Daily Health Policy Report

Friday, July 12, 2013

Last updated: Fri, Jul 12

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

State Watch

Public Health & Education

Coverage & Access

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Connecting Minnesota’s Latino Community To Health Care

Minnesota Public Radio's Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "When Samuel Alcocer arrived at the reception desk of a North Minneapolis clinic with a swollen cheek in 1996, he was desperate for relief. One of his wisdom teeth had erupted into a throbbing, painful ache. At the time, Alcocer, a native of Santa Cruz in the Mexican state of Guanajuato, spoke no English. No one at the clinic spoke Spanish. ... Seventeen years later, Alcocer helps to make sure others don't have a similar experience, working as a Spanish interpreter at the same clinic in Minneapolis. ... [Latinos] are a big part of the state’s uninsured population. One in eight Minnesota Latinos lacks health insurance" (Stawicki, 7/12). Read the story

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Capsules: Can Humor Sell Health Insurance?; Republicans Ready To Try Obamacare Repeal – Again And Again

Now on the Kaiser Health News blog, Sarah Varney, working in collaboration with NPR's Planet Money, questions James Percelay, a New York marketing expert, about the challenges that health insurers will have getting people to sign up for coverage on the new online marketplaces: "When the Affordable Care Act's health insurance exchanges open for business in the fall, it will be a new game. Customers will be able to comparison shop in the new online marketplaces, and health insurers will have to sell themselves to the general public in a way they haven't before. The law's requirement that almost everyone buy insurance sounds like a marketer's dream – captive shoppers directed by the government to buy your product. But when the product is health insurance, there are undoubtedly some pitfalls: Customers may not love your brand. In fact, they may despise you. You doubled, tripled, quadrupled their premiums. You denied them coverage because of a pre-existing condition just when they needed you most" (Varney, 7/12).

Also, Mary Agnes Carey reports on the House GOP leadership's plan for more votes against the health law next week: "The House will vote next week on measures to delay the 2010 health law’s individual and employer mandates, House Speaker John Boehner said Thursday. The votes would be the 38th and 39th time House Republicans have voted to repeal all or part of the law. Congressional Republicans saw a new opportunity to kill or weaken President Obama’s signature policy achievement last week. That was when administration officials announced that the law’s requirement that employers with 50 or more workers offer insurance in 2014 or pay a fine had been postponed for one year" (Carey, 7/11). Check out what else is on the blog

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Political Cartoon: 'Government Surveillance?'

Kaiser Health News provides a fresh take on health policy developments with "Government Surveillance?" By Nick Anderson, Houston Chronicle.

Meanwhile, here is today's health policy haiku:


Like the proverb says:
If at first you don't succeed --
Aw, geez, not again!


If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Upcoming House Votes Part Of GOP Assault On Health Law

Bloomberg: House To Vote To Repeal Individual Health-Care Mandate
House Speaker John Boehner said the chamber will vote next week to delay the 2010 health-care law's requirement that most Americans carry health insurance. At his weekly news conference today, the speaker said it's not fair for President Barack Obama's administration to keep that provision in effect while postponing enforcement of the requirement that businesses provide their workers with insurance (Hunter, 7/11).

Kaiser Health News: Republicans Ready To Try Obamacare Repeal – Again And Again
The votes would be the 38th and 39th time House Republicans have voted to repeal all or part of the law. Congressional Republicans saw a new opportunity to kill or weaken President Obama’s signature policy achievement last week. That was when administration officials announced that the law’s requirement that employers with 50 or more workers offer insurance in 2014 or pay a fine had been postponed for one year ... Administration officials and proponents of the law say the delay will cause few people to go without coverage because most businesses with 50 or more workers already provide health coverage to employees (Carey, 7/11).

National Journal: Beohner Capitalizes On White House Obamacare Delay
Boehner's idea now is to run one bill that would enshrine into law the employer-mandate delay, forcing Democrats to publicly acknowledge the implementation problem or side against the White House in its delay decision. The second bill would go further than the White House did by also delaying the individual mandate for a year (Frates, 7/11).

Politico: Marco Rubio: Defund Obamacare Or No Spending Deal
Sen. Marco Rubio pledged Thursday that he won't vote for a short-term spending bill to keep the government open unless it defunds the Affordable Care Act. "I will not vote for a continuing resolution unless it defunds Obamacare," the Florida Republican said at a breakfast hosted by The Weekly Standard and Concerned Veterans for America. He called on his fellow senators to do the same. ... The spending showdown is likely to hit around the time that enrollment in the Obamacare health insurance exchanges start in October (Cunningham, 7/11).

National Journal: Obamacare Delay? What Obamacare Delay?
The employer mandate was one of many ancillary provisions—not critical to Obamacare’s central mission—that the administration has jettisoned in its race to build the exchanges in time. But signing people up for new insurance plans and giving them tax credits to do so is the main idea. It will take a major calamity for the administration to delay this crucial piece of the law (Sanger-Katz, 7/12).

CQ HealthBeat: A Health Law Change Dozens Of House Democrats Back: Slowing Down DSH Cuts
Hospitals are stepping up their pleas to lawmakers to delay cuts in a type of payment that framers of the health law thought would become less necessary as more uninsured Americans get health coverage. At issue are so-called "DSH payments." The term refers to Medicare and Medicaid payments to facilities that policy wonks call "Disproportionate Share Hospitals" (Reichard, 7/12).

