Daily Health Policy Report

Thursday, July 12, 2012

Last updated: Thu, Jul 12

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Campaign 2012



Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospitals Finding Patients On Google, Facebook

Kaiser Health News staff writer Phil Galewitz, working in collaboration with The Philadelphia Inquirer, reports: "Penn is one of a small, but growing number of hospitals taking their advertising campaigns to Facebook, Google and other websites.  Fewer than 150 of the nation's 6,000 hospitals use Google and Facebook to market services, estimates Rob Grant, executive vice president of eVariant, a Simsbury, Ct.-based hospital consulting firm. He and other experts predict the numbers will rise as more see the value of highly targeted campaigns that enable them to track results" (Galewitz, 7/12). Read the story.

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How The SCOTUS Medicaid Ruling Could Save Money

Kaiser Health News staff writer Marilyn Werber Serafini, working in collaboration with Politico Pro, reports: "The Supreme Court ruling on the health care law could have an unexpected effect -- saving the federal government money, say some budget experts" (Werber Serafini, 7/11). Read the story.

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Firefighters Prevail In Fight For Health Insurance

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "It all started around a kitchen table in Custer, South Dakota. John Lauer, a 27-year-old seasonal firefighter for an elite U.S. Forest Service wildland fire team, sat down with some colleagues to write a petition" (Whitney, 7/11). Read the story.

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Capsules: Rockefeller, MedPAC: Focus Dual Eligibles Overhaul On Care Over Costs; Teaching Doctors About The Cost Of Care; Mass. Global Payment Approach Lowers Costs, Improves Care; Could Grass-Roots Pressure Trigger Change Of Heart In Texas?

Now on Kaiser Health News' blog, Mary Agnes Carey reports on efforts to overhaul a program for dual eligibiles: "In a letter to HHS, Rockefeller asked Secretary Kathleen Sebelius to 'take immediate steps to halt this initiative as currently structured and to take the time necessary to develop a well-designed and thoroughly evaluated care coordination model for dual eligibles that meets the standards outlined in the law'" (Carey, 7/12).  

Jenny Gold reports on efforts to educate doctors on the cost of care: "All new doctors take the Hippocratic Oath, promising to care for their patients to the best of their abilities. But what does that mean in terms of the cost of that care, when medical debt accounts for more than 60 percent of personal bankruptcies in the United States?" (Gold, 7/11).

Also on Capsules, David Schultz reports on a study of a global payment system in Massachusetts: "There's some encouraging news in the ongoing struggle to control health care costs without sacrificing quality. The Alternative Quality Contract, a global payment model put in place by Blue Cross Blue Shield of Massachusetts in 2009, has both curbed costs and improved the quality of care, according to a Harvard Medical School study published today in the journal Health Affairs" (Schultz, 7/11).

In addition, KUHF's Carrie Feibel, working in collaboration with Kaiser Health News and NPR, reports on Texas and the Medicaid expansion: "Health reform advocates and Democrats in Texas are reacting to Gov. Rick Perry's vow to turn down both the Medicaid expansion and health insurance exchange mandated in the federal health law" (Feibel, 7/11).

And, finally, Chrisitan Torres offers a report on how one public figure's family is benefitting from the health law: "Push aside that cup of coffee and check this out: TV personality and former House Republican Joe Scarborough revealed this morning that his 24-year-old son is among those benefiting from the health law" (Torres, 7/11). Check out what else is on the blog.

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House Debates Repeal Of Health Law (Video)

In these Kaiser Health News video excerpts, Rep. John Dingell offers Republicans his gavel from Medicare passage, and House Majority Leader Eric Cantor denounces "Washington-based care" (7/11). Watch the video.

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Political Cartoon: 'Repeal And …'


Kaiser Health News provides a fresh take on health policy developments with "Repeal And …" by John Darkow.

And it's a bonus day today for health policy haikus:


How many more votes
For repeal? Not as fun, but
This year's summer "pool."


What to do about 
Republican governors
With heads in the sand?
- Beau Carter

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

Republican-led House Votes (Again) To Repeal Health Law

The repeal effort is a means for Republican leaders to rev up voters before November's elections. Five Democrats also voted with the majority. As with previous efforts, however, the measure is expected to languish in the Democrat-controlled Senate.

The New York Times: Repeal Of Health Care Law Approved, Again, By House
Waging old battles with new zeal, the House passed a bill on Wednesday to repeal President Obama's health care overhaul law less than two weeks after the Supreme Court upheld it as constitutional (Pear, 7/11).

Los Angeles Times: House GOP Leads Passage Of Health Care Law Repeal
For the 33rd time, House Republicans steered passage of legislation taking aim at the nation's new healthcare law – this time in a largely symbolic vote to repeal it. The two-day floor debate was orchestrated by GOP leaders to rev up voters before the November election, tapping into the deep divisions that remain over the plan two years after President Obama's signature domestic achievement became law (Mascaro, 7/11).

The Wall Street Journal: GOP House Moves To Repeal Health Law In Symbolic Vote
The House voted on Wednesday to repeal President Barack Obama's health-care law, a symbolic act in the wake of the Supreme Court's recent ruling upholding the legislation.  The 244-185 vote was largely along party lines, with five Democrats joining all Republicans in voting to undo Mr. Obama's much-debated program. The vote allowed Republicans to reaffirm their opposition to the health-care law, but repeal has little chance of taking effect (Bendavid, 7/11).

USA Today: House Votes To Repeal Health Care Law
It was the 33rd vote to repeal the law or eliminate funding for its provisions since Republicans took control of the chamber last year. None of the GOP's efforts stood a chance of enactment because Democrats control the Senate and the White House, which issued a veto threat Monday on the GOP's repeal bill (Davis, 7/11).

The Associated Press: Slap To Obama: GOP House Votes To Kill Health Law
Pressing an election-year point, Republicans pushed yet another bill through the House on Wednesday to repeal the nation's two-year-old health care law, a maneuver that forced Democrats to choose between President Barack Obama's signature domestic achievement and a public that is persistently skeptical of its value. The vote was 244-185, with five Democratic defectors siding with Republicans (Espo, 7/12).

