Daily Health Policy Report

Friday, July 13, 2012

Last updated: Fri, Jul 13

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

Capitol Hill Watch

Quality

Health Information Technology

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Maine's Efforts To Pare Medicaid May Put It On Collision Course With Administration

Kaiser Health News staff writer Phil Galewitz reports: "In what is shaping up as the first state-federal showdown on Medicaid following the Supreme Court's ruling on President Barack Obama's health law, Maine is moving ahead with plans to cut about 38,000 people from its rolls to balance its state budget" (Galewitz,7/12). Read the story.

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Ten Things You Didn't Know Were In The Affordable Care Act

Kaiser Health News staff writers David Schultz and Christian Torres write: "So you think the Supreme Court upheld a law that requires most people to buy health insurance? That's only part of it. The measure's hundreds of pages touch on a variety of issues and initiatives that have, for the most part, remained under the public's radar" (Schultz and Torres, 7/12). Check out the list.

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Capsules: Mayo Clinic 'Affiliations' Spread The Brand

Now on the blog, Minnesota Public Radio's Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "There's a lot of jockeying for position in the health care market as medical centers prepare to implement the provisions of the federal Affordable Care Act. The debate over the health care law has created a lot of uncertainty in the market. Many health care providers are responding by linking with each other to manage the risk" (Stawicki, 7/12). Check out what else is on the blog.

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Political Cartoon: 'Medical Science?'

Kaiser Health News provides a fresh take on health policy developments with "Medical Science?" by Jimmy Margulies.

And here's today's health policy haiku:

SKY HIGH TAB 

Retirees' health
care costs
? The airline's intent
wasn't forever...  
-Anonymous

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

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Health Reform

Governors' Concerns Continue To Surface About Health Law's Medicaid Expansion

Though much of the dust-up following the Supreme Court's Medicaid decision has come from Republican governors vowing to opt out of the expansion, news outlets report that some Democratic governors also have concerns. Meanwhile, Kentucky became the 13th state to say it would set up its own online insurance exchange where individuals and small businesses could shop for coverage beginning in 2014.

The New York Times: Lines Are Drawn Over Opting Out Of Medicaid Plan
In the weeks since the Supreme Court ruled that states could opt out of a plan to vastly expand Medicaid under President Obama's health care law, several Republican governors have vowed to do just that, attacking the expansion as a budget-busting federal power grab (Goodnough, 7/12).

The Washington Post: Medicaid Expansion A Tough Sell To Governors Of Both Parties
While the resistance of Republican governors has dominated the debate over the health-care law following last month's Supreme Court decision to uphold it, a number of Democratic governors are also quietly voicing concerns about a key provision to expand coverage (Aizenman and Tumulty, 7/12).

Stateline.org/McClatchy Newspapers: For Some States, Medicaid Expansion May Be A Tough Fiscal Call
Even those governors who eventually accepted the stimulus money may be wary of participating in the expansion of Medicaid, the jointly funded federal-state health care program for low-income people. The federal government currently pays 50 percent to 80 percent of the cost of Medicaid coverage in each state, with the poorest states getting the largest proportion of federal money. But many of the states that would qualify for the highest federal match already leave federal money on the table by maintaining Medicaid programs that are more restrictive than they have to be (Vestal, 7/12).

USA Today: Health Law Ruling Reveals Governors' Split
A 50-state survey by USA TODAY shows only Republican governors are refusing to expand Medicaid and only Democrats are vowing to expand it following the court's ruling that states cannot be penalized for failing to enlarge the program. More than half the governors are undecided (Wolf, 7/12).

Politico Pro: DSH Could Incentivize Medicaid Expansion
If you think the Supreme Court ruling means HHS can’t cut states’ health care funding, think again. The Affordable Care Act calls for an $18.1 billion cut to federal payments for free or poorly compensated care that hospitals provide to uninsured and Medicaid patients, the idea being that there won’t be so many uninsured after the coverage expansions. And how HHS decides to apply the so-called Disproportionate Share Hospital cuts is of great interest to states and hospitals — especially if they’re used in a way that hits harder in states that don’t expand Medicaid.  “Do the DSH reductions hit everyone? You bet they do,” said Matt Salo, executive director of the National Association of Medicaid Directors. He cited the letter from HHS Secretary Kathleen Sebelius to governors this week as a strong indication that HHS would proceed with the DSH cuts and all other provisions not explicitly addressed by the court (Norman, 7/13).

