Really Busy Month' Ahead On Health Care
KHN's Mary Agnes Carey talks with Politico Pro's Paige Winfield Cunningham about the latest Republican efforts to delay or repeal Obamacare provisions, including postponing a mandate on individuals to carry health insurance (7/11).

National Journal: House GOP Adopts New, Populist Critique Of Obamacare
In the ongoing rhetorical wars against the president’s health care law, House Republicans have found a new critique—and it has a populist bite. The argument goes like this: By delaying last week a requirement that employers with a workforce of 50 or more offer their workers insurance, the White House gave a break to small business. But it isn’t granting a similar reprieve to ordinary Americans by postponing the law’s unpopular requirement that individuals obtain health insurance or face a fine (Hollander and Sanger-Katz, 7/11).

Des Moines Register: Harkin Questions Legality Of Delay In Obamacare
U.S. Sen. Tom Harkin, a steady supporter of President Barack Obama’s signature health reform program, put the White House on the defensive Wednesday by questioning the legality of a delay in one of the law’s key provisions. The Iowa Democrat was quoted in the New York Times Wednesday saying he didn’t understand what authority the president used to postpone by a year a requirement that large employers provide health insurance to full-time employees (Leys, 7/11).

The Hill: Treasury Dept. Defends ObamaCare Mandate Delay
In response to questions from congressional Republicans, Treasury said the delay was "an exercise of the Treasury Department's longstanding administrative authority" to provide flexibility with new laws. ... Republicans have questioned whether the delay is legal, since the law says the policy should take effect in 2014. Treasury cited past instances in which it delayed penalties associated with new legislation (Baker, 7/10).

The Hill: ObamaCare Setbacks Hand Weapon To Opponents Of Law
Republicans are launching a new offensive against President Obama’s healthcare law, hoping flaws in the implementation will help undermine public confidence in the Democrats who passed it. Republicans’ anti-ObamaCare sentiments have ratcheted up to a fever pitch since the administration announced last week that it would delay a provision of the healthcare law requiring large employers to offer healthcare coverage to their workers or pay a penalty (Baker, 7/10).

NPR: GOP Says, Why Not Delay That Health Care Law, Like, Forever?
Sensing that recent delays in key portions of the Affordable Care Act have caught the Obama administration at a weak point in its rollout of the law, Republicans in Congress are doubling down on their efforts to cripple the measure, at least in the eyes of the public if not in fact. ... [Sen. John Thune, R-S.D.] got 45 other GOP senators to sign onto a letter to the president urging him to shelve the law entirely. ... Democrats, however, said Republicans were overreacting. "We don't know exactly what the landscape will look like in January, but it's entirely possible this decision will help consumers," said Rep. Jim McDermott, D-Wash, at the subcommittee hearing (Rovner, 7/11).

Modern Healthcare: Tavenner Rips 'Myths' Surrounding ACA
After remaining largely silent following last week's Obama administration decision to delay for one year the healthcare reform law's employer mandate, CMS Administrator Marilyn Tavenner on Tuesday issued what she called a "reality check" in the form of a blog post titled "Myth vs. Fact: Health Insurance Marketplace on Track." "Unfortunately, there have been some mischaracterizations of these regulations and confusion about how the Marketplace will work when it opens later this year," Tavenner wrote. "Let's do a reality check on some of the myths that have been circulating" (Block, 7/10).

Modern Healthcare: Reform Update: Insurance Exchanges In Line of Fire
The U.S. Senate's HHS appropriations bill that started to advance this week, which includes much of the healthcare funding sought by the Obama administration, is likely headed for a series of partisan political battles, including over funding for the new state health insurance exchanges. The bill was approved Tuesday by the Senate Labor, Health and Human Services, and Education, and Related Agencies Appropriations Subcommittee. The full Appropriations Committee will consider it Thursday (Daly, 7/10).

Politico: Role Reversal: GOP Members Dispense Obamacare Advice
Republican lawmakers have spent the past three years blasting Obamacare, but now they have a new role: helping people sign up for it. It’s a role reversal that puts party politics at odds with constituent service. Even Obamacare’s most strident opponents say that if people call their offices looking for help when enrollment starts in October, they’ll direct their staff to assist (Haberkorn, 7/10).