Bloomberg: U.S. House Again Votes to Repeal Obama's Health Care Law
The Republican-led U.S. House voted to repeal President Barack Obama’s health care law, demonstrating party leaders' resolve to undo the president's main domestic-policy achievement….The House won't pursue other major health-care legislation before the November election because "the big thing is going to be the election," Representative Wally Herger, a California Republican who leads the health subcommittee of the Ways and Means Committee, said in an interview (Tiron and Rowley, 7/12).

Reuters: House Votes To Repeal Obama Healthcare Law, Again
The Republican-led House of Representatives, on a near party-line vote of 244-185, on Wednesday once again passed a bill to repeal President Barack Obama's overhaul of the healthcare system. Just like previous House efforts to end the two-year-old healthcare law, the bill is certain to be stopped by Obama's fellow Democrats who control the Senate (Ferraro and Smith, 7/11).

NPR: House Votes to Repeal Health Care Law
With a vote of 244 to 185, the Republican-controlled House of Representatives just voted to repeal the Affordable Care Act, President Obama's signature domestic legislation known colloquially as "Obamacare" (Peralta, 7/11).

Kaiser Health News: House Debates Repeal Of Health Law (Video)
In advance of Wednesday's House vote to repeal the health law, Rep. John Dingell offers Republicans his gavel from Medicare passage, and House Majority Leader Eric Cantor denounces "Washington-based care" (7/11).

The Hill: House Votes 244-185 To Repeal Health Care
The House voted again Wednesday to repeal President Obama’s healthcare law, a largely symbolic gesture that gave Republicans some revenge against the Supreme Court ruling that declared the law constitutional. Republicans also see it as a way to motivate their base this fall as they fight to keep control of the lower chamber, win the Senate and take the White House. Members approved the repeal legislation on a 244-185 vote, after five hours of debate that stretched over two days. Five Democrats, most of them facing tough reelection bids, supported the repeal effort alongside the GOP, prompting the Republican National Committee (RNC) to declare the result "bipartisan" (Viebeck and Kasperowicz, 7/11).

NewsHour (Video): In Symbolic Vote, House Republicans Move To Repeal Health Care Law
Republicans in the House on Wednesday voted to overturn the health care reform law recently upheld by the Supreme Court. For an overview of where the controversy stands in the states -- where governors have ramped up support and opposition to the law -- Gwen Ifill speaks with reporters from Nevada, Texas and Washington, D.C (7/11).

ABC: House Obamacare Repeal: Thirty-Third Time's The Charm?
The House vote was largely along party lines, 244 – 185. Five House Democrats – all of whom also opposed the law when it passed in 2010 – crossed party lines to vote with the majority. No Republicans defected on the vote. The five Democrats voting for repeal hailed from red or purple states and included Rep. Dan Boren of Oklahoma, Reps. Mike McIntyre and Larry Kissell of North Carolina, Rep. Mike Ross of Arkansas, and Rep. Jim Matheson of Utah (Parkinson, 7/11).

MinnPost:  Minnesota Delegation Splits Along Party Line On Affordable Care Act Repeal
The Minnesota U.S. House delegation split on party lines on another vote to repeal the Affordable Care Act on Wednesday, nearly two weeks after the Supreme Court ruled the law constitutional.  The final tally was 244-185. Minnesota's four Republicans voted for the bill; its four Democrats voted against it. The delegation's votes were identical to the ones they took the last time the House tried repealing the whole law, back in January 2011 (Henry, 7/11).

Marketplace:  What Is The Cost Of A House Vote? (AUDIO)
Say this for Republicans in the House of Representatives, they're nothing if not determined. Today they held the 33rd vote in the past 18 months to repeal the health care law. It passed, like all the others before it, along -- yes -- party lines.  Going nowhere in the Senate, but it did occur to us that, there being no such thing as a free lunch, all this symbolic voting must actually cost something, right (Marshall-Genzer, 7/11)? 

News outlets also offer reports exploring the absence of "replace" plans and other strategies to undermine implementation of the law -

Politico: Still No GOP Plan To 'Replace'
Even as they cheer their "Obamacare" repeal vote, here's a reality check: House Republicans have done next to nothing they promised they would when it comes to health care. Sure, they've voted to kill parts of President Barack Obama's law more than 30 times, slashing funding, using the votes as red meat to rally the base — even squeezing some into law (Sherman and DoBias, 7/11).

Medscape:  Repeal Isn't Only Way To Block Health Law, Says House GOP
As expected, the Republican-controlled US House of Representatives voted today 244 to 185, mostly along party lines, to repeal the Affordable Care Act (ACA) — for the 31st time. And once again, President Barack Obama promised to veto the legislation repealing his landmark health law should it reach his desk, which is unlikely, given the Democrat-controlled Senate. However, Republicans have several other strategies available to delay or block implementation of the law.  Congress has already eliminated some individual provisions, including trimming subsidies for purchasing health insurance and cutting funds for the law's Prevention and Public Health Fund. So far, Congress has struck $52 billion from the law, Debbee Keller, a spokesperson for the House Committee on Ways and Means, told Medscape Medical News in a written statement (Jaffe, 7/11).

The Hill: Conservatives Tell GOP Leaders They Want Health Care Funding Fight This Year
Conservatives in the House are pushing GOP leaders to continue the campaign against President Obama's healthcare law even after Wednesday's vote to repeal the law. Reps. Jim Jordan (R-Ohio) and Michele Bachmann (R-Minn.) are gathering signatures this week for a letter asking GOP leaders to defund the healthcare law this year. "We appreciate your willingness to schedule a vote on the full repeal of ObamaCare," the letter states. "We should continue efforts to repeal the law in its entirety this year, next year, and until we are successful.  However, in the meantime, there is more we can do in Congress." Jordan chairs the Republican Study Committee, and Bachmann leads the House Tea Party Caucus (Baker, 7/11).