The Hill: House Dem: Refusing Medicaid Dollars A 'Historic Mistake'
A House Democrat warned Virginia Gov. Bob McDonnell (R) that refusing the healthcare reform law's Medicaid expansion will be a "costly and historic mistake." The Supreme Court's decision to uphold the law has touched off a fiercely partisan debate over whether to expand Medicaid. Many GOP governors have said they will refuse federal funds to expand the program because they worry that financial obligations to future beneficiaries will be too great. Among the governors threatening to do this is McDonnell, a possible vice presidential candidate for the GOP. In a letter, Rep. Gerry Connolly (D-Va.) urged him to not to let the opportunity pass. "The choice we face as Virginia’s leaders is momentous," he wrote. "Will we allow this once-in-a-lifetime opportunity to leverage billions of dollars of federal funds to help Virginia’s families, businesses, and bottom line" (Viebeck, 7/12)?

Here's how the story is taking shape on the state level -

Kaiser Health News: Maine's Efforts To Pare Medicaid May Put It On Collision Course With Administration
In what is shaping up as the first state-federal showdown on Medicaid following the Supreme Court's ruling on President Barack Obama's health law, Maine is moving ahead with plans to cut about 38,000 people from its rolls to balance its state budget" (Galewitz,7/12). 

Houston Chronicle: State Sharply Lowers Estimate Of Medicaid Expansion Cost
On the heels of Gov. Rick Perry's declaration that Texas will not expand Medicaid because it is too costly, his health and human services commissioner said Thursday that fully implementing health care reform would cost the state about $11 billion less over 10 years than previously estimated. Executive Commissioner Thomas Suehs told a Texas House subcommittee that the new estimate is between $15 billion and $16 billion in state costs over a decade, compared to the previous estimate of $26 billion to $27 billion. The state would get an additional $100.1 billion in federal money over that time, according to the Texas Health and Human Services Commission - money that Suehs acknowledged would be attractive to local entities grappling with the cost of caring for the quarter of the state's population that currently is uninsured (Fikac, 7/13).

McClatchy Newspapers: Alaska Gov. Sean Parnell Might Reject Medicaid Expansion
Alaska Gov. Sean Parnell is expressing "serious concerns" about letting the federal government pay for medical care of more than 30,000 lower-income Alaskans, saying it would also result in state costs he's hesitant to take on. Parnell refused requests for an interview this week. But he provided a written statement in which he laid out reservations with allowing the Medicaid expansion in the federal health care law. The U.S. Supreme Court upheld most of the law last month but said the states have a choice on the expansion of Medicaid eligibility to anyone with an income up to 133 percent of the poverty level, among the major parts of the law (Cockerham, 7/12).

Richmond Times-Dispatch: Bolling Opposes Expansion Of Medicaid In Virginia
Lt. Gov. Bill Bolling on Thursday said he opposes the expansion of Medicaid in Virginia under the federal health care overhaul. Bolling heads GOP presidential nominee Mitt Romney's Virginia campaign. He is vying with Attorney General Ken Cuccinelli for the 2013 GOP nomination for governor (Cain, 7/13).

Texas Tribune: State Medicaid Chief Weighs In On Health Reform
Though Texas will not expand its Medicaid program, the Supreme Court decision to uphold the Affordable Care Act will put a strain on the state’s finances and health care system, Billy Millwee, the state's outgoing Medicaid chief, said in a panel discussion on Thursday. … He is among the first senior officials at the Texas Health and Human Services Commission to weigh in on the decision (Luthra, 7/12).

Meanwhile, on the subject of state-based health exchanges -

Los Angeles Times: Kentucky To Implement Key Part Of Obama's Healthcare Law
As right-leaning states such as Texas and Florida redouble their opposition to President Obama's healthcare law in the wake of last month's Supreme Court decision, Kentucky is joining the list of states that will establish its own insurance exchange in 2014, implementing a central pillar of the Affordable Care Act (Levey, 7/12).

The Hill: Kentucky Says It Will Implement Central Piece Of Obama's Health Law
Kentucky will set up its own insurance exchange rather than allow the federal government to take the lead — the 13th state to commit to an exchange since the Supreme Court's healthcare ruling. Gov. Steve Beshear (D) said in a letter to Health and Human Services Secretary Kathleen Sebelius that he will sign an executive order to create an exchange. Beshear's letter bucks a trend of solidly red states rejecting the Affordable Care Act. Some conservative governors have staunchly refused to set up exchanges, even though that decision ultimately gives the federal government more power over their states' healthcare systems (Baker, 7/12).

Politico Pro: Kentucky Moves Ahead With Exchange
Kentucky is the latest state to tell HHS that it plans to run its own health insurance exchange. With Senate Minority Leader Mitch McConnell and Sen. Rand Paul in Kentucky’s delegation, the state may not seem like the most obvious place for an exchange to take root. It hasn’t passed legislation to get one going, nor has the governor taken executive action to establish one. But that’s all about to change soon. Democratic Kentucky Gov. Steve Beshear, who said he had been waiting on the Supreme Court ruling before moving forward, has told HHS Secretary Kathleen Sebelius that he will "soon" issue an executive order to create the state’s exchange (Millman, 7/12).