Politico: Congressional Black Caucus To Launch Obamacare Tour
Department of Health & Human Services Secretary Kathleen Sebelius won’t be alone when she’s on the road pitching Obamacare this summer. Members of the Congressional Black Caucus are planning an eight-city tour of their own to “ensure communities are equipped with the information they need” to access health insurance exchanges and understand the impact of the health law. It’s not about the politics but about getting community members the facts they need, they say (Cheney, 7/11).

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Health Reform

Analysis Finds Obamacare Opponents Outspent Supporters On Ads By 5-1

The study of television ads finds that critics have spent at least $385 million since the law was enacted in March 2010. Meanwhile, supporters are looking for innovative ways to attract young healthy people to join plans offered on the online marketplaces.

USA Today: Health Care Law Opponents Dominate Advertising Wars
Opponents of the 2010 health care law have out-spent supporters by nearly 5-1 on the airwaves — as conservatives seek to cast doubts about its effects and pledge to keep it at the forefront of federal, state and local races, an analysis shows. Critics of the Affordable Care Act spent at least $385 million from March 2010, when Congress enacted the sweeping health care measure, through the end of last month, according to an analysis of TV advertising nationwide by Kantar Media. The biggest spender among opponents: Crossroads GPS, a political advocacy group affiliated with Republican strategist Karl Rove (Schouten, 7/10).

The Washington Post: Q: What Do Porta-Potties, Coffee Cups And Airplanes Have In Common? A: Obamacare.
In Connecticut, selling Obamacare involves renting an airplane. Oregon might try to reel in hipsters with branded coffee cups for their lattes. And in neighboring Washington, the effort could get quite intimate: The state is interested in sponsoring portable toilets at concerts in an effort to reach uninsured young adults. The advertisements, developed with political consultants and communications firms, illustrate the ability of the health-care law’s supporters to pinpoint the precise group they want to sign up for Obamacare — young and healthy Americans who won’t weigh down the system with high medical bills (Kliff, 7/10).

MPR News: Persuading Young Adults To Buy Into Health Care Takes New Tack
Robert Bauer is young, lean and healthy -- just the kind of person the government wants to buy into its new health insurance exchanges. Bauer though, doesn't see the need. The 24-year-old works in organic farm fields three days a week, and prides himself on eating well. He's uninsured now and doesn't plan to buy coverage this fall in the exchanges. ...  The question is whether young people, starting in October, sign up or just pay the penalty, which in the first year isn't much, the greater of $95 or 1 percent of income in 2014 (Stawicki, 7/10).

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Community Health Centers Get $150 Million For Health Law Enrollment

Also, Walgreen and the Blue Cross and Blue Shield Association announces a combined effort to help get information to consumers about getting insurance through the federal health law.

CQ HealthBeat: Health Centers Get Grants To Push Overhaul Enrollment
Community health centers across the country will share in $150 million in grants that Health and Human Services Secretary Kathleen Sebelius said Wednesday will help them enroll up to 3.7 million Americans in the new marketplaces this fall. HHS on Wednesday announced that 1,200 centers will get at least $59,000 each, money available through the health care law (Bunis, 7/10).

The Wall Street Journal: Community Clinics Get 'Obamacare' Grants
The Obama administration Wednesday announced it awarded $150 million in grant money that will be shared by more than 1,100 community health centers to help enroll patients into insurance programs under the Affordable Care Act, commonly known as "Obamacare." Separately Walgreen Co. and the Blue Cross and Blue Shield Association announced a new campaign Wednesday designed to tell consumers about the health law and provide information about how to obtain insurance coverage (Corbett Dooren, 7/10).

Huffington Post: Walgreens, Blue Cross Blue Shield Join Obamacare Education Campaign 
Walgreens will provide brochures to customers at its more than 8,000 Walgreens and Duane Reade stores across the U.S. and has debuted a consumer information website, LearnAboutReform.com, with the Blue Cross Blue Shield Association, an affiliation of 38 health insurance companies (Young, 7/10).

Bloomberg: Walgreen Joins Blue Cross To Promote Health Exchanges
The announcement may provide a lift two weeks after the National Football League threw water on the idea of becoming a partner with the Obama administration, which has struggled to sell the law’s benefits amid roadblocks by Republican opponents. The Walgreen-Blue Cross effort would be the largest by private industry to promote the 2010 health-care law (Wayne, 7/10).

Politico: Blue Cross, Walgreens Team For Obamacare Campaign
The partnership shows the strong role the private sector could have in explaining the health care reform law to a public that largely does not understand it. “There’s a lot of confusion, a lot of questions and it’ll take a tremendous collaborative effort to make sure people have the information they need to make informed choices,” said Brad Fluegel, a Walgreens senior vice president and chief strategy officer (Haberkorn, 7/11).