CT Mirror:  To Murphy, Republicans Have 'Fatal Attraction' To Health Care Act
Rep. Chris Murphy, D-5th District, compared the GOP's repeal campaign to the movie "Fatal Attraction," which featured Glenn Close as a scorned woman who ruthlessly pursues Michael Douglas and his movie family.  "Having now had 30 separate debates on this floor over repeal of the heath care bill ... House Republicans have finally hit their boil-the-bunny moment," Murphy said, a reference to Close's cruel dispatch of a family pet. "Americans want us to move on" (Radelat, 7/11).

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Health Reform

Governors Continue To Mull, Question Medicaid Expansion

It's likely to be a hot topic this weekend as the nation's governors meet in Williamsburg, Va.  

The Washington Post: Medicaid Expansion Likely To Dominate National Governors Association Meeting In Williamsburg
In the weeks since the Supreme Court ruling, several Republican governors opposed to the law have declared that they will opt out of its Medicaid expansion, which is set to take effect in 2014 and would cover those earning 133 percent or less of the federal poverty level (Felicia Sonmez, 7/11).

The Associated Press/Washington Post: Idaho Governor Otter Still Open To Exchange, Medicaid Expansion After Ruling, Will Study Both
Gov. C.L. "Butch" Otter isn't dismissing an insurance exchange or expanding Medicaid eligibility rules for his state because he doesn't want to cut off opportunities to make health care more affordable for Idaho residents. Otter said Tuesday he plans to study both options following the U.S. Supreme Court's decision to uphold President Barack Obama's health care overhaul (7/11).

Kaiser Health News: Could Grass-Roots Pressure Trigger Change Of Heart In Texas?
Health reform advocates and Democrats in Texas are reacting to Gov. Rick Perry's vow to turn down both the Medicaid expansion and health insurance exchange mandated in the federal health law (Feibel, 7/11).

Reuters: Nebraska Governor Says State Cannot Afford Medicaid Expansion
Nebraska Governor Dave Heineman said on Wednesday the state cannot afford the expansion of the Medicaid program under President Obama's healthcare law, but stopped short of saying whether the Midwestern state would join six others rejecting the expansion. Heineman, a Republican, said in a letter to senators Wednesday that the expansion would force Nebraska to cut funding for education (7/11).

The Washington Post: Connolly Urges McDonnell To Participate In Medicaid Expansion
U.S. Rep. Gerry Connolly is urging Gov. Bob McDonnell to avoid "a costly and historic mistake" by opting Virginia out of the federal health-care law's Medicaid expansion (Kumar, 7/11).

In related news -

The Associated Press/Washington Post: Lt. Gov. Kinder, GOP Lawmakers Challenge Ballot Summary For Missouri Health Insurance Measure
Missouri Lt. Gov. Peter Kinder and other top Republican legislative leaders filed a lawsuit Tuesday accusing the secretary of state’s office of writing a health care measure ballot summary that is "blatantly false, deceptive and intended to mislead the people." The Republican-controlled Legislature approved a statewide ballot measure for November that would ask voters whether Missouri officials should be barred from creating a health insurance exchange without approval from voters or the Legislature (7/11).

Meanwhile  -

Kaiser Health News: How The SCOTUS Medicaid Ruling Could Save Money
The Supreme Court ruling on the health care law could have an unexpected effect -- saving the federal government money, say some budget experts. The exact amount of savings is still unknown, because it depends on how many states decide not to expand their Medicaid programs, now that the court has said that they have a choice in the matter (Werber Serafini, 7/11).

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Campaign 2012

Romney Vow To Repeal Health Law Received With Boos

GOP presidential hopeful Mitt Romney was the target of boos after he told the NAACP that he'd repeal Obama's federal health law if he became president. The audience, however, applauded other parts of his speech.

The Wall Street Journal: NAACP Cool Toward Romney's Overtures
Republican White House hopeful Mitt Romney drew loud boos Wednesday when he pledged to repeal President Barack Obama's health law in a speech to the country's largest civil rights organization (O’Connor, 7/11).

Politico: Mitt At NAACP: Booed On Health Care
The Republican's call to repeal the health-care overhaul -- which forms a standard part of Romney's stump speech -- also drew loud cries that temporarily drowned out his speech, causing Romney’s reception by the group to veer from genial to borderline hostile (Summers, 7/11).

The Associated Press: Romney Faces NAACP, Booed For Hitting 'Obamacare'
The reception was occasionally rocky though generally polite as the Republican presidential candidate sought to woo a Democratic bloc that voted heavily for Obama four years ago and is certain to do so again. Romney was booed when he vowed to repeal "Obamacare" -- the Democrat's signature health care measure -- and the crowd interrupted him when he accused Obama of failing to spark a more robust economic recovery (Hunt, 7/11).

McClatchy Newspapers: As Mitt Romney Courts NAACP, Audience Boos Vow To Repeal Health Care Law
The overwhelmingly Democratic group roundly booed him, however, when he declared that he’d repeal the health care law. "I'm going to eliminate every nonessential, expensive program I can find; that includes Obamacare," Romney said to a long chorus of jeers. A woman in the back of the hall shouted, "You mean Romneycare" (Douglas and Lightman, 7/11).

Market Watch: Romney Booed At NAACP Conference Over Health Comments
Presumptive Republican presidential nominee Mitt Romney spoke before the heavily Democratic NAACP convention Wednesday and was met with lukewarm applause, and some boos. Romney didn't score any points when he went off script and vowed to repeal President Barack Obama’s health care overhaul law. The remark was met with sustained boos that reportedly lasted for roughly 10 seconds (Britt, 7/11).

Reuters: Romney Speech To NAACP Draws Boos, Raises Questions On Strategy
Appearing before the annual convention of the NAACP -- a group whose members are among Obama's strongest supporters -- Romney gave what amounted to his standard campaign pitch, emphasizing his ability to create jobs. Although several of his lines were greeted with applause, Romney drew waves of boos when he blasted Obama's record on jobs and the health care overhaul that was backed by the president and recently upheld as constitutional by the U.S. Supreme Court (Holland, 7/11).