The Associated Press: Ky. Guv Tells Feds He's Creating Health Exchange
Gov. Steve Beshear has alerted the federal government of his intention to create a statewide health insurance exchange to help Kentuckians find affordable coverage. The Democratic governor sent a letter this week to Health and Human Services Secretary Kathleen Sebelius informing her of his plan (7/12).

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Polls: Public Views Health Law As A Tax, Opinions Divided Along Party Lines

A Quinnipiac poll finds that most people view the health law as a tax increase, while a survey by the Pew Research Center for People and the Press not only found that the public is sharply divided over the law, but in regard to the court, too.

McClatchy Newspapers: New Poll Finds Mixed Messages From Public On Health Care
By a 55-36 percent margin, people think the law has a tax increase, according to a new Quinnipiac University poll released Thursday. Most people have to obtain coverage by 2014 or face a penalty -- or a tax, depending on one's point of view. At the same time, voters said, by a 48-45 percent margin, they agreed with the June 28 Supreme Court ruling upholding the law. Yet by 49-43 percent, they want it repealed. The House of Representatives Wednesday voted for repeal on a largely party line vote. The Democratic-run Senate is not expected to go along (Lightman, 7/12).

Politico: Poll: Health Care Is A Tax Hike
The Affordable Care Act is a tax hike, a majority of American voters say, according to a new Quinnipiac poll. Fifty-five percent of voters say the health care law is a tax hike, compared with 36 percent who say it isn't. Meanwhile, a plurality — 49 percent — also say that Congress should repeal the ACA, while 43 percent say the law should not be repealed. The Supreme Court recently upheld the core of the ACA’s provision, a move that 59 percent of American voters say will not affect their vote. Twenty-seven percent of voters say that it makes them less likely to vote for President Barack Obama, while 12 percent say it makes them more likely to vote for him (Mak, 7/12).

National Journal: Poll: Majority Of Voters Believe 'Obamacare' A Tax
A majority of voters say that Democrats’ signature health reform law is a tax hike, according to a national poll from Quinnipiac University released on Thursday. More than half of those polled, 55 percent, say that the law is a tax increase, while 36 percent say it is not.  The Supreme Court in June ruled that the law’s insurance requirement was constitutional under Congress's taxing power. Since then, Republicans have hammered home the point that the law increases Americans' taxes, although Democrats have argued that it is more accurately a penalty (McCarthy, 7/12).

The Hill: Poll: GOP Approval Of Supreme Court Has Plummeted Since Health Care Ruling
Republican voters took a strongly negative view of the Supreme Court in the wake of its healthcare ruling, according to a new poll. The survey, conducted by the Pew Research Center for People and the Press, found that the healthcare decision has produced sharp partisan divides not just over the law, but also the court itself. Fifty-one percent of Republicans in the latest poll said they have an unfavorable view of the court, while just 38 percent had a favorable view. Republican leaders largely steered clear of attacking the court after its healthcare decision, but pundits and some rank-and-file members were critical of Chief Justice John Roberts (Baker, 7/12).

Tampa Bay Times/Miami Herald: Poll: Most Floridians Disapprove Of Federal Health Care Law, Half Want It Repealed
A majority of Florida voters oppose the national healthcare law and half want it repealed, a new Miami Herald/Tampa Bay Times/Bay News 9 poll shows two weeks after President Barack Obama’s signature achievement was largely upheld by the U.S. Supreme Court. Only 43 percent of voters statewide support the Affordable Care Act and 52 percent oppose it, with 5 percent undecided. With the exception of southeast Florida, more voters think the law will make the healthcare system worse. More voters also favor the state opting out of provisions of the law, something Gov. Rick Scott has already said it would do. And 50 percent want to see Republicans follow through on their vow to repeal the law, with 43 percent saying it should remain (Leary, 7/12).

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Campaign 2012

Democratic Candidates Claim They Are Now On 'Offense' In The Health Debate

News outlets report on how the messaging battles are taking shape, both in terms of the presidential and congressional campaigns. 

The New York Times: Campaign Memo: Candidates Racing For Future, Gaze Fixed Firmly On The Past
Mr. Obama's campaign on Thursday hammered Mr. Romney over business deals from the turn of the century, just days after the president summoned supporters to the East Room for the latest salvo over tax cuts enacted by his predecessor a decade ago. Mr. Romney's Republican supporters in Congress countered by voting in the House to repeal Mr. Obama's two-year-old health care program and by trying to force a Senate vote on President George W. Bush's tax cuts (Baker, 7/12).