Local and regional news outlets concentrated on the community health center grants -

MPR News: Minn. Health Centers To Receive $1.68M For Uninsured
Sixteen Minnesota health centers will share $1.68 million in federal funds to help uninsured Minnesotans obtain coverage under the federal health care law. ... The extra funding is earmarked for the Minnesota health centers to hire 29 additional staff. Each of the 16 Minnesota health centers will receive a minimum of $65,000 (Stawicki, 7/10).

Minneapolis Star Tribune: Feds Announce $1.6 Million Grant To Minnesota Community Health Clinics
The grants announced Wednesday range from $66,000 to $255,000, depending on the number of uninsured patients each clinic serves. About 37 percent of patients visiting the state’s community health clinics are uninsured, according to the Minnesota Association of Community Health Centers (Griffin, 7/10).

CT Mirror: Community Health Centers To Hire Workers To Get Uninsured Covered
Connecticut community health centers are getting federal funds to hire 28 people to help enroll uninsured state residents in coverage as part of the federal health reform law, the U.S. Department of Health and Human Services announced Wednesday. Thirteen Connecticut health centers are getting just under $1.6 million for the effort (Levin Becker, 7/10).

Arizona Republic: Arizona Centers Get $2.3 Million To Enroll Uninsured
Non-profit community health centers are on the front lines as the federal government prepares for sweeping changes, including Medicaid expansion and online health-insurance exchanges. The grants will help hire and train an estimated 2,900 outreach and eligibility workers nationwide, including 45 in Arizona (Reinhart, 7/10).

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Health Care Marketplace

UnitedHealth Sees Shift Toward Outcome-Based Incentives

The nation's largest insurer predicts it will have $50 billion in accountable-care contracts with health care providers by 2017, up from $20 billion now.

Bloomberg: UnitedHealth Sees Accountable-Care Work Doubling By 2017
UnitedHealth Group Inc. said it will more than double payments to physicians tied to quality and cost efficiency within five years, in the latest sign of transformation in the American medical system. UnitedHealth, the biggest U.S. insurer, said it expects to spend about $50 billion under accountable-care contracts by 2017, compared with $20 billion now (Nussbaum, 7/10).

Minneapolis Star Tribune: UnitedHealth Expands Efforts To Link Cost, Quality
UnitedHealth Group Inc. plans to push more doctors and hospitals toward contracts that link their pay with quality and cost measures, aiming to more than double the value of such agreements over the next five years. The move by the operator of the nation's largest insurance company could hasten a shift already underway, as insurers and the federal government move away from paying health care providers for each individual treatment and instead provide financial incentives to get patients healthier at less cost (Crosby, 7/10).

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Women's Health

Maryland's Action May Offer Middle Ground In Abortion Clinic Debate

After a woman was hurt during an abortion, the state tightened its oversight. Americans continue to hold complex views on the subject, even as lawmakers on Capitol Hill gear up for a possible Senate fight on a bill banning abortion after 20 weeks of pregnancy.

The New York Times: Maryland's Path To An Accord In Abortion Fight
The 18-year-old woman arrived at Johns Hopkins Hospital by medevac helicopter in critical condition. Her uterus and bowel had been pierced during a late-term abortion that had started in New Jersey and ended at an unmarked, unregulated clinic in Elkton, in northeastern Maryland. ... The near disaster in an Elkton mall led to something rare in this era of polarized abortion politics -- sharply tightened oversight of Maryland abortion clinics that came into full force this year and won praise from both sides of the political divide (Eckholm, 7/10).

The Washington Post: Four Decades After Roe V. Wade, Views Of Most Americans Still Complex, Conditional
The absolutist voices have always dominated the abortion debate. But as it flares again in Congress and in legislatures across the country, the fight this time is heading into complicated political terrain, stirring the ambivalence that most Americans feel about the issue. ... Fine lines are not something activists on either side often recognize. But four decades after the Supreme Court’s landmark decision in Roe v. Wade, the views of most of Americans on abortion remain complex and conditional (Tumulty, 7/10).

Politico: Marco Rubio: Abortion Bill A 'Work In Progress'
Sen. Marco Rubio is "very supportive" of the effort to introduce a bill banning abortion after 20 weeks, and is working with other senators on the bill, he told Politico. The Florida Republican wouldn't say whether he will be a lead sponsor of the proposed legislation (Everett, 7/10).