In other campaign news, a race for Missouri attorney general is also focusing on the health law --

St. Louis Beacon: Martin Ad Promises New Legal Strategy To Upend Federal Health Care Law
Ed Martin, a Republican candidate for Missouri attorney general, has released his first television ad this week; it is a spot that focuses on his opposition to the federal health care law. Entitled "Minute," the 30-second ad features the St. Louis lawyer standing in what appears to be a hospital. Martin notes that "over 30 states filed lawsuits to stop Obamacare -- but not Missouri. Our attorney general sat it out," said Martin, referring to incumbent Democratic Attorney General Chris Koster. "I'm Ed Martin. During my first minute in office -- and I mean minute -- we’ll have a new legal strategy to stop Obamacare" (Rosenbaum, 7/11).

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GAO Questions Legality Of Medicare Advantage Bonuses

In a 10-page letter sent Wednesday to HHS Secretary Kathleen Sebelius, the Government Accountability Office's general counsel raised questions about the $8.3 billion demonstration program, which Republicans had criticized as a ruse to mask some of the health law's cuts in seniors' benefits. 

The Associated Press: Gov't Auditors Doubt Legality Of Medicare Bonuses
Government auditors Wednesday questioned the legality of a costly Medicare bonus program, escalating a running skirmish in the broader battle over President Barack Obama's health care law and its consequences for seniors. In a letter to the administration, Government Accountability Office General Counsel Lynn Gibson wrote that the nonpartisan agency remains concerned about Medicare's legal authority to undertake the $8.3 billion Medicare Advantage quality bonus program. Launched well after the overhaul passed, the bonus program effectively restored some of the cuts that the legislation made to popular private insurance plans within the giant health care program for seniors and disabled people (Alonso-Zaldivar, 7/11).

CQ HealthBeat: Congressional Watchdog Continues To Criticize Medicare Advantage Demonstration
The General Accountability Office is continuing to hammer away at the Obama administration's $8.35 billion Medicare Advantage demonstration program, this time in a 10-page letter Wednesday to Health and Human Services Secretary Kathleen Sebelius that questions her authority to create the pilot effort. Under the health care overhaul, the best-performing private Medicare health plans, called Medicare Advantage plans, were to receive bonuses. The idea was that these plans would have an incentive to get the highest performance rating: five stars. But administration officials decided that instead of relying on the health care law language, they would use their authority under Social Security to create a demonstration program that would give bonuses starting with average-performing plans that were rated at three stars (Bunis, 7/11).

Modern Healthcare: GAO Questions HHS Stance On Advantage Plan Bonus Program
Nonpartisan congressional auditors were not convinced by HHS' explanations that the department had any legal authority to launch its $8 billion pilot program of bonus payments to Medicare Advantage plans. Lynn Gibson, general counsel for the Government Accountability Office, wrote HHS Secretary Kathleen Sebelius on Wednesday that her department's responses to a January GAO report questioning the legal authority for the program failed to describe any legal basis. ... Republicans have long argued that the pilot program was simply a slush fund aimed at masking the health law's financial undercutting of the increasingly popular private Medicare Advantage plans until after President Barack Obama faced re-election (Daly, 7/11).

In other news related to the Medicare program -

CQ HealthBeat: Docs Tell Baucus Medicare Payments Should Move Toward Team-Based Care
Physician groups urged senators Wednesday to stabilize Medicare payments and launch a period of experimentation with new forms of reimbursement and health care delivery that involve close collaboration with patients and other providers. Senate Finance Chairman Max Baucus, under the gun to find payment offsets for legislation blocking a scheduled Jan. 1 payment cut of 27 percent, appeared to be thinking along similar lines after hearing from the groups at a morning round table the committee sponsored (Reichard,7/11). 

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WellPoint Deal Triggers Predictions Of More Medicaid M&As Activity

The Wall Street Journal's Deal Journal: Goldman Predicts More Medicaid-Tied M&A After WellPoint Deal
Investors were clearly thinking the same thing Monday, when the news sent shares of Amerigroup rivals Molina, Centene and WellCare soaring. Each remains up significantly this week, with Molina up 14 percent to $26.22; Centene up 19 percent to $34.41; and WellCare up 20 percent to $63.24 (Kamp, 7/11).

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Health Care Marketplace

The Changing Dynamics Of Doctors' Offices

The New York Times reports on how some physicians are dispensing drugs in their offices. Meanwhile, CNN Money explores the "demise" of the solo practitioner.

The New York Times: Insurers Pay Big Markups As Doctors Dispense Drugs
When a pharmacy sells the heartburn drug Zantac, each pill costs about 35 cents. But doctors dispensing it to patients in their offices have charged nearly 10 times that price, or $3.25 a pill (Meier and Thomas, 7/11).

CNN Money: Demise Of The Solo Doctor
The solo doctor is a vanishing breed. Squeezed by high costs and shrinking insurance reimbursements, independent doctors are closing up shop or going to work at hospitals or bigger group practices where they aren't directly responsible for overhead costs. Fresh insight on the trend came this week in a report from one of the country's largest physician recruiting firms. The finding: By 2014, two-thirds of the nation's nearly 1 million doctors will be employed by hospitals. As hospitals staff up, they are plucking off physicians who once ran independent practices but couldn't afford to stay in business, said Travis Singleton, senior vice president with Merritt Hawkins, a physician recruiting and consulting firm that did the survey (Kavilanz, 7/11).

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Study: Despite Popular Theory, Medicaid Patients Visit ER Mostly For Emergencies

Medicaid patients may not overuse the emergency room for routine care, despite popular notion, a new study has found.

The Washington Post: Study: Most Medicaid Patients Visit The ER For Urgent, Not Routine, Care
Policymakers frequently say that Medicaid patients overuse the emergency room for routine care, citing it as a factor driving up health care costs. But a new study says that the majority of Medicaid visits to the emergency room are for urgent or serious issues (Kliff, 7/11).

Reuters: Medicaid Patients Turn To Hospitals For Emergencies, Not Routine Care
Most people covered by government health insurance for the poor visit hospital emergency rooms for perceived emergencies, not for routine care, much like those with private insurance, according to a study released on Wednesday. Researchers said the study helps dispel the notion that poor patients are clogging hospitals for routine treatment -- for a bad cold, for example -- that others receive at lower cost in a clinic or at a doctor's office (Heavey, 7/11).