Politico: FreedomWorks Says Burn Obamacare Cards
FreedomWorks launched a campaign Thursday to rebrand the health care law — and the requirement that most Americans obtain insurance or face a penalty — as a military-style draft. And it's asking resisters to burn their "Obamacare draft cards." Never mind the fact that there are no such thing as Obamacare cards (Cheney, 7/11). 

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Rollout Resembles Some Of The Problems Of Medicare Part D

NPR examines how the implementation of that last big government health program might offer lessons for the health law. Also, two stories explore outreach to people needing insurance, and the grocery chain Wegmans reportedly is cutting health benefits to part-time workers.

NPR: Messy Rollout Of Health Law Echoes Medicare Drug Expansion
It hasn't been a good week for the Affordable Care Act. After announcements by the administration of several delays of key portions of the law, Republicans returned to Capitol Hill and began piling on. "This law is literally just unraveling before our eyes," said Rep. Paul Ryan, R-Wis., at a hearing of the House Ways and Means Committee. ... [But] "About this time in 2005, the percentage of people who had an unfavorable opinion of the law was actually higher than those who had a favorable opinion," says Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute (Rovner, 7/12).

The Associated Press: Q&A: Latest Health Law Fight: Battle Of Mandates
The battle of the mandates is the latest clash in the long-running political fight over health care — a fight that's far from over. Under President Barack Obama's big overhaul, most people will be required to have insurance starting next Jan. 1, and larger businesses were supposed to offer affordable health care to their employees who average 30 hours of work a week. Here are some questions and answers in the aftermath of the administration's sudden delay of the employer mandate. ... Most people are unaffected because they already have coverage (Alonso-Zaldivar, 7/12).

Related, earlier KHN story: FAQ: What Workers And Employers Need To Know About The Postponed Employer Mandate (7/3)

The Hill: Wegmans Grocery Chain Cuts Healthcare For Part-Time Workers
The Wegmans supermarket chain has stopped offering health insurance to its part-time employees, according to a report in The Buffalo News. The popular chain had previously offered coverage to employees who worked at least 20 hours per week. But the company has dropped that benefit, citing President Obama's healthcare law, employees told the News. The healthcare law requires large employers to offer insurance to all employees who work more than 30 hours per week. The Obama administration announced last week that it would not enforce the requirement until 2015 (Baker, 7/11).

Kaiser Health News: Connecting Minnesota's Latino Community To Health Care
When Samuel Alcocer arrived at the reception desk of a North Minneapolis clinic with a swollen cheek in 1996, he was desperate for relief. One of his wisdom teeth had erupted into a throbbing, painful ache. At the time, Alcocer, a native of Santa Cruz in the Mexican state of Guanajuato, spoke no English. No one at the clinic spoke Spanish. ... [Latinos] are a big part of the state’s uninsured population. One in eight Minnesota Latinos lacks health insurance (Stawicki, 7/12).

Kaiser Health News: Can Humor Sell Health Insurance?
The law's requirement that almost everyone buy insurance sounds like a marketer's dream – captive shoppers directed by the government to buy your product. But when the product is health insurance, there are undoubtedly some pitfalls: Customers may not love your brand. In fact, they may despise you. ... It’s the perfect moment, says [James Percelay, the co-founder of the viral marketing firm Thinkmodo], for a little humor (Varney, 7/12).

Other news outlets reported on several other issues dealing with the law --

St. Louis Beacon: Obama, Congress Shifting Billions From Public Health Initiatives To Other Programs
An ounce of prevention may be worth a pound of cure, but finding money for prevention can be elusive when it comes to health care. Case in point is what is happening with the federal health reform law. Unprecedented spending to prevent illness and improve public health is one key promise of the Affordable Care Act. ... But typical of the roller-coaster history of ACA, some of the money for this part of the program is being shifted, raising concerns that public health spending will be undermined in future years (Joiner, 7/11).

CNN Money: Computer Glitch Causes Latest Obamacare Delay
An Obamacare computer glitch could limit penalties for most smokers -- but at the same time raise insurance costs for younger tobacco users. It's the latest delay in the implementation of the Affordable Care Act, which largely goes into effect in 2014. According to Obamacare rules, insurers that offer plans on the new exchanges are prohibited from denying insurance to those with a preexisting condition. But they are allowed to charge more based on age and tobacco use (Pagliery, 7/12).

The Hill: Analysis: HHS Is No. 1 In Violations Of Anti-Paperwork Law
The American Action Forum (AAF) found that the Health and Human Services Department has violated the anti-paperwork statute more than any other department in the past three years. ... "HHS lacked the legal authority to compel the collection of information, but still imposed the paperwork," the conservative think tank's analysis said (Baker, 7/11).

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Federal Appeals Court Upholds Health Law's Employer Mandate

A panel of the 4th Circuit threw out a lawsuit from Liberty University that challenged both the law's requirement of large employers to provide insurance for workers and the administration's contraception coverage requirement.