Politico: Democrats Say GOP Playing Politics With Abortion
Senate Democrats on Wednesday sharply criticized a House-passed bill that would ban abortions after 20 weeks, disparaging it as an "extreme and dangerous" attack on women's health. The bill stands no chance of passing the Democratic-controlled Senate but has nonetheless incensed abortion rights activists and others on the left (Delreal, 7/10).

Meanwhile, in Texas, House lawmakers there passed a bill further regulating the procedure, including banning it after 20 weeks of pregnancy, and sent it to the Senate, where it could be voted on as soon as Friday.

The New York Times: Texas House Passes Measure Tightening Clinic Rules And Restricting Access To Abortion
The Texas House of Representatives passed a vigorously contested bill on Wednesday restricting access to abortion. ... The bill, like its predecessor, would ban abortions after 20 weeks of pregnancy and hold abortion clinics to the same standards as hospital-style surgical centers, among other requirements. Its supporters argue that the heightened requirements will protect women’s health; opponents counter that the restrictions are intended solely as a burden on the clinics that perform abortions and will impose expenses that will force many of them to close (Schwartz, 7/10).

Los Angeles Times: Texas Abortion Bill Headed To Senate After House Votes 
A restrictive abortion bill is heading to the floor of the Texas Senate after the state's House of Representatives approved the legislation Wednesday on a 96-49 vote. The Republican-dominated House voted mostly along party lines, a day after more than 10 hours of debate. Lawmakers rejected all proposed amendments to the bill. ... The Senate is expected to take up the bill Thursday and could vote on it as early as Friday (Kelly, 7/10).

Dallas Morning News: Texas House Gives Final Approval To Abortion Restrictions, Setting Up Quick Senate Action
Far-reaching legislation to restrict abortions in Texas won final approval from the House on Wednesday, setting up the prospect that the Senate could send it to Gov. Rick Perry in a few days for his signature. Abortion-rights advocates nonetheless continued their push against the bill. Planned Parenthood officials brought their statewide tour to Dallas, drawing about 150 people protesting the legislation (Stutz and Fancher, 7/10).

Texas Tribune: House Approves Abortion Restrictions
The House voted 96-49 on Wednesday to give final approval to proposed abortion regulations in Texas. House Bill 2, which would ban abortion at 20 weeks and enact some of the strictest regulations in the country on abortion providers and facilities, now heads to the Senate. "If we’re going to ask for more children to come into this world, we should provide for them," said state Rep. Ruth Jones McClendon, D-San Antonio. She offered an amendment, which lawmakers tabled, that would have extended state benefits to children put into the foster care and adoption system by women who could not access abortion as a result of the legislation (Aaronson, 7/10).

Texas Tribune: Dewhurst Confident Of Abortion Bill Vote
On the eve of an expected vote on controversial abortion restriction legislation, Lt. Gov. David Dewhurst said Wednesday that he is confident the legislation will make it to the governor’s desk for signature during the current 30-day special session. "I'm excited about this opportunity and want to get this bill passed," Dewhurst said during the Laura Ingraham Show (Ura, 7/10).  

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Public Health & Education

Longer Life For Americans, But Obesity Problem Persists

Americans are living longer than they did 20 years ago, but they still lag other countries on life expectancy and the obesity rate, a new study has found.

The Wall Street Journal: Americans Are Living Longer, But Not Necessarily Healthier, Study Shows 
Americans are living longer than they did two decades ago, but they are losing ground on key measures of health to people in other developed nations, a new study shows. The findings, from the most comprehensive analysis of the health of the U.S. population in more than 15 years, show progress in reducing death rates, adjusted for age, across a variety of diseases. But death rates from illnesses associated with obesity, such as diabetes and kidney disease, as well as neurological conditions like Alzheimer's disease, are on the rise (Winslow, 7/10).

NBC News: Americans Live A Little Longer, Still Lag Other Rich Countries (Video)
Americans may be living longer and even exercising a little more, but we really are not much healthier than we were 10 years ago and we are still far behind other rich countries when it comes to our health, researchers said Wednesday. The biggest survey of U.S. health in 15 years breaks down death, disease and disability county by county -- and makes some very unflattering comparisons to other countries. It's a big, comprehensive dive into what kills us and what makes us sick (Fox, 7/10).