Modern Healthcare: Reforms Needed To Cut ER Costs: Report
The belief that Medicaid enrollees overuse hospital emergency departments for routine care may be overstated, but primary-care offices still may not be equipped to handle relatively minor but still urgent cases as quickly and effectively, according to a new report by the Center for Studying Health System Change. The report also suggested that hospitals may be exacerbating ED overuse problems by seeking to draw people into their departments with billboard advertising and electronic messages that highlight the departments' short wait times (Robeznieks, 7/11).

Other studies look at quality at community health centers, teaching doctors about the cost of care, and global payments and a Blue Cross spending reduction in Massachusetts --

Los Angeles Times: Study: Community Health Centers Sometimes Top Private Practices
Federally funded community health centers perform equal to or better than private practices on a number of quality-care measures, according to a new study. The results demonstrate that community health centers are capable of providing high-quality care to an often complex patient population (Bardin, 7/11).

Kaiser Health News: Teaching Doctors About The Cost Of Care
All new doctors take the Hippocratic Oath, promising to care for their patients to the best of their abilities. But what does that mean in terms of the cost of that care, when medical debt accounts for more than 60 percent of personal bankruptcies in the United States (Gold, 7/11)?

Kaiser Health News: Mass. Global Payment Approach Lowers Costs, Improves Care
There's some encouraging news in the ongoing struggle to control health care costs without sacrificing quality. The Alternative Quality Contract, a global payment model put in place by Blue Cross Blue Shield of Massachusetts in 2009, has both curbed costs and improved the quality of care, according to a Harvard Medical School study published today in the journal Health Affairs (Schultz, 7/11).

Boston Globe: Blue Cross Plan Shows Reduction In Spending
The largest private-sector effort to tame medical spending in Massachusetts appears to be getting results, as doctors who agreed to work on a budget have cut costs by using less-expensive imaging and lab companies and expanding office hours to reduce emergency room use. Health spending for patients treated through Blue Cross Blue Shield of Massachusetts’ pioneering global-payment program grew more slowly in 2010 than for patients whose physicians were paid the traditional way — receiving a separate fee for every office visit, test, and procedure. At the same time, the 4,800 doctors in the program scored higher on measures of quality of care, according to research published Wednesday (Kowalczyk, 7/11).

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State Watch

Medicaid News: Federal Officials Question Drop In Pa.'s Rolls

In Pennsylvania, the federal government is checking into why 130,000 people were removed from the Medicaid program.

Philadelphia Inquirer: Federal Agency Asking About The Sharp Drop In Pa.'s Medicaid Rolls
Pennsylvania has dropped tens of thousands of people from its Medicaid rolls since last summer -- and now the Obama administration wants to know if the state wrongly cut off those benefits. The federal agency that oversees how states administer Medicaid sent a letter last month to the Department of Public Welfare saying initial data showed 130,000 people, including 89,000 children, had been dropped from state Medicaid rolls between August and January. Those people were dropped, noted the federal Centers for Medicare and Medicaid Services, when DPW was struggling with a backlog, leaving it unable to sort through all the information people had submitted in efforts to qualify for the benefit (Couloumbis, 7/12).

The Associated Press/Houston Chronicle: LePage Sharpens Medicaid Attack Against Pingree
[Maine] Gov. Paul LePage sharpened his attack on U.S. Rep. Chellie Pingree over Medicaid cuts on Wednesday, suggesting Pingree is part of the "jet-setting Washington culture that keeps people dependent on government handouts." The Republican governor was angered when he learned Pingree, a Democrat, had urged Health and Human Services Secretary Kathleen Sebelius to reject Medicaid cuts approved by the legislature that will eliminate coverage for more than 20,000 Mainers. LePage contends the cuts are legal because the Supreme Court decision that upheld President Barack Obama's federal health care overhaul limited congressional power to expand Medicaid (Sharp, 7/11).

Meanwhile, California outlets look at several aspects of Medicaid there.

Contra Costa Times/McClatchy Newspapers: Medi-Cal Compensation Inadequate, Doctors Say, As Enrollment Boom Looms
As California gears up for a major expansion of Medi-Cal under national health reform, such compensation is leading to a critical concern: Will enough physicians be willing to see the influx of new patients? Many doctors now refuse to accept Medi-Cal patients or sharply limit the number they see because of what they describe as extremely low reimbursement rates. As a result, patients report difficulty getting timely care, a problem the expansion could worsen (Kleffman, 7/11).

San Francisco Chronicle: Hospitals See Pros And Cons To Health Care Law
Hospital administrators in the state said they largely support the federal health care reform legislation upheld by the Supreme Court last month, but many are apprehensive about major pieces of the law, including the possible expansion of the state's Medicaid program. … Locally, hospital executives said they've been preparing for the onset of the reforms, mainly through administrative changes, such as moving to electronic medical records expected to streamline the health care process. But most added that there are significant unanswered questions about how health care reform will affect their business and the patients they serve (Cuda, 7/11).

California Healthline: Rural Clinics Hope DHCS Email Will Turn Tide In Medi-Cal Benefits Lawsuit
The Department of Health Care Services has been accused of withholding information in a court case -- information that has the potential to change the reimbursement status of rural health centers and federally qualified health centers in California, according to court documents filed Monday in the U.S. Court of Appeals Ninth Circuit by the California Association of Rural Health Clinics. Officials from DHCS could not comment on the lawsuit, according to Norman Williams, deputy director of public affairs for DHCS (Gorn, 7/12).

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Judge Keeps Injunction Against Miss. Abortion Law In Place

A federal judge continued to block a Mississippi law that could close the state's last abortion clinic, while he considers more evidence.

The New York Times: Judge Maintains Injunction Against Mississippi Law On Abortion Clinics
Lawyers debated before a federal judge on Wednesday whether a new law governing abortion clinics in Mississippi should remain blocked or go into effect and thus set in motion a process that could lead to the closing of the state's lone abortion clinic (Robertson, 7/11).