Politico: DCCC: We're Winning On Health Care
The day after the House voted to repeal the health care law again, the Democratic Congressional Campaign Committee says it's winning the health care debate and Democratic members are now on "offense" (Nocera, 7/12).

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Capitol Hill Watch

Health Groups Brace For Sequester, Ask Congress To Undo Scheduled Cuts

Hospital groups are planning lobbying efforts to convince lawmakers to cancel a 2 percent Medicare cut that would kick in next January. Meanwhile, 3,000 groups signed a 64-page letter expressing concern about the impact of non-defense discretionary spending reductions.  

Politico Pro: Hospitals Plan Lobby Blitz Against Sequester
The major hospital groups have stayed mum on the pending Medicare cuts headed their way under the budgetary sequester process. But that could change in a big way. The American Hospital Association and the Federation of American Hospitals are readying a Capitol Hill lobbying blitz in an effort to persuade lawmakers to cancel the 2 percent Medicare cut that goes into effect next January. Their hope is to match the intensity displayed by the defense sector, which has been a vocal opponent of the automatic cuts from the start and quickly mobilized their allies in Washington to pressure Congress to overturn them (DoBias, 7/13).

CQ HealthBeat: Sweating The Sequester — Groups Express Alarm About Health Cuts
A coalition whose members would be affected by automatic cuts in non-defense discretionary spending under the budget control law sent a letter Thursday to members of Congress warning that the reductions would be "devastating" to the nation. The law calls for automatic cuts in defense spending and in other types of federal discretionary spending, including funding of agencies such as the National Institutes of Health, the Food and Drug Administration, and other health-related federal offices. Sixty-three pages of the 64-page letter list the 3,000 groups that signed it, hundreds of them health organizations (Reichard, 7/12).

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Quality

Malpractice Payments Decline For Eighth Consecutive Year

Medscape:  Malpractice Payments Continue Downward Slide
The number and total value of malpractice payments made on behalf of physicians declined in 2011 for the eighth consecutive year, according to a new study released yesterday by the consumer group Public Citizen.  The study analyzes information from the National Practitioner Data Bank (NPDB), a federal clearinghouse on malpractice payments. Malpractice insurers and other organizations that pay a malpractice claim on a physician's behalf must report it to the NPDB. Payments include jury awards and settlements (Lowes, 7/12).

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Health Information Technology

Study: Online Medical Records -- Accessible By Patients -- May Aid Preventive Care

Reuters: Interactive Health Records May Boost Preventive Care
Medical records that patients can access online may encourage more people to get recommended screening tests and immunizations, a new study suggests. In a clinical trial at eight primary care practices, researchers found that patients who used such "interactive" health records were more likely to become up-to-date on recommended preventive care (Norton, 7/12).

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State Watch

Ariz. Abortion Law Challenged In Lawsuit; Mo. Gov. Vetoes Contraception Bill

News outlets look at these developments in states and also assess overall efforts this year by state legislatures to restrict abortions as some states to continue to press against the Obama administration's contraceptive coverage mandate.

NPR: State Legislatures Stay Busy On Abortion Laws
2011 was a banner year for state laws restricting abortion. And 2012 looks like runner-up. That's the central finding of the midyear report from the Guttmacher Institute, the reproductive policy research group that keeps track of such things. There were 39 laws restricting abortion enacted in the first half of 2012. While that's less than half the 80 put in place during the first half of last year (Rovner, 7/12).

The Associated Press: GOP Pressing On With Contraception Lawsuit
Seven states trying to block part of the federal health care law that requires contraception coverage will continue with their lawsuit despite last month's U.S. Supreme Court ruling that upheld most of the law, according to Nebraska Attorney General Jon Bruning, who is leading the case. The federal lawsuit is challenging a rule that requires contraception coverage in health care plans -- including for employees of church-affiliated hospitals, schools and outreach programs. The suit argues that the rule violates the rights of employers that object to the use of contraceptives, sterilization and abortion-inducing drugs (Schulte and Murphy, 7/12).

The New York Times: Lawsuit Tries To Block New Arizona Abortion Law
A group of doctors and women's rights advocates challenged Arizona's new abortion limits in a federal lawsuit on Thursday, claiming that they violate the Constitution and pose a threat to women's health (Eckholm, 7/12). 