Medpage Today: Gains Made, But U.S. Still Lags In Life Expectancy
The overall life expectancy in the U.S. increased from 75 to 78 years during the period of 1990 to 2010, but with an increase in expected years lost to disability (9.4 to 10.1 years), according to Christopher Murray, MD, DPhil, of the Institute for Health Metrics and Evaluation at the University of Washington in Seattle. Compared with other countries, the U.S. dropped in its rankings in terms of life expectancy at birth (going from No. 20 to No. 27), life years lost to premature death (moving from 23rd to 28th), healthy life expectancy (jumping from 14th on the list to 26th), and age-standardized death rate (18th to 27th) between 1990 and 2010, they wrote in the study published in the July 10 issue of the Journal of the American Medical Association (Pittman, 7/10). 

And in another study --

Los Angeles Times: We're Exercising More But Still Fighting Obesity, Study Shows
Americans are exercising more, but that has not done much to slim their waistlines, underscoring the immense challenge confronting doctors and health advocates fighting the nation's obesity crisis. In more than two-thirds of the nation's counties -- including some of the unhealthiest -- men and women became more physically active over the last decade, according to data published Wednesday in the online journal Population Health Metrics. Three-quarters of California's counties saw gains in physical fitness for both men and women (Levey and Gorman, 7/10).

And one major American city limits group exercise in their public parks -- 

The New York Times: In Health-Conscious Denver, Limits On Group Exercise
In Denver, one of the healthiest cities in America, fitness fans are fuming over rules from the city and private officials that restrict group exercise in parks and open spaces. "You can smoke pot, but you can't exercise," Mr. Lindley said, as the scent of a newly legalized substance drifted past. "This is Colorado." A skirmish over exercise in the public square seems fitting in a place where people spend more on road bikes than on their cars, and Lycra attire is the unofficial uniform of the weekend (Healy, 7/10).

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State Watch

Louisiana Blue Cross: Insurance Costs Will Drop For Many Under Health Law

The Miami Herald: Educating Florida About Health Care Reform Starts With Conversation
Enroll America, a Washington, D.C.-based nonprofit whose mission is to educate Americans about their healthcare options under the Affordable Care Act, kicked off its Florida campaign Wednesday in Miami with a training session for more than 25 newly hired organizers who will be reaching out to residents statewide. ... While the plans don’t exist yet, and even the “navigators” who will help Floridians understand the new marketplace aren’t yet known, Enroll America and other groups are wasting no time getting the healthcare word out (Borns, 7/10). Produced in partnership with Kaiser Health News.

The Associated Press: Blue Cross Describes Health Law Impact On Premiums
Louisiana's largest private health insurer, Blue Cross and Blue Shield of Louisiana, estimated Wednesday that two-thirds of its customers who buy their own policies will pay the same premiums or less under the federal health care overhaul. But that's only if people take advantage of federal subsidies being offered under the law, Blue Cross officials said, outlining the anticipated effects of the Affordable Care Act (Deslatte, 7/10).

The Associated Press/Akron Beacon: Medicaid Supporters Rally For Expansion In Ohio
Democratic state lawmakers on Tuesday urged "meaningful" action from Republican Gov. Kasich on Medicaid expansion, as the governor rallied a group of supportive residents to increase pressure on their representatives to support extended health coverage. While both Kasich and Democrats favor Medicaid expansion, they appeared split Tuesday over how to accomplish it. The issue has struggled to gain traction in a Legislature controlled by the governor's fellow Republicans (Sanner, 7/10).

Milwaukee Journal Sentinel: Access, Insurance Cited As Top Health Care Issues
Longstanding problems that defy simple solutions, such as access to health care in low-income neighborhoods, were among the top concerns raised in an extensive overview of health needs in Milwaukee County. The assessment was the first of its kind and must be done by nonprofit health systems every three years to maintain their tax-exempt status under the Affordable Care Act (Boulton, 7/10).

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State Highlights: N.Y. Expects $20M Savings With Psychiatric Care Overhaul

The Associated Press: N.Y. To Overhaul State Psychiatric Care
New York plans to overhaul its psychiatric services over the next four years by consolidating 24 inpatient hospitals into 15 regional centers and establishing two dozen outpatient hubs. The plan released to The Associated Press by the Office of Mental Health on Wednesday begins in 2014 and is expected to save $20 million the first year (7/10).