Politico: Appeals Court Tosses Liberty University Challenge To Obamacare
A federal appeals court on Thursday tossed the Liberty University lawsuit that challenged both the Obamacare employer mandate and its contraception coverage requirements. A three-judge panel of the Fourth Circuit Court of Appeals ruled that the employer mandate, which the Obama administration last week postponed until 2015, is constitutional. The panel rejected the contraception challenge on a technicality -- not on the merits -- because Liberty did not include that aspect in its first court filings in 2010 and a lower court never heard it (Haberkorn, 7/11).

The Wall Street Journal: Appeals Court Upholds Obamacare's Employer Mandate
The U.S. Court of Appeals for the Fourth Circuit in Virginia said the plaintiff, Rev. Jerry Falwell's Liberty University, had legal standing to bring the case. But it rejected the school's claim that the employer mandate was unconstitutional. ... It's the first time an appeals court has shot down a challenge to the Obamacare employer mandate, according to Carl Tobias, a constitutional scholar at the University of Richmond (Gershman, 7/11).

The Hill: Federal Appeals Court Rejects ObamaCare Challenge
A federal appeals court on Thursday rejected a challenge to the individual and employer mandates in President Obama's health care law, while declining to rule on the law's contraception mandate. The 4th Circuit Court of Appeals ruled Thursday in a legal challenge filed by Liberty University, the conservative Christian school founded by Jerry Falwell (Baker, 7/11).

The Associated Press: Appeals Court Rejects Lawsuit Over Health Care Law
Liberty attorney Mat Staver said he plans to appeal. "At least the court reached the merits and did not try to dodge the issues on procedural or standing grounds," he said in a telephone interview. "This clears the way to go to the U.S. Supreme Court, which will be the final stop anyway." A Justice Department spokesman did not immediately respond to a telephone message (O’Dell, 7/11).

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Mass. Employer Health Insurance Mandate Repeal Moves Forward

Gov. Deval Patrick has agreed to end a state mandate that employers provide health insurance to their employees, included in Massachusetts' 2006 health care overhaul, because a federal law -- which is now delayed a year -- was set to impose a similar mandate on employers.  The repeal is included in the 2014 budget.

Boston Globe: Repeal Of Employer Mandate Moving Forward, Patrick Says 
Governor Deval Patrick said Thursday that he will not block the repeal of a state mandate for employers to provide health insurance to their workers or pay a penalty, though the Obama administration last week announced a delay in the federal program that was supposed to take its place. The state's landmark 2006 health care law included a provision, referred to as the "fair share employer contribution," requiring that employers with more than 10 workers provide coverage or pay the state $295 per employee. Some business groups saw the requirement as onerous and initially pushed to loosen the law, but the Patrick administration agreed to eliminate it because a similar federal mandate was set to take effect in January. The repeal was included in the 2014 budget, which Patrick likely will act on tomorrow (Conaboy, 7/11).

In the meantime, state-based health insurance marketplaces make news --

Health Policy Solutions (a Colo. news service): Colorado Receives $116 Million Exchange Grant
Colorado will get another $116 million to help launch the state's new health exchange, Connect for Health Colorado. Federal cuts known as sequestration chopped $9 million from the state’s $125 million request. Last month, exchange CEO and Executive Director Patty Fontneau said that some programs may have to withstand higher cuts than others because managers already have signed contracts for services or technology so they cannot spread the cuts evenly across all programs (Kerwin McCrimmon, 7/11).

California Healthline: Should Covered California Be Allowed To Keep Secrets?
Three years ago when legislation was written to create California's health insurance exchange, lawmakers thought it would be a good idea to let the new exchange board keep a few competitive secrets. Now some legislators aren't so sure. Covered California, as the exchange is now known, has the authority to keep all contracts confidential for a year and the health plan rates concealed indefinitely. … We asked legislators and stakeholders to explain the advantages and disadvantages of allowing Covered California to keep secrets (7/11).

Kansas Health Institute: Several States Ahead Of The Curve On Insurance Exchanges
Most states that have chosen to run their own health insurance marketplaces or exchanges will be running ahead of schedule in the offerings and information they will provide their consumers and small businesses, according to a new study. The report, done by researchers at Georgetown University's Health Policy Institute, looked at the 17 states and the District of Columbia that have opted to run their own exchanges. (Kansas officials opted to have the federal government run the Kansas exchange.) (7/11).

And repercussions of state decisions on the health law's Medicaid expansion ripple across America --

Marketplace: States' Refusal To Expand Medicaid Complicates Health Care For Many Uninsured
The health care reform law calls for a big expansion of Medicaid, the federal healthcare program for the poor. But last year’s Supreme Court made that expansion optional. And some of the biggest states, with the most poor people, are opting out.  So far, 23 states and the District of Columbia have agreed to expand Medicaid, six are undecided, and 21 have said no. Among them: Texas, which is where 47-year-old Ricardo Rios lives. He would qualify for Medicaid, under the health care law’s expansion plan if Texas hadn’t opted out. He’s praying the state’s leaders change their minds (Marshall-Genzer, 7/12).

The Associated Press: Medicaid Agency Gearing Up For Questions On Law
South Carolina's Medicaid agency is ramping up its call center in expectation of a surge of questions about the federal health care law. Deputy Director John Supra said the agency began increasing its hours July 1 and the agency is hiring in preparation of a full ramp-up in October, when people can begin buying health insurance through online marketplaces called exchanges (Adcox,7/11).