Reuters: Rights Groups File Suit Challenging Arizona Abortion Ban
Rights groups challenged a controversial Arizona law banning most abortions after 20 weeks of pregnancy on Thursday, seeking to block the measure before takes effect in early August. The law was signed by Republican Governor Jan Brewer in April, handing Republicans a win in an ongoing national drive to impose greater restrictions on abortion in a presidential election year (Schwartz, 7/12).

Arizona Republic: Lawsuit Challenges Arizona Abortion Restrictions
Three Arizona abortion providers went to federal court Thursday to try to block an Arizona law that bans most abortions beginning at 20 weeks. They are seeking a preliminary injunction to stop the law before it takes effect Aug. 2. The suit alleges the legislation violates the protections outlined in the U.S. Supreme Court's Roe vs. Wade decision, which permits abortions before a fetus is viable (Pitzl, 7/12).

St. Louis Beacon:  Nixon Vetoes Measure Targeting Coverage Of Contraceptives
Days before the deadline, Missouri Gov. Jay Nixon has vetoed a bill that would have allowed employers to decline to provide coverage for abortion, contraception or sterilization.  In his veto letter made public this morning, the governor said that state law already "provided strong religious protections"’ that allow employers to decline to provide coverage for abortion or contraceptives.  But Nixon said the new bill, SB 749, extended such rights to insurance companies and would allow them to deny such coverage "even if that position is inconsistent with the right and beliefs of the employee or employer" (Mannies, 7/12).

Reuters: Missouri Law To Deny Birth Control Coverage Vetoed
Missouri's Democratic Governor Jay Nixon on Thursday vetoed a bill that could have resulted in women being denied insurance coverage for contraception, in the latest battle over Catholic Church objections to providing birth control coverage as part of the new health care law. Republican lawmakers in Missouri drafted the law in response to President Barack Obama's policy of requiring insurers to cover birth control for free as part of the new federal health care law, even if they work for a church or other employer that has a moral objection (Murphy, 7/12).

Kansas City Star: Override Of Nixon's Veto Of Contraception Insurance Limits Predicted
A bill allowing Missouri employers to choose whether to cover contraception and abortion services may still become law, despite Gov. Jay Nixon's veto Thursday. Lawmakers of both parties said the veto was primed for an override when lawmakers reconvene in September. "I'd put it at a 100 percent chance that we'll pass an override in the Senate, and I would put it in the 95 percentile that the House does it, too," said Sen. Will Kraus, a Lee's Summit Republican (Kraske, 7/12).

The Associated Press: More Abortion Restrictions Anticipated In Miss.
The owner of Mississippi's only abortion clinic said Thursday she expected legislators to keep trying to put new restrictions on the facility and the procedure, regardless of how a federal judge rules in a fight over a new state law. "They've made their intent quite clear," Diane Derzis told The Associated Press. "They're going to keep coming back. They're not going to be satisfied until they have driven us out of business. I think everybody can see that” (Pettus, 7/12).

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Minn. Attorney General Files New Paperwork To Support Accretive Lawsuit

The Minnesota attorney general, who is suing Accretive Health over its patient bill-collection practices, filed a memorandum in federal court citing additional patient claims to buttress the action against the debt-collector.

Modern Healthcare: New Patient Claims Added To Accretive Case
Minnesota's attorney general filed a memorandum in federal court with new patient claims to support the state's lawsuit against Accretive Health. … The memorandum includes affidavits from an additional 10 patients (Lee, 7/12).

(St. Paul) Pioneer Press: Accretive Health: Swanson Adds More Cases To Lawsuit Critical Of Collection Practices At Hospitals
Minnesota Attorney General Lori Swanson has filed more paperwork to support her legal claims against Accretive Health Inc., this time highlighting cases of what she calls "reprehensible" collection tactics in emergency rooms while children were being treated. Swanson's filing Thursday, July 12, responded to an Accretive Health motion earlier this month in which the Chicago-based health care consulting firm asked a judge to dismiss Swanson's second amended complaint. Swanson alleges that Accretive Health violated state and federal privacy laws, state debt-collection laws and state consumer-protection laws through its work from 2010 to 2012 at Minneapolis-based Fairview Health Services (Snowbeck, 7/12).

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State Roundup: Stark Price Differences At Calif. Hospitals

A selection of health policy stories from California, Massachusetts and Florida.

Los Angeles Times: Fresno, Orange County Rank Lowest On Hospital Prices, Study Show
The typical patient in the San Mateo area was charged nearly $48,000 for a Cesarean birth in 2010 while the average charge in Fresno was less than $13,000, according to a report published Thursday by the California Public Interest Research Group's Education Fund, a nonprofit consumer advocacy organization (Terhune, 7/12).