Detroit Free Press: Cardiology Practice, Jackson Hospital To Pay $4M In Lawsuit Alleging Medically Inappropriate Heart Procedures
A cardiology practice and a Jackson hospital have agreed to pay the federal government $4 million to settle a lawsuit that claimed patients were subjected to medically inappropriate heart procedures. It was a doctor who blew the whistle on the questionable practices, the government said (Baldas, 7/10).

California Healthline: Contentious Physical Therapy Legislation Approved By Committee
The Senate Committee on Business, Professions and Economic Development on Monday finally approved a contentious bill to allow professional corporations to directly employ physical therapists. Monday's intense and multifaceted discussion followed a hearing in the same committee just a week before, a hearing which went on so long, it had to be carried over to this week (Gorn, 7/10).

California Healthline: Aetna And United Are Out Of California. Who’s Moving In?
United Healthcare has more than 4,700 hospitals in its national network. Valley Health Plan has four. That relative scale is one reason why United's departure from California's individual market last week got so many headlines -- even though the health plan only covers 8,000 people -- while the news of Valley's inclusion in Covered California last month got almost none. And on the surface, the thought of losing the nation's largest health insurer doesn't seem to augur much good for the Golden State's health reform efforts. Especially in the wake of Aetna's similar announcement last month (Diamond, 7/10).

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Quality

Studies Find Pediatricians Slow To Use Interpreters When Needed; Fewer Surgeries For Doctors In Training

Several outlets look at physician practice issues.

Reuters: Many Pediatricians Still Not Using Interpreters
Close to half of pediatricians do not use a professional interpreter when seeing patients and families with a limited understanding of English, according to a new study. ... Using family members is not recommended because they are more likely to make errors while translating or to withhold sensitive or painful information for emotional reasons, [Lisa DeCamp of Johns Hopkins University School of Medicine in Baltimore] told Reuters Health by email (Doyle, 7/10).

Reuters: Less Practice For Surgeons-In-Training After Restrictions
Surgeons-in-training had fewer opportunities to take part in operations after restrictions on their working hours were put in place in July 2011, according to a new analysis. Researchers tracking a group of first-year surgical residents during 2011 and 2012 found the trainee surgeons took part in an average of 26 percent fewer operations than their counterparts in the previous four years (Seaman, 7/10).

Related, earlier coverage from KHN: Some Doctors Question If Shorter Intern Shifts Endanger Patients (Boodman, 7/9).

Meanwhile, Marketplace examines the lack of supplies doctors and hospitals are encountering -

Marketplace: Markets Come Up Short In Drugs For Premature Babies (Audio)
If there is a crucial need, markets will provide. Not always, and not in the case of critical nutrients needed to help premature babies. It turns out, America is facing a bizarre shortage of  medical grade basic nutrients such as phosphorus and zinc. The Pittsburgh Post Gazette reports neonatal intensive care units are scavenging to keep preemies alive, sometimes taking from adult patients elsewhere in the hospital (Brancaccio, 7/10).

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Medicare

CMS To Settle Payment Fight Over Gamma Knife

The Wall Street Journal: CMS Steps In To Settle Gamma Knife-Varian Fight
The Centers for Medicare and Medicaid Services has proposed a new rule that would effectively put to rest a provision inserted into last year's fiscal cliff bill by Senate Majority Leader Harry Reid (D., Nev.) to help a U.S. company. The original provision threatened to slash payments to the Swedish maker of a radiosurgical device called the Gamma Knife, thereby helping its competitor, a U.S. company that makes Linac -- short for linear accelerator -- machines. ... Under the rule proposed Monday, CMS would reimburse any facility performing the delicate brain tumor radiosurgery in a single treatment the same amount (Mundy, 7/10).

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Weekend Reading

Weekend Reading: Doctors Who Decide, Death Desires, and Decisions

Washington Monthly: Special Deal
On the last week of April earlier this year, a small committee of doctors met quietly in a midsized ballroom at the Renaissance Hotel in Chicago. There was an anesthesiologist, an ophthalmologist, a radiologist, and so on—thirty-one in all, each representing their own medical specialty society, each a heavy hitter in his or her own field. The meeting was convened, as always, by the American Medical Association. Since 1992, the AMA has summoned this same committee three times a year. It’s called the Specialty Society Relative Value Scale Update Committee (or RUC, pronounced “ruck”), and it’s probably one of the most powerful committees in America that you’ve never heard of. ... it’s the committee members’ job to decide what Medicare should pay them and their colleagues for the medical procedures they perform (Haley Sweetland Edwards, 7/2013).