The Associated Press: Judge Continues To Block Mississippi Abortion Law
A federal judge on Wednesday continued to block a state law that threatens to shut down Mississippi's only abortion clinic and make it nearly impossible for women to get the procedure in the state. U.S. District Judge Daniel P. Jordan III temporarily blocked the law July 1 and extended that order Wednesday, though he did not say when he would rule on the clinic's request for a preliminary injunction that would put the law on hold for a longer period. If he grants that request, the case eventually would go to trial (Pettus, 7/12).

Bloomberg: 'Abortion Queen' in Last-Ditch Battle to Save Mississippi Clinic
Diane Derzis carries a Taser, a Smith and Wesson and a nickname: "abortion queen." "It doesn't in any way injure my self-confidence," said Derzis, who owns Mississippi's last abortion clinic and three others in the U.S. South. "I kind of like being the queen."… Derzis, 58, and her lawyers are trying to prevent the state from becoming the first with no abortion clinic, and argued in U.S. District Court yesterday that the requirement is unconstitutional because it will effectively ban the procedure (Deprez, 7/12).

Reuters: Judge Extends Halt To New Mississippi Abortion Law
A federal judge on Wednesday extended a temporary restraining order blocking Mississippi from enforcing a new state law that tightens requirements on abortion clinics, saying he wanted time to review how the law will be applied. The new law, which took effect on July 1, has threatened to close the state's last abortion clinic and make Mississippi the only U.S. state without such a facility (Le Coz, 7/11).

Unplanned pregnancies in Texas and Planned Parenthoods in Kansas and Iowa make news --

Texas Tribune: (VIDEO) The Price Of Unplanned Pregnancies In Texas
What happens when family planning is out of reach for poor and uninsured Texans? In the final segment of our Fertile Ground series, we explore the costs to communities and taxpayers of the state's high rate of unplanned pregnancies (Tan, 7/12).

AP/Kansas City Star: New Problem Arises In Johnson County's Planned Parenthood Case
Johnson County’s top prosecutor acknowledged in court Wednesday that he’s facing a new problem in pursuing a criminal case against a Planned Parenthood clinic in the Kansas City area. District Attorney Steve Howe said his office is trying to replace an expert witness retained to support 58 misdemeanor criminal charges alleging that the clinic in Overland Park performed illegal abortions in 2003. Howe said the witness, an out-of-state physician and medical school professor of obstetrics and gynecology, is too ill to serve as a witness (Hanna, 6/11).

Des Moines Register: Planned Parenthood Reiterates Opposition To Proposed Rule Change On State Funding For Abortion
Planned Parenthood of the Heartland on Wednesday again argued that a proposed rule change barring state government-paid abortions would violate federal law and endanger millions or even billions in funding for medical care. The comments from the family-planning organization came during a meeting this morning of the Council on Human Services, the board within the Iowa Department of Human Services that will decide whether to take action on a petition for the rule change filed by Republican lawmakers (Noble, 7/11).

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State Roundup: Bankrupt Calif. City's Retirees Sue

News outlets examine health issues in California, Connecticut, Florida, Kansas, Massachusetts, Missouri, New Mexico and Oregon.

Los Angeles Times: Stockton Retirees Sue To Stop City From Cutting Health Benefits
A group of Stockton retirees has filed suit in U.S. Bankruptcy Court in Sacramento asking for a restraining order against the city's moves to cut their health benefits. The city informed retirees by letter that they must pay their premiums by July 30 or "medical coverage will be canceled retroactive to July 1." The move is part of the city's "pendency plan" aimed at keeping it solvent while it seeks protections from creditors under federal bankruptcy law (Marcum, 7/12).

Boston Globe: State Officials Say New Law Has Saved More Than $175M In Health Insurance
Massachusetts officials said Wednesday that a new law ­designed to help municipalities and school districts reduce their health insurance costs has saved more than $175 million in premium costs for 127 municipalities and districts. Administration and Finance Secretary Jay Gonzalez said the law, which was intended to "modernize benefit plan ­design' at the municipal level, was the result of "all stakeholders acknowledging the fact that high costs were crushing munic­ipalities at the expense of services and jobs and that we needed a solution" (Finucane, 7/11).

Health Policy Solutions (a Colo. news service): Doctors, Patient Challenge New Mexico Assisted Suicide Ban
The question before the court in New Mexico is absurdly simple and yet impossibly complex. What is the meaning of "assisting suicide"? … Two oncologists from the University of New Mexico Health Science Center and a patient with advanced cancer are the plaintiffs in a lawsuit filed in New Mexico District Court designed to clarify the legal definition of assisting suicide. That decision, likely to come in the next year, could send reverberations through the medical establishment in the Rocky Mountain West and across the country. Morris v. New Mexico contends that the statute outlawing "assisting suicide" (NM Statute 30-2-4) never was intended to apply to physicians treating patients in the late stages of terminal illnesses (Carman, 7/11).

Medpage Today: Take Docs Out Of Assisted Suicide Equation?
A federal/state, highly regulated mechanism should be created so that terminal patients can obtain a lethal dose of medication with which to end their lives if they so choose, suggest Lisa Soleymani Lehmann, MD, PhD, and Julian Prokopetz, of Brigham and Women's Hospital in Boston. That would free doctors from direct involvement in such cases, they argued in a Perspective piece in the July 12 issue of the New England Journal of Medicine. In the U.S., assisted suicide is illegal in all states except Oregon, but there is a trend toward "greater social and legal acceptance," the authors wrote (Walker, 7/11).

Health News Florida: Contract Switch Brings More Delay
Florida Health Choices, which is building an insurance website for small employers, has switched contractors after accusing the first one of lax security and outsourcing some work to China. Created in 2008, the state-authorized non-profit was supposed to have the exchange in operation last summer. Now the board and staff hope it will be up by January 2013 (Jordan Sexton, 7/12).