California Healthline: Similar Procedures, Different Prices At California Hospitals
The cost of many hospital services varies widely across the state -- with some facilities charging two or three times as much for a similar procedure, according to a report released yesterday by the California Public Interest Research Group. Higher cost at one hospital doesn't necessarily mean higher quality, according to Pedro Morillas, CalPIRG's legislative director. … The report, "Your Price May Vary: Geographic Variation in Hospital Charges in California," said that some cost disparities could be attributed to regional differences -- such as the $144,900 price tag for angioplasty in the San Jose area, compared to a charge of $44,400 for the same thing in Bakersfield (Gorn, 7/13).

Boston Globe: Mass. Health Coverage Architects In Demand In Other States
Kevin Counihan, an architect of the online insurance exchange that was key to expanding health care coverage in Massachusetts, found himself playing a familiar role this week -- briefing state officials on how to create a new health insurance marketplace. … Counihan was addressing the Governor’s Health Care Cabinet in Connecticut, which like many states is scrambling to build from scratch the insurance apparatus called for in President Obama’s new health care law. Nowhere is there more experienced talent for the job than in Massachusetts, which developed the nation’s first and only universal health coverage system six years ago (Weisman, 7/13).

The Associated Press/Boston Globe: Mass. Lawmakers Save Hospital, Reject Governor's Plans
The 150-year-old Taunton State Hospital, which was on Governor Deval Patrick's chopping block, got a reprieve Thursday as lawmakers voted to override his veto and keep the psychiatric hospital open. The state Senate rejected Patrick’s budget veto to close the hospital in Southeastern Massachusetts. The House of Representatives overrode the veto Wednesday (Young, 7/13).

Health News Florida: Surgeon Gen. Blasts Post Article
A war of words has erupted between one of the state's major newspapers and Dr. John H. Armstrong, who is both Florida's Surgeon General and secretary of the Department of Health. In a statement sent to the media via e-mail Wednesday afternoon, Armstrong called an article about an outbreak of tuberculosis that appeared in the Palm Beach Post this week inaccurate, misleading and "reckless." The headline on the article by Post reporter Stacey Singer was "Worst TB outbreak in 20 years kept secret" (Gentry, 7/12).

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Health Policy Research

Research Roundup: Medication Adherence, Performance At Community Health Centers

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

Archives of General Psychiatry: Effects of Medicare Part D Coverage Gap On Medication And Medical Treatment Among Elderly Beneficiaries With Depression -- For people diagnosed with depression, it's important that they adhere to their medication regimen so that they avoid recurrent episodes. But because of Medicare's Part D coverage gap, financially burdened seniors might not take their prescriptions as recommended. This study looked at Medicare beneficiaries diagnosed with depression in 2007. Those falling into the Part D gap reduced their monthly antidepressant use by 12.1 percent, while those who had at least generic drug coverage reduced their monthly use by 6.9 percent. These disruptions in medication use "could place older adults in harm's way," the authors write (Zhang et al, 7/2)

American Journal of Preventive Medicine: Federally Qualified Health Centers And Private Practice Performance On Ambulatory Care Measures --  Federally qualified health centers and similar community facilities are expected to carry a large share of the burden from the health law's expansion of insurance coverage. This study compares such providers to private practice primary care on 18 different quality measures. Overall, FQHCs and FQHC-like providers performed evenly with private practice, but they also performed better in areas including depression and heart disease treatment. The researchers write that the findings "can provide policymakers with some reassurance as to the quality of chronic disease and preventive care" at community health centers (Goldman et al, 7/10).

Archives of Internal Medicine: Effect Of A Pharmacist Intervention On Clinically Important Medication Errors After Hospital Discharge: A Randomized Trial -- Ensuring patients understand and stick to their medication regimen after they leave the hospital is an important part of improving outcomes and avoiding readmissions. One strategy is to provide direct contact with a pharmacist who counsels the patient and follows up via telephone. Researchers compared this intervention to the usual discharge care and found no significant difference in outcomes. Both patient groups averaged around the same number of adverse drug events in the 30 days after discharge; those with extra help had only a slight improvement in the number of medication errors that could lead to an adverse event. The researchers concluded that more-intensive care, including further follow-up with patients, may be necessary (Kripalani et al, 7/3).

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

Medscape: Standardized Asthma Care For Kids May Not Improve Outcomes
Emergency departments (EDs) that use evidence-based standardized protocols (EBSPs) to treat children with asthma have similar rates of hospital admissions as EDs that do not use EBSPs, according to a new Canadian study. The findings were published online July 9 in the Archives of Pediatric Adolescent Medicine (Garcia, 7/9).