Columbus Dispatch: Kasich Urges Legislators To Extend Medicaid This Summer 
A week after state lawmakers adjourned for summer recess, Gov. John Kasich and other supporters of expanding Medicaid packed into the Statehouse yesterday to urge legislators to return to Columbus to extend tax-funded health coverage to tens of thousands poor, uninsured Ohioans. "As Americans, we need to beat back this notion that when somebody’s poor, somehow they are lazy," Kasich told a cheering crowd of several hundred (Candisky, 7/10). 

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Health Care Marketplace

Health IT Systems Being Used To Track Doctors, Too

Some physicians feel second-guessed by systems that track how they handle their patients. Also, in other coverage about health care delivery, the Fiscal Times examines the growth of minute clinics.

The Wall Street Journal: Hospitals Prescribe Big Data To Track Doctors At Work
Marnie Baker, a pediatrician at California's MemorialCare Health System, has an easy manner and ready smile. Now, though, her job is to be the bearer of a serious and, for some of her colleagues, unwelcome message. She's the voice of a program that digitally tracks their performance, informs them when they don't measure up—and cajoles them to improve. MemorialCare is part of a movement by hospitals around the U.S. to change how doctors practice by monitoring their progress toward goals, such as giving recommended mammograms. It isn't always an easy sell (Wilde Mathews, 7/11).

Fiscal Times: How Minute Clinics Are Revolutionizing Health Care
In a country that's getting fatter, older, and needs more medical care, there's a huge opportunity for companies to really disrupt the American health care system. Rattle the dust off those old bones if you will. The opportunity waits in plain sight at your local pharmacy, and some companies like Walgreens and CVS have taken notice and hope that you will too. Walgreens, the largest pharmacy chain in America, made an aggressive move in April to expand its Take Care retail clinic's services to include diagnosing and treating chronic conditions like asthma, diabetes and high cholesterol (Nisen, 7/11).

Earlier from KHN: Walgreens Becomes 1st Retail Chain To Diagnose, Treat Chronic Conditions

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WellPoint Agrees To $1.7M Fine After Patient Data Exposure

HHS announced that the insurance company has agreed to the penalty after personal data for more than 600,000 people enrolled in plans was found accessible over the Internet.

Modern Healthcare: WellPoint To Pay $1.7 Million HIPAA Penalty
WellPoint, which serves nearly 36 million people through its affiliated health plans, has agreed to pay a $1.7 million penalty to HHS for potential violations of the privacy and security rules under the Health Insurance Portability and Accountability Act of 1996. Between Oct. 23, 2009, and March 7, 2010, access to personal data for 612,402 people -- their names, dates of birth, addresses, Social Security numbers, telephone numbers and health information -- was made available to unauthorized users as the result of online security weaknesses, HHS said Thursday (Landen and Conn, 7/11).

Reuters: WellPoint Fined $1.7 Million For Exposing Health Data On Internet
Health insurer WellPoint Inc agreed to pay a fine of $1.7 million for allowing health and other personal information from hundreds of thousands of people to be accessed over the Internet, the U.S. Department of Health and Human Services said on Thursday. Security weaknesses in a WellPoint online application database exposed information for 612,402 individuals between October 2009 and March 2010, according to the agency (7/11).

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State Watch

Texas Abortion Vote Near; N.C. House Passes Restrictions

Reuters: Texas Posed To Enact Abortion Restrictions Despite Opposition
Texas on Friday is poised to enact a ban on most abortions after 20 weeks of pregnancy, ending a bitter political fight that stirred national debate over what critics see as laws threatening the right to abortion in the United States. The Republican majority in the Texas Senate is expected to vote Friday or early on Saturday to impose the ban on late-term abortions, and enact tough new regulations for clinics performing the procedure, and restrict administration of the so-called "abortion pill," RU486 (MacLaggan, 7/12).

Dallas Morning News: Texas Senate Republicans Poised To Send Abortion Bill To Perry
To mark the importance of the coming vote, Lt. Gov. David Dewhurst and several lawmakers held a Capitol news conference Thursday. ... Dewhurst emphasized that he will not allow a replay of what happened in a special session in June. Loud protesters in the Senate gallery drowned out a final vote on an abortion bill just as the clock ran out on the 30-day session (Stutz, 7/11).

CNN: Texas Abortion Bill A Step Closer To Law
The bill originally failed to pass during the previous special session because of a filibuster from Democratic Sen. Wendy Davis. ... [Dewhurst]  blamed the media for lionizing Davis and accused the senator of being out of the American mainstream. ... Critics of the measure say it would shut down most abortion clinics in Texas -- denying access to many in rural communities -- and force women to seek dangerous back-alley abortions (Rubin, 7/11).

Bloomberg: Texas Threat To Abortion Clinics Dodged At Flea Markets
At an open-air flea market outside McAllen, Texas, near the Mexican border, shoppers can buy a goat and get their car windows tinted. Tables with handwritten signs touting Viagra) are stocked with herbal remedies promising to burn fat and boost breast size. You can also find pills to end a pregnancy. Bazaars like this have become home to a black market where women too poor to afford an abortion at a clinic or deterred by state mandates (Deprez, 7/12).