CT Mirror:  Health Exchange Panel Struggles To Balance Need Vs. Cost In 'Benchmark' Plan
The panel working to create the state's first health exchange received a crucial recommendation Wednesday: Don't make the insurance plans so affordable that they don't cover essential patient needs.  A working group of the exchange's board of directors recommended unanimously Wednesday that it establish a health benefits "benchmark" -- the minimum levels of coverage plans in the exchange must provide -- based on ConnectiCare's HMO plan (Phaneuf, 7/11).

St. Louis Beacon:  Highest Percentage Of Missouri's Uninsured Reside In Rural Counties
Most Missouri counties with the highest percentage of uninsured residents are concentrated in two congressional districts -- the 6th in the northern part of the state and the 8th in southeast Missouri, according to data in a new report. The study does not break down the number of uninsured Missourians by congressional districts. But that is one way to look at the issue as federal lawmakers decide whether to try to reverse all or parts of the health reform law that will give most people access to health insurance by 2014 (Joiner, 7/11).

The Lund Report:  Providence Health Plans Asks For 15.7 Percent Increase
Providence Health Plans is seeking a 15.7 percent average increase for people who purchase their own coverage starting November 1. If approved, 12,162 Oregonians would be impacted. The actual rate increase depends upon a person’s age and whether their family members are on their insurance plan. …Providence contends this rate request is justified because of increased healthcare costs and increased utilization (Lund-Muzinkant, 7/11).

Kansas Health Institute News: KHIE Board Presented With Proposal To Dissolve The Organization By August 
For seven years, members of the Kansas Health Information Exchange board have worked to form the public-private entity KHIE, Inc., which now regulates the exchange of digital health records in the state. Today, board members were presented with a proposal to dissolve KHIE, Inc., by August and hand over the board's regulatory authority to the Kansas Department of Health and Environment. The proposal comes on the cusp of digital health information exchange going live in Kansas, which officials have said would begin next week (Cauthon, 7/11).

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Weekend Reading

Longer Looks: Keeping Parkinson's A Secret

Every week, KHN reporter Shefali S. Kulkarni selects interesting reading from around the Web.

The New York Times: Keeping Parkinson's Disease A Secret
When Nancy Mulhearn learned she had Parkinson’s disease seven years ago, she kept the diagnosis mostly to herself, hiding it from friends, colleagues -- even, at first, her mother, sister and teenage children. After seven months, she decided she had to tell her family, and they settled into an unspoken agreement not to talk about the disease. ... "I didn’t want anybody to feel sorry for me," she said. "To have people look at you and start crying -- that’s not what anyone wants." In that, Ms. Mulhearn is hardly alone. Doctors and researchers say it’s not uncommon for people with Parkinson’s to conceal their diagnoses, often for years. But the secrecy is not just stressful to maintain; experts fear that it also may be slowing down the research needed to find new treatments  (Katie Yandell, 7/9).

Slate: Dr. Drew Cashes In
If you've ever seen Dr. Drew Pinsky on TV, you've seen the look: lips pursed, eyes narrowed, head slightly tilted to stage right. It's an expression that seems practiced in front of a mirror, designed to dispense to his troubled patients precisely the right dosage of compassion tinged with disapproval -- but, instead, it makes him look like his mind is somewhere else, off golfing or figuring out where his next paycheck is going to come from. Thanks to the Justice Department, we now know of a Dr. Drew payday large enough to trigger a reverie or two. As part of its monstrous $3 billion settlement with the pharmaceutical giant GlaxoSmithKline (GSK), the DOJ unsealed documents showing that the dear doctor had taken in at least $275,000 for "services for Wellbutrin." ... According to the government's complaint, Dr. Drew was hired to "deliver messages about [Wellbutrin SR] in settings where it did not appear that Dr. Pinsky was speaking for GSK." After Pinsky suggested that Wellbutrin might be responsible for increasing a woman's orgasm rate -- to as many as 60 orgasms in a good night -- an internal GSK memo noted approvingly that Dr. Drew had "communicated key campaign messages" about Wellbutrin to the public (Charles Seife, 7/9).

The Economist: A Sweet Idea
Like any other electrical device, a pacemaker needs a power source. Since the first permanent pacemaker was installed in 1958, manufacturers of implantable medical devices (IMDs) have tinkered with many different ways of supplying electricity to their products. A variety of chemical batteries have been tried, as well as inductive recharging schemes and even plutonium power cells that convert the heat from radioactive decay into electricity. ... Today, non-rechargeable lithium-based batteries are common. Used in many cardiological and neurological implants, they provide between seven and ten years of life. ... But that has not dissuaded researchers from continuing to seek perfection, in the form of a compact, perpetual energy source which does not require external recharging. Now, several researchers are closing in on just such a solution using glucose, a type of sugar that is the main energy source for all cells in the body (6/30).

The Journal Of The American Medical Association: Learning To Talk
The more doctor-speak becomes second nature to us, the more it can distance us from our patients. It is easy to lose sight of the possibility that even the most basic medical words may be jibberish to our patients. ... I recently caught myself launching into a monologue from the door in the emergency department about precautions to take and what to expect after a concussion to a 22-year-old patient. I paused, examined his frightened face, and then asked if he knew what a concussion was -- he hesitated, then shyly shook his head no. I sat down by his bed, started over, and walked him through it. I felt like I had made a connection (Dr. Alison Landrey, 7/11).

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Editorials and Opinions

Viewpoints: Rick Perry Says Obama Is Selling A 'Broken' Medicaid System; House GOP Assailed For 'Foolish' Repeat Of Repeal Vote

USA Today: Editorial: Your Health Care Vs. Your Governor
Not so meaningless, however, are recent decisions of several states to resist what ought to be some of the less controversial aspects of ObamaCare. They're refusing to set up easy-to-use exchanges that would help residents make insurance choices. And they're turning down a Medicaid expansion, which will deny insurance to millions who can't afford coverage and shift the cost of their care to people who have it (7/11).

USA Today: ObamaCare A Bad Deal For The States
Setting aside the brazen intrusion into state sovereignty and the gross federal overreach, the practical problem with ObamaCare's Medicaid expansion is that the product the administration is selling is broken. State and federal budgets are simply unable to handle an expansion of this magnitude (Texas Gov. Rick Perry, 7/11).