Medscape: Use Of Generic Drugs Reduces Costs Of AIDS Relief
Since its inception nearly a decade ago, a US program for supplying AIDS medications to the developing world has grown significantly. Meanwhile, costs of treatment per patient have dramatically fallen. The primary reason? The increasing availability of generic antiretroviral drugs, according to a review article published in the July issue of Health Affairs. The President's Emergency Plan for AIDS Relief (PEPFAR) was set up in 2003 with the aim of supporting prevention, treatment, and care efforts in 15 focus countries in the developing world (Fox, 7/9).

Medscape/Reuters: On-Screen Smoking May Turn Teens On To Cigarettes
Youths who watch a lot of movies with cigarette-smoking characters -- whether the films are rated R or PG-13 -- are more likely to start smoking themselves, researchers suggest in a new study out Monday. The report's lead author said the finding supports the idea that it's the smoking itself -- and not the sex, profanity or violence that may go along with it in certain films -- that influences youths to take up the habit (Pittman, 7/9).

Reuters: Patients Avoid Disagreeing With Doctor, May Ignore Advice
Most people are unwilling to contradict their doctor in discussions on medical treatment, according to a U.S. survey showing that most want a say in treatment decisions or they may end up not following the advice. The findings, which appeared in the Archives of Internal Medicine, are based on an online panel of 1,340 adults who were told to imagine they had heart disease and then asked how they wanted to be involved in their own treatment (Pittman, 7/12).

Modern Healthcare: EHR Use Leads To Improved Image Review: Study
Using an electronic health record to review portal images can lead to improvements in patient care and safety, according to a new study. The study—results of which are published in the July issue of the Journal of the American College of Radiology—found that use of an EHR improves compliance with record-keeping and timeliness policies. Better compliance, in turn, can improve patient care and safety, the authors said (Lee, 7/10).

Reuters: Expensive, Newer Stents Not Better For All -- Study
Many heart patients get newer, pricey stents inserted during artery-clearing procedures, even if it's not clear they would be worse off with more basic, less expensive stents, a new study suggests. The new findings are an example of ways technology gets overused and at times misused in healthcare, according to a commentary accompanying the study (Pittman, 7/9).

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Editorials and Opinions

Viewpoints: Wis. Gov. Calls Obamacare 'Bad Policy;' 'DoThe Math' Before Deciding On Medicaid Expansion

The Washington Post: Obamacare Is An Unhealthy Prescription
Since the Supreme Court upheld President Obama's health-care mandate, there has been exhaustive discussion about the philosophical basis of this federal law. As Election Day approaches, debate will surely grow about the proper role of our federal government. But while much attention has focused on Congress's intention to repeal or replace the Affordable Care Act, too few are studying the law's practical impact. The best place to see the effects of the law is in our nation's laboratories, the states. Although the Supreme Court has ruled on the constitutionality of the act, Wisconsin shows that it is bad policy (Wisconsin Gov. Scott Walker, 7/12).

Houston Chronicle: Let's Do The Math Before Deciding On Medicaid Expansion
We need to engage in reality-based math before rejecting existing or expanded Medicaid with all of its intrusions…. Medicaid indeed troubles states like Texas that struggle to raise taxes. But before we give up an opportunity to get a lot of benefit for a relatively low cost because we can't accept paying money via taxes instead of insurance premiums or hospital bills, we need to get beyond labels and convenient but sloppy math (Seth J. Chandler, 7/12).

Kansas City Star: Nixon Should Use, Not Hoard, Political Capital
Obamacare haters in the Missouri legislature immediately vowed that Missouri would not raise its limits, which currently cover adults at a measly 19 percent of the poverty level. Nixon could lead on this issue. He could say clearly, as he did in his campaign four years ago, that Missouri's very low limits are "a wrong, mistaken policy that (have had) a horrific effect on working parents." He could say he will do all in his power to persuade the legislature to raise the limits and take advantage of the billions of dollars in federal aid that would pour into Missouri to boost the state’s medical infrastructure. But when asked this week about the limits, all Nixon would say is "It's complicated" and assure us he's working through it (Barbara Shelley, 7/12).

Fox: We, The People, Must Save Health Care
Our focus should be on the question, "How do we stop what is certain to be a threat to every freedom that crosses its path?" ... Congress made this mess; it's not up to the Supreme Court to fix it. And if the mess is going to get cleaned up, it's up to the people (Tony Perkins, 7/11).

The Wall Street Journal: Medicaid Moment Of Truth
In medicine, the treatments known as heroic measures pose grave risks to patients but are performed anyway because the alternative is certain death. That also more or less describes what Chief Justice John Roberts did to save the Affordable Care Act, and now the entitlement faces another challenge, especially in the states (7/12).