The New York Times: North Carolina House Passes New Restrictions On Abortion
Legislation that would impose new restrictions on abortion clinics moved out of the North Carolina House of Representatives on Thursday in a form that would give wide power to Gov. Pat McCrory’s administration. The bill became the focus of battling factions in the Republican Party this week, with a series of public legislative debates and back-room maneuvering over how to create new limits that would appeal to the governor, who is a Republican (Blinder, 7/11).

CNN: N.C. House Passes Restrictive Abortion Bill
The bill would place requirements on clinics that family planning advocates say would make it hard for them to stay in business. Among the requirements is the presence of a doctor when an abortion is being performed. The bill allows North Carolina's health department to make temporary new rules for the state's 31 abortion clinics as it sees fit (Brumfield, 7/11).

Meanwhile --

Reuters: Parent Must Be Told Before Teen Abortion In Illinois: Court
A parent must be notified 48 hours before a girl under the age of 18 gets an abortion in Illinois, the state Supreme Court ruled on Thursday, ending nearly two decades of legal wrangling over the issue. The Illinois court decision is the latest in a series of state measures adopted recently to restrict abortion. Texas and North Carolina are currently considering more restrictions on abortion and Republicans across the United States have championed similar measures (O’Brien, 7/11).

The New York Times: Ready Access To Plan B Pills In City Schools
Last month, the Obama administration seemingly changed the landscape of access to emergency contraception across the country when, in a reversal, it agreed to allow the best-known pill, Plan B One-Step, to become available to all ages without a prescription. Until recently, only those 17 and older could buy it over the counter. But New York City had long ago come to an accommodation with the idea that girls as young as 13 or 14 should have easy access to the pill. Through a patchwork of nurses’ offices and independent clinics operating in schools, students can now get free emergency contraceptives like Plan B One-Step in more than 50 high school buildings (Hartocollis and Bond, 7/11).

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State Highlights: Calif. Insurers, Lawmakers Fight Over Premium Disclosure

California Healthline: Insurers, Legislators Clash Over Premium Disclosure Bill
Despite opposition from insurers, the Assembly Committee on Health last week approved a bill designed to lower health insurance premiums by requiring plans to disclose more information about their rates. SB 746 by Sen. Mark Leno (D-San Francisco) would require insurers selling coverage to employers with 50 or more employees to provide more detailed information about how and why they raise health insurance rates. Leno said the bill was prompted by a recent dust-up between San Francisco unions and Kaiser Permanente. Union officials asked Kaiser for data and reasons for rate increases. Leno indicated he has not been satisfied with the insurer's response (Hart, 7/11).

Boston Globe: For-Profit Hospitals Put To Test In Mass.
The pending return of health care giant Tenet Healthcare Corp. to Massachusetts has the potential to shake up the state's hospitals and doctors networks, which are already rapidly consolidating. The for-profit system, which owns 49 hospitals in 11 states, will enter a marketplace much changed from the one it left in 2004, when the chain sold Saint Vincent Hospital in Worcester and the MetroWest Medical Center hospitals in Framingham and Natick to Vanguard Health Systems Inc. for $126.7 million (Weisman, 7/12).

CT Mirror: Malloy Sides With Unions, Vetoes Bill Key To Waterbury Hospital Deal
Gov. Dannel P. Malloy vetoed a bill Thursday that was opposed by health care unions seeking leverage in the proposed acquisition of financially struggling Waterbury Hospital by a major national for-profit company, Vanguard Health Systems of Tennessee. The veto of the bill, which would have given Vanguard the governance structure it says is necessary to operate in a state unfamilar with for-profit hospitals, cast uncertainty over the acquisition strongly supported by Waterbury Mayor Neil O'Leary as a means to retain a major employer (Pazniokas, 7/11).

Los Angeles Times: Probe Of California's Prison-Based Mental Health Facilities Ordered
Citing evidence of doctor shortages, treatment delays and "denial of basic necessities, including clean underwear," a federal judge on Thursday ordered an in-depth probe of conditions at prison-based mental health facilities run by the California Department of State Hospitals. U.S. District Judge Lawrence K. Karlton has been overseeing mandated improvements of care for mentally ill prisoners throughout California, treatment that the courts 18 years ago deemed so substandard as to be unconstitutional (Romney and St. John, 7/12).

Detroit Free Press: Kevyn Orr Floats Plan To End Health Care For Early Police, Fire Retirees
Representatives of city unions and pensioners met Thursday with members of emergency manager Kevyn Orr's restructuring team to begin talks on drastic changes to health care for current and retired workers. One proposal floated was the elimination of health care coverage for some firefighters and police officers who retire early (Helms, 7/11).

Milwaukee Journal Sentinel: State Supreme Court Says Surrogate Birth Contract Enforceable
For the first time in Wisconsin, the Supreme Court found Thursday that a woman's agreement to give birth to a baby for a man and his wife is an enforceable contract, except for a provision that would terminate the birth mother's parental rights. The ruling could ease the process of surrogate births in Wisconsin, though it doesn't mean the Menomonee Falls parents of the child in this case will be able to deny some role for the birth mother, formerly a close friend of the couple. But the court recognizes its limits in addressing the sometimes challenging and confounding questions at issue: "We respectfully urge the Legislature to consider enacting legislation regarding surrogacy," the decision reads (Vielmetti, 7/12).