Related, earlier KHN story: Panel Calls For ‘Drastic Changes’ In Medicare Doctor Pay (Rau, 3/4)

The Atlantic: Make Your Wishes Known
Dr. Kenneth Prager, a 70-year-old medical ethicist, was sitting in his office at the New York Presbyterian Hospital waiting for a patient when he got a call from a colleague. He was happy to hear from Dr. Steve Williams, 56, who had trained under him and was now the chief medical officer of a nearby hospital. But he grew uneasy when he began to understand the reason for the call. Most of the time, ethicists handle cases where a family refuses to let a family member go. This was just the opposite. Williams was caring for a 36-year-old patient who was unconscious, and on several forms of life support, but was expected to recover. The patient's family, though, believed it was best to pull the plug (Ashwaq Masoodi, 7/10).

The New Yorker:  How Should Doctors Share Impossible Decisions With Their Patients?
On a Friday evening a few months ago, my mom broke her arm. A doctor in the E.R. told her it was a simple fracture, and put her arm in a sling. The following Monday, though, she called me. She had consulted two surgeons who had a different assessment: the bone was broken in four places, surgery would be quite involved, and the rates of complications were high. … Here’s the thing: I’m a doctor. Strictly speaking, I know what avascular necrosis means. It means the bone can die. It means the blood vessels can be compromised. Which means, again, dead bone. My mom, a cardiologist, knows this too, as does my father, a rheumatologist. But what I meant was: What did it really mean? How would it feel? How was she supposed to make such an impossible decision? (Lisa Rosenbaum, 7/5).

The New England Journal Of Medicine: From Imagine Gatekeeper To Service Provider – A Transatlantic Journey
In Britain, where I trained in surgery, residents feared radiologists. One radiologist was nicknamed “Dr. No,” since his first response was always to deny requests for any imaging other than a plain radiograph. We had no computerized order-entry system, so after rounds, the junior doctor brought requests to the radiologist for discussion. It took flawless knowledge of the patient, a reasonable grounding in clinical medicine, and a certain stoicism to emerge unscathed from these discussions. … When I began a diagnostic-radiology residency in the United States, I was struck by both the abundance of CT scans, MRIs, and technologists and the fact that in nearly all requests for suspected pulmonary embolism (PE), the stated indication was “pulmonary-artery aneurysm.” The two phenomena turned out to be linked by a common thread: U.S. radiologists were service providers, not gatekeepers (Saurabh Jha, 7/4).

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Editorials and Opinions

Viewpoints: 'Implosion' Of The ACA; Administration 'Spin Machine'

The Wall Street Journal: Big Government Implodes 
July 3 was the quiet afternoon that a deputy assistant Treasury secretary for tax policy announced in a blog post that the Affordable Care Act's employer mandate would be delayed one year. Something about the "complexity of the requirements." ... Even if you are a liberal and support the goals of the Affordable Care Act, there has to be an emerging sense that maybe the law's theorists missed a signal from life outside the castle walls. While they troweled brick after brick into a 2,000-page law, the rest of the world was reshaping itself into smaller, more nimble units whose defining metaphor is the 140-character Twitter message (Daniel Henninger, 7/10). 

The Wall Street Journal: The ObamaCare Spin Machine Revs Up 
Meanwhile, the temporary reprieve from the employer mandate will not stop many businesses from preparing their people for when the company stops providing insurance. They'll also continue limiting more part-time employees to fewer than 30 hours a week, in order to avoid being snared by this provision in the law. To offset this development, the administration desperately wants to sign up as many people for health policies as possible, hoping the newly insured will be grateful voters on Nov. 4, 2014 (Karl Rove, 7/10). 

The Washington Post: Republicans' Obamacare Search-And-Destroy Mission 
Last week, the administration announced it was delaying by a year the implementation of one of Obamacare’s provisions, the requirement that large employers provide health insurance. You'd think the opposition party, which has spent four years denouncing the health-care reforms, would be delighted by the reprieve. But on Wednesday, Republicans on the House Ways and Means Committee held a hearing to condemn the administration — for incomplete enforcement of the law they hate (Dana Milbank, 7/10).

MinnPost: Obamacare And The Myth Of Rate Shock
Arguments about health-insurance rate shocks when the Affordable Care Act (Obamacare) kicks in willfully disregard key facts behind the policy. Claims regarding rate shock are based on the premise that the cheap plans on the market today are no longer going to be available, and the new plans will be incredibly expensive (Kevin George, 7/11).