Reuters: How One Model State Is Implementing Healthcare Reform
Now that the U.S. Supreme Court has ruled on healthcare reform, the front line of the battle moves to the states. ... To get a sense of what's at stake, consider Maryland - a state that has been moving aggressively to implement the ACA since President Obama signed it in 2010. The state expects to hit all the federal deadlines to be ready to go in January 2014 (Mark Miller, 7/12).

MinnPost:  Roberts' Health-Care Ruling Is Based On A Strategic Inconsistency
By now anyone paying attention knows that Supreme Court Chief Justice John Roberts' ruling determined the Affordable Care Act to be constitutional because the penalty that enforces the individual mandate is a tax. Less well known is that Roberts' ruling also declared the opposite: The penalty that enforces the individual mandate is not a tax. Roberts' reasoning is inconsistent and strategic. It enables him to do two things he otherwise could not do in the same ruling: declare the ACA constitutional and limit congressional power under the commerce clause (Jeffrey L. Bineham, 7/12).

Baltimore Sun: Universal Health Care On The Horizon
U.S. Chief Justice John G. Roberts Jr. and the Supreme Court have not only upheld the Affordable Care Act, they struck down a barrier to universal health care for Americans. Looking forward from the Supreme Court's decision, by defining the cost of expanding coverage as a tax, the court has moved our thinking toward universal health care as a proper cost of the country's well-being (Dr. James Burdick, 7/12).

The Hill: Perilous Precedent For Any President
The religious exemption the Obama administration has provided in its HHS regulations supports the conclusion that the president wants evangelical and Catholic voices out of the public square and consigned to roles on Sunday mornings. The so-called "accommodation" by the administration to shift the cost of abortion-inducing drugs and sterilization to insurers is a farce, an accounting gimmick. That is why groups like little Ave Maria University are in federal court (Jim Towey, 7/11).

Des Moines Register: People Need Insurance, Not Symbolism
The vote was a variation of something [House Republicans] have done 30 times before. With Democrats occupying a majority of seats in the U.S. Senate and with a Democrat in the White House, the House Republicans' vote was purely symbolic and will not affect a single American's access to health insurance. But lawmakers should not be let off the hook for their votes. As the Nov. 6 election approaches, Iowans should ask Republican Reps. Steve King and Tom Latham what they intend to do if their dream to kill health insurance reform becomes a reality. What are their plans to insure as many Americans as the health law does (7/12)?

Denver Post: Hot Shots Earn Health Insurance
The wildland firefighters who inhaled smoke and ash as they desperately worked to save Colorado homes deserve more than our gratitude — they also deserve health insurance, even the part-timers. We were heartened that President Obama, who recently visited Colorado's fire zones, saw it the same way. On Tuesday, the president ordered his administration to offer health insurance to seasonal, federal firefighters, a group previously denied such coverage (7/12).

Journal of the American Medical Association: The Uncertainty Is Not Ending
With the long-awaited ruling by the Supreme Court on the Affordable Care Act (ACA)—notably the Court’s assertion that the individual mandate is constitutional, as well as its finding that the requirement that states expand their Medicaid coverage or lose all Medicaid money is coercive—some seem to think that "uncertainty" related to the ACA has ended. In fact, nothing could be further from the truth (Gail Wilensky, 7/12).

Health Policy Solutions (a Colo. news service): Stigma A Barrier To HIV Treatment Despite Medical Advances
Today, with access to medical treatments and care, HIV need not lead to AIDS and death. Indeed, people living with HIV can expect a high quality of life and normal life span. But decreased death and better medicines have led to false perceptions that HIV isn't a serious health threat or that people are no longer at risk. We are concerned that these beliefs and other societal barriers have kept our state's diagnosis rate, averaging 430 Coloradans per year, from declining over the past decade (Dr. Benjamin Young and Dr. David Cohn, 7/13). 

The Washington Post: Medicine That Is More Placebo Than Cure
Some drugs that the World Health Organization (WHO) has approved for distribution to the world's poor are of inferior quality — shoddy products that hurt people who urgently need medicine — and some of the manufacturers, predominantly Chinese and Indian firms, may be knowingly producing them. This is the conclusion of my research teams' studies, published this week in the journal Research and Reports in Tropical Medicine (Roger Bate, 7/12).

Houston Chronicle: Good Incentive On Childhood Cancer Drugs
We don't necessarily fault the drug companies for their choice not to deliver these drugs. They are incentivized by the system in place to do good by doing well, and that means creating drugs that help large numbers of patients and, in the process, yield healthy bottom lines for the companies. But that is scant consolation for the families of children caught in the middle. They deserve better than to be effectively abandoned because their illness doesn't fit the economic model dictated by the U.S. health care system (7/12).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.