Oregonian: Oregonians Pay On Average 10 Times More For Top-Selling Brand Name Drugs
Oregonians have paid on average 10 times more for top-selling prescription drugs because of deals between drug manufacturers to delay production of generics. The 20 top prescription drugs that paid off their rivals to keep generics off the market resulted in average delays of five years that left patients paying up to 33 times as much for brand names, according to a report released Thursday from the Oregon State Public Interest Group and Community Catalyst. The drugs listed include some common prescriptions: Lipitor, Tamoxifen and Cipro (Karlamangla, 7/11).

The Lund Report: Global Budget Could Mitigate 'Perverse Incentive' For Child Abuse Intervention
Visits to the Children's Center in Oregon City usually start with a call to the child abuse hot line -- and end with the gift of a quilt and a teddy bear. If the Department of Human Services or a law enforcement officer determines after follow-up that a child should be seen, the child, along with a parent or other caregiver, visits the center, which is one of 21 like it in the state (McCurdy, 7/11).

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Public Health & Education

'Defanged' HIV Used To Deliver Gene Therapy

Researchers are having success using a "defanged" version of HIV to deliver gene therapy to children suffering from genetic diseases, a development that could improve other such care.

The Wall Street Journal: Defanged HIV Shows Promise In Gene Therapy 
Six children with rare genetic diseases were successfully treated using gene therapy that was delivered with a modified form of the AIDS virus, researchers said Thursday. HIV, which causes AIDS, is proving a boon to gene therapy because the ability to infect cells that makes the virus so dangerous has also rendered it an efficient agent for delivering replacement genes into a patient (Winslow, 7/11).

Los Angeles Times: Gene Therapy Using HIV Helps Children With Fatal Diseases, Study Says
Italian researchers have used a defanged version of HIV to replace faulty genes -- and eliminate devastating symptoms -- in children suffering two rare and fatal genetic diseases. Improved gene therapy techniques prevented the onset of metachromatic leukodystrophy in three young children and halted the progression of Wiskott-Aldrich syndrome in three others (Pandika, 7/11).

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Coverage & Access

Gay Men Plan Blood Donation Protest

Gay men plan to try to donate blood Friday in protest to a 1977 policy that bans them from doing so. Also, gay health care rights have changed due to a Supreme Court ruling.

USA Today: Blood Drive To Challenge Ban On Donations From Gays
Gay men across the nation plan to offer to donate their blood Friday, even though they expect to be turned away. The blood drive, targeting 53 donor sites nationally, is designed to protest a 1977 federal policy barring gay and bisexual men from donating blood (Leys and Hall, 7/11).

The Philadelphia Inquirer (Analysis): The Supreme Court's Decision May Bring Big Changes For LGBT Health Care
In a major victory for gay rights, the Supreme Court last month struck down part of the Defense of Marriage Act (DOMA), the federal law that had limited recognition of marriage to one between a man and a woman. This judicial move may herald major changes for the gay community with regard to health care access and cost (Field, 7/11).

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Health Policy Research

Research Roundup: PSA Testing Recommendations Often Ignored; Medicaid Expansion's Impact

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

Health Affairs: Population Aging And Emergency Departments: Visits Will Not Increase, Lengths-Of-Stay And Hospitalizations Will – The authors examined how the growing number of elderly Americans would affect the large and increasing part of non-catastrophic outpatient care. Using Census Bureau and nationally representative survey data, researchers quantified the number of ED visits that would occur if the demographic structure of the U.S. population changed, but everything else remained the same. “We observed that it is actually infants and young adults, not the elderly, who account for the largest number of ED visits,” the authors write, and conclude: However, the data do predict increases in visit lengths and the likelihood of hospitalization. As a result, the aggregate amount of time patients spend in EDs nationwide will increase 10 percent faster than population growth. This means that ED capacity will have to increase by 10 percent, even without an increase in the number of visits. Hospital admissions from the ED will increase 23 percent faster than population growth, which will require hospitals to expand capacity faster" (Pallin et al., 7/8).

Annals Of Family Medicine: Telephone Outreach To Increase Colon Cancer Screening In Medicaid Managed Care Organizations: A Randomized Control Trial – As screening rates for colorectal cancer (CRC) increased over time, the number of deaths related to the disease declined. But among Hispanic, African American, low-income, and immigrant populations, the screening rates remain low. Researchers at Dartmouth Hitchcock Medical Center examined whether an 18-month telephone outreach by three Medicaid managed care organizations in New York (MMCO) could increase screening rates. They provided support and information  to more than 500 randomly-selected patients. "CRC screening telephone outreach was successfully delivered using internal MMCO resources rather than externally funded research staff, with CRC screening rates from one-third higher to nearly double among women receiving the intervention," the authors write. They conclude: "This study shows that MMCOs, key players in the delivery of health care to publicly insured and underserved populations, can successfully implement interventions to increase CRC screening, reducing health care disparities among a difficult to reach population"(Dietrich et al., 7/9).