Health Policy Solutions (a Colo. news service): The Role Of The Employer Mandate In The Affordable Care Act
So, perhaps the question about the delay is less important than whether the employer responsibility provision is the best approach to meet the law’s objectives. Employer reporting could be less onerous. The law could be modified to base the penalty on the percentage of payroll that a business spends on health care instead of a threshold based on full-time employees. That kind of discussion would require both sides to recognize the benefit of working together to improve the law for both employers and employees. Given the politically polarized Congress, that seems unlikely (Bob Serno, 7/10).

New England Journal Of Medicine: Bundle With Care – Rethinking Medicare Incentives For Post-Acute Care Services
Although health policy experts disagree on many issues, they largely agree on the shortcomings of fee-for-service payment. The inefficiency of a payment method that rewards increases in service volume, regardless of health benefit, has become practically indefensible. But replacing discrete payments for each service with bundled payment for a set of services does not simply promote efficiency; it also potentially promotes skimping on care or avoidance of costly patients (Judith Feder, 7/10).

Health Policy Solutions (a Colo. news service): Finding Systems Of Care That Drive Value
We are all health care consumers, whether paying directly or indirectly for coverage or care. In the past, many people were unaware of specific health care costs because there was little cost-sharing involved, and price transparency in health care has been limited. Yet as patients pay higher out-of-pocket costs, they are taking a closer look at doctor and hospital bills – and rightly so. The recent spotlight on facility fees for physicians employed by health systems illustrates one aspect of health care sticker shock (Eric Worthan, 7/10).

The Star Ledger: The A.P. Is Missing The Real Story Concerning Obamacare And Smoking 
The Associated Press has an article on a glitch in Obamacare that will make it impossible to impose a proposed 50 percent hike in premiums on smokers. The article is fine as far as it goes, but the writer misses a key point: Even without the glitch, most smokers will be exempt from the individual mandate to purchase insurance (Paul Mulshine, 7/11).

The New York Times: What’s Wrong With a 20-Week Abortion Ban?
The way the Catholic Association mentions "late-term" abortions, you might think the only women who had them were lazy and callous, just waiting around until the last second for no good reason. But as Cecile Richards, the head of Planned Parenthood, told me in an email, nearly 99 percent of abortions occur before 21 weeks; abortions later on often involve rare, severe fetal abnormalities and real threats to a woman’s health. In many cases, women are facing the need to terminate a desired pregnancy, not an unwanted one (Andrew Rosenthal, 7/10).

Baltimore Sun: A Better MCAT May Not Produce Better Doctors
What does it take to become a good doctor? In the midst of a period of health care reform and primary care shortages, how we do to encourage talented students who want to give back to the community to go into medicine? (Diane Kuhn, 7/10).

Medpage Today: 7 Golden Rules For EHR Implementation
Eligible physicians are dropping out of the HITECH incentive program. Why? Often, it's because a practice implements an EHR and then tries to mimic all their old paper processes and workflows. That can get them through the vendor's initial implementation, but it is not sustainable for the long term. Workflows and operational processes must be modified to optimize the new tool. Technology changes what is feasible, and to adapt, we need to change what we do every day (Rosemarie Nelson, 7/10).

Des Moines Register: Iowa View: Wellmark Cash Pile Raises Questions
Wellmark Blue Cross and Blue Shield recently announced it will not increase rates for individuals and small businesses who agree to renew their business prior to Jan. 1, 2014. On the surface, this decision is welcome, short-term relief for the working families and small businesses that have been tightly squeezed by Wellmark’s recent string of double-digit rate increases (Matt McCoy, 7/10).

The Lund Report: Oregon Plan to Cut Diabetes Testing By 95%
Ask anyone with diabetes. Testing blood sugar levels is a pain. It takes time, fingers become sore and the levels change during the day based on diet, exercise and other factors. They tolerate that because it is important. Managing blood sugar levels is critical to managing diabetes (Judy Fry and Denise Cedar 7/10).

Des Moines Register: The Register’s Editorial: Change Surplus Law If Wellmark is Troubling
Wellmark Blue Cross and Blue Shield provides health insurance to about 2 million Iowans, two-thirds of the state’s population. Iowans can have confidence that the vast majority of their premiums are used to cover the cost of prescription drugs, hospital care, visits to physician offices and other health services for policyholders. But Iowans might be surprised to learn how the state’s largest health insurance company uses some of the money that doesn’t directly pay for health care (7/10).

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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.