The Atlanta Journal-Constitution: Medicaid Expansion Is A Bad Deal For Georgians
The salient number here is not $35 billion, which is the estimated amount Washington would chip in toward Georgia's Medicaid expansion between 2014 and 2023. It's $4.5 billion, the minimum amount this move would cost Georgia taxpayers in those years…. Even if state lawmakers were inclined to spend an extra billion or two on health care, they'd be wise to avoid the golden handcuffs of a Medicaid expansion (Kyle Wingfield, 7/12).

Des Moines Register: Government's Authority To Coerce Will Not End With Obamacare
The court did, however, invalidate the part of the Obamacare's Medicaid expansion that would have taken away current Medicaid funding (a figurative "gun to the head," in the words of the court) from states that did not follow Obamacare’s order to dramatically increase their Medicaid programs. ... This expansion would cost states billions and would further crowd out other important state priorities, such as education, transportation and public safety, all in the name of throwing millions into a failing, unsustainable Medicaid system (Rep. Steve King, 7/11).

Los Angeles Times: In His Heart, Romney Cares About Blacks, Healthcare. Really.
And now, a lesson in political-speak: being specific vs. being silly. Republican presidential nominee-to-be Mitt Romney told the NAACP that he has the "best interest" of Americans at heart and that blacks in particular should vote for him. ... it's apparently impossible for him to communicate why he believes he's the best man for African Americans. But if it were, Romney said, black people would vote for him. Apparently they'll just have to trust him on that score (David Lazarus, 7/11).

The Washington Post: Republicans Vote to Repeal Medicare Cuts They Voted For And Are Campaigning Against
Just now, the House voted, one more time, to repeal the Affordable Care Act, by an almost straight-line party vote of 244-185, with every Republican voting for "full repeal" and all but five Democrats voting against it. ... a parade of Republicans went to the House floor today bashing Barack Obama, the Democrats, and the health law for cutting $500 billion from Medicare — one of their central attacks on Dems for two straight cycles now — despite supporting those very same cuts in their own budget, the Paul Ryan plan (Jonathan Bernstein, 7/11).

The Wall Street Journal: No One Would Miss ObamaCare, But The Window For Repeal Is Two Years
President Obama has repeatedly warned that Americans will be hurt if part or all of the legislation is rolled back. "People's lives are affected by the lack of availability of health care," Mr. Obama has told reporters, "the inaffordability of health care, their inability to get health care because of pre-existing conditions." In fact, very few people would be hurt if part or all of the law is repealed, and millions of them would be helped (Merrill Matthews, 7/11).

McClatchy Newspapers: Dogged Effort To Repeal Health Care Law Misses The Big Picture
The ink on the Supreme Court decision affirming the Affordable Care Act isn't yet dry, but Republican leaders in the House this week will vote on a measure to scrap the law. We write this as a lifelong Democrat and Republican. We are nurses first, and we know that good health care isn't about politics and profits. The partisan bickering that pollutes our political system has no place in our hospitals and clinics. Our patients simply cannot afford any more delays when it comes to affordable care and protections from the worst of insurance company abuses (Margie Forest and Bonnie Chappell, 7/11).

Baltimore Sun: House Foolish To Vote Against Health Care Reform
Next time the more bombastic in Washington rail against government waste, let them include every cent lost to Wednesday's dog and pony show in the House of Representatives, where time that might have been used constructively was frittered away with yet another attack on health care reform. For those who might have accidentally tuned into C-Span shortly before 1:30 p.m., that was not a repeat but an actual live telecast. For the 33rd time since the Patient Protection and Affordable Care Act was passed in 2010, the House held a vote to repeal part or all of it (7/11).

Denver Post: Pay Me Now, Pay Me Later
This is the fundamental difference, I think, between the American approach to health care and the European one. Europeans regard health care as a right. Americans, especially those in the middle class, see it almost as a privilege, less essential perhaps than a car (Eva Syrovy, 7/12).

Houston Chronicle: First We Should Decide If Health Care Is A Right
Since the 2008 election campaign, the United States has not engaged in a debate about health care at all. We have engaged in a debate about how to pay for health care, particularly the health care consumed by those without health insurance…. How to pay for health insurance is the second debate we should have. The first debate is whether or not health care is a right of the citizenry of this country (Dr. Leonard A. Zwelling, 7/11).

Journal of the American Medical Association: Physicians' First Amendment Rights To Discuss Firearms With Patients Upheld In Florida
Although the Supreme Court has moved further in recent years in affirming the right to bear firearms, physicians who discuss firearm safety with their patients do not detract from the patients' right to possess firearms allowable under state law. Patients are free to accept or reject physician advice, but they attend a medical consultation precisely to receive objective information about their health and safety (Lawrence Gostin, 7/11).

CNN: Mississippi's End Run Around Abortion
It's possible (the Mississippi) legislature has cannily unlocked a way to make abortion illegal without having to overturn Roe v. Wade. The state has instituted a series of unreasonable regulations for doctors who perform abortions. Using a practice very similar to the kind of bottlenecking that was done to suppress black votes during the Jim Crow era, Mississippi has systematically squeezed the number of abortion clinics in the state down to just one. And if a federal court ultimately finds its new regulations constitutional, that one will be gone too (LZ Granderson, 7/12).

Health Policy Solutions (a Colo. news service): How Hot-Spotting Stops 'Bedbugs' And Other Social Ills
There are numerous social "bedbugs" just outside the health care sector that negatively impact individuals' health. In more abstract terms, these factors are known as the "social determinants of health" – the economic, environmental, behavioral and social conditions that influence individual and group differences in health status. Collectively, they are the circumstances in which people are born, grow up, live, work and age (Dr. Mark Wallace, 7/11).

San Francisco Chronicle: State Must Address Adult-Care Issues
Naturally, those people who found themselves no longer eligible for [Community-Based Adult Services] want a fair explanation of why this is the case. Unfortunately, the process for ruling people eligible has been contentious and confusing…. One of the ultimate solutions might be to revisit the eligibility requirements. But in the meantime, the state needs to abide by the criteria to which it agreed (7/11)

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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.