American Journal Of Preventive Medicine: Prostate-Specific Antigen Testing: Men’s Responses To 2012 Recommendation Against Screening – The U.S. Preventive Services Task Force (USPSTF) has recommended against prostate-specific antigen (PSA) testing for middle-aged men with no history of prostate cancer. Researchers aimed to assess the level of awareness regarding the new recommendation among men aged 40-74. After surveying 1,089 men, they found that while 62 percent agreed with the recommendation, only 13 percent said they would not get a PSA test in the future, while "54% were non-intenders (they planned to not follow the U.S. Preventive Services Task Force recommendation and get a prostate-specific antigen test in the future) and 33% were undecided." The authors conclude that "consumers are favorably disposed to PSA testing, despite new evidence suggesting that the harms outweigh the benefits. The new USPSTF recommendation against PSA testing in all men may be met with resistance" (Squiers et al., 7/9).

Kaiser Family Foundation: The Impact Of Current State Medicaid Expansion Decisions On Coverage By Race And Ethnicity – The June 2012 U.S. Supreme Court decision on the federal health law gave states the choice to expand Medicaid. As of July 1, 24 states are moving forward in expanding their Medicaid programs and six are considering it. In this issue brief, researchers analyzed 2011 survey data to determine the implications resulting from states’ decision to reject or proceed in expanding Medicaid. "[P]eople of color will be disproportionately impacted by state decisions to expand Medicaid; the impact of current state Medicaid expansion decisions varies widely by race and ethnicity, Blacks are at highest risk of continuing to face coverage gaps due to state decisions not to expand at this time; and expansion decisions by a few key states have significant implications for coverage across races and ethnicities," the authors write (Artiga and Stephens, 7/2).

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

Medpage Today: GAO Says No To Ditching Paper Drug Labeling
Eliminating paper drug labeling such as package inserts in favor of e-labels could compromise the availability of information for some patients, physicians, and pharmacists, a government study found. Stakeholders provided no consensus on the advantages or disadvantages of relying on drug labeling available only electronically,the Government Accountability Office (GAO) said in a report Monday. Drug manufacturers have supported eliminating paper labels, whereas patient advocates suggest it could adversely affect public health (Pittman, 7/11).

NPR: After FDA Approval, Drugmakers Often Miss Study Mark
Since 2007, the Food and Drug Administration has had the power to require drugmakers to continue studying the safety of their pills or other medicines as a condition for approving them in the first place. Before then, the studies were largely voluntary and many never got done. So how's the mandatory approach going? Kevin Fain, a research fellow at Johns Hopkins Bloomberg School of Public Health, and some colleagues took a look at the five-year period ending in 2011. ... before the FDA got new powers there were over a thousand studies — more than half of those the agency expected to be performed— that hadn't been started by drugmakers. That number fell to 775 studies, or about 44 percent, in 2011. ... The analysis appears in JAMA (Naudziunas, 7/11).

Oregonian: Residents Who Complete Rural Rotation More Likely To Work In Rural Areas
Surgical residents who complete a rotation in a rural area are far more likely to later practice in a rural area, according to a study published this month. Researchers from Oregon Health & Science University looked at data from residents at OHSU who had completed the school's year-long rural rotation. They found that those who did the rotation were both far more likely to later practice in a rural area, and also to enter into general surgery practice (Karlamangla, 7/10).

Related KHN story: Wanted: Mavericks And Missionaries To Solve Mississippi's Doc Shortage (Hess, 4/26)

Medscape: Telehealth Safe for Some Postoperative Evaluations
Hands-on ambulatory surgery in some instances can be followed by hands-off telehealth assessments for postoperative patient, according to a new prospective case series from the Palo Alto Veterans Administration Health System in northern California. The study, by certified medical assistant Kimberly Hwa, MMS, PA-C, and Sherry M. Wren, MD, a professor of general surgery at Stanford Medical School in California, suggests telehealth can safely substitute for the standard postoperative clinic visit while maintaining a high level of patient satisfaction. The study was published online July 10 in JAMA Surgery (Brice, 7/10).

Medscape: Physicians Urged to Ask Elderly Patients About Guns
The medical imperative to talk to patients about gun ownership and hence gun safety — an imperative challenged by Florida and Wisconsin lawmakers — usually centers on the need to prevent a small child from discovering, say, a loaded Glock in Dad's dresser. However, physicians also should inquire about guns in the homes of geriatric patients who may be at a higher risk for a gun-related fatality — particularly suicide — because of dementia, delusions, memory problems, and depression, according to an article by a healthcare attorney published online yesterday in the Annals of Internal Medicine (Lowes, 7/11).

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Editorials and Opinions

Viewpoints: GOP Should Focus On Fixing Health Law; Bishops Refuse To Accept Victory

Los Angeles Times: It's Time To Focus On Fixing The Affordable Care Act, Not Gutting It
Conservatives have married their political fortunes to the notion that Obamacare is a catastrophe and must be discarded in its entirety — even though some of the signature elements of the law, such as a requirement that most people be insured, are ideas that they originated. "There's plenty of blame to go around for what's wrong with the law," said Mark Pauly, a healthcare economist at the University of Pennsylvania's Wharton School. "What we need now is an informed debate about how it can be made better." And that's precisely what we're not getting (David Lazarus, 7/11).

The New York Times: G.O.P. Still Trying To Stop Health Care Reform
Just because there is no sign of actual governing arising from Congress, it doesn't mean that the right-wing dominated House Republican Caucus is just sitting around doing nothing. To the contrary, in addition to plotting the demise of the first real chance at immigration reform in decades, House G.O.P. leaders are thinking of new ways to continue their long-running show of trying to stop health care reform from taking effect (Andrew Rosenthal, 7/11).

The Washington Post: The Catholic Health Association V. The Bishops V. Obama
Last week, the Obama administration published its final guidelines for contraception coverage by insurers, putting what should be closure on years of back-and-forth debates with the Catholic bishops. ... the Catholic Health Association, which represents the country's largest group of nonprofit health care providers, found the compromises to be considerably accommodating to the religious liberty of religious hospitals, and endorsed the policy this week. Sadly, the predictable answer from Cardinal Dolan and Archbishop Lori, was "not good enough." Like the tea party faction in Congress, anything Obama is for, these prelates are against. They refuse to accept victory in order to keep fighting with President Obama (Anthony M. Stevens-Arroyo, 7/11).  

The Wall Street Journal: Connecticut And ObamaCare
Connecticut appears to be yet another state that will stumble its way into ObamaCare. It wasn't supposed to be this way. The Nutmeg State, run by Democratic Gov. Dannel Malloy and a heavily Democratic legislature, was one of the first to sign up to run its own health-care exchange and has received more than $150 million in federal grants to do so. But as the Oct. 1 start date approaches, projections are not cheery. "It's going to be rocky in this first year," said Kevin Counihan last month at a board meeting of the Connecticut Health Insurance Exchange. "This is not simple. It's highly complex. It's unprecedented, and it's not going to be smooth" (Harry Graver, 7/11). 

USA Today: Get Obamacare, While Supplies Last
On Oct. 1, the uninsured can start signing up for coverage under ObamaCare. But should every policy be sold with an asterisk: Guaranteed access to care ... while supplies last? Maybe. The unpleasant truth is that we don't have enough doctors to offer quality care to a growing number of Americans, never mind the nearly 30 million uninsured who'll begin to gain coverage under ObamaCare starting in 2014 (Paul Howard, 7/11).

The Baltimore Sun: How Do Liberals Hate NSA Intrusion But Love Obamacare?
Self-proclaimed civil libertarians are up in arms over the National Security Agency's massive database containing information about whom we call and what we do on the Web. Defenders of the program say, "So what?" Unless you're a terrorist, no one in the government will ever bother to access that information. That's not good enough, say civil libertarians (Jonah Goldberg, 7/12).

Bloomberg: How Republicans Can Exploit Obamacare
Republicans have responded to the delay of an important component of President Barack Obama’s health-care reform by escalating their attacks. Here's a suggestion: Instead of trying to wreck the law, focus on using it to prove the superiority of conservative principles (7/11).

JAMA: Are Officials Who Predict Health Reform Doom And Gloom Sowing A Self-Fulfilling Prophesy?
As 2014 approaches, the health policy community is focused on implementation of the Affordable Care Act’s (ACA’s) main coverage provisions: the opening of health insurance exchanges, related reforms of the individual market, and the Medicaid expansion that states can choose to adopt or reject. … Although all these questions are important, politics may play a particularly significant role in state cooperation, which, itself, has implications for some of the other issues (Austin Frakt, 7/11).

And, in opinions on other subjects --

The New York Times: My Life, Post Exposure
I grew up in a Modern Orthodox Jewish family in New Jersey, where my "sex talk," at 13, came in the form of my mother handing me a book of anatomical comics. Inside it, she placed post-it notes to indicate her feelings. In the masturbation section: "God does not approve of this." In the gay sex section: "Definitely not." When I came out at 18, I had to learn everything on my own. Last year, as a 21-year-old college student, I got my hardest lesson (Isaac Lobel, 7/11). 

The Washington Post: An AIDS-Free Generation Is Closer Than We Might Think
Because of the extraordinary progress in the fight against HIV/AIDS, we can now consider a question that just a few years ago seemed far-fetched. No longer is it whether we can achieve an AIDS-free generation. Now, the question is: How long will it take and will it be sustained? Vaccines historically have played an important role in the control and even elimination of global health scourges such as smallpox, polio and measles. So two important questions regarding an AIDS-free generation are: Is an HIV vaccine needed to reach this goal, and if so, what role will it play? (Anthony S. Fauci, 7/11).

USA Today: Beware Of Self-Help Gurus
Nationally known self-help guru James Arthur Ray is scheduled to be released Friday after serving 20 months in prison for the deaths of three people during a 2009 sweat-lodge ceremony he conducted as the surprise culmination of his "Spiritual Warrior" inspirational retreat. All signs suggest Ray will attempt to rebuild his motivational videos, books and seminar business. But unlike Martha Stewart's post-prison rebranding through benign recipes, Ray's return to lead workshops on "harmonic wealth," "practical mysticism" and other "life-altering experiences" underscores the need for people to ask questions, do their research and take caution when choosing a self-improvement program (Christine B. Whelan, 7/11). 

Bloomberg: Americans Die Younger Than Europeans. They Don't Need To
If you wanted to pick a single metric to judge the success of a country, one measure that both conservatives and liberals could agree on, life expectancy may be your best bet. On that metric, the U.S., which spends more on health care than any other developed country, is doing terribly. A new study in the Journal of the American Medical Association shows just how badly (Flavelle, 7/11).

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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.