Daily Health Policy Report

Monday, July 15, 2013

Last updated: Mon, Jul 15

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

'Wildfire' Growth Of Freestanding ERs Raises Concerns About Cost

Kaiser Health News staff writer Phil Galewitz, working in collaboration with USA Today, reports: "In this fast-growing Houston suburb, six ERs are just a short drive away. She chose Texas Emergency Care Center, a facility that feels like a Western lodge with its earth-toned brick walls, leather chairs and coffee bar. The eight-bed ER that opened last year has almost everything -- except, that is, an attached hospital" (Galewitz, 6/15). Read the story.

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Kentucky's Rush Into Medicaid Managed Care: A Cautionary Tale For Other States

Reporting for Kaiser Health News, in collaboration with The Washington Post, Jenni Bergal writes: "Kaden Stone loves playing baseball, riding his bike and watching Duck Dynasty on TV at his red-brick ranch-style house in rural south central Kentucky. Despite his energy, the tiny boy of eight with a crewcut and missing front tooth can't eat much, the result of congenital bowel problems that have required dozens of surgeries and procedures. He needs PediaSure, says his mother, who was shocked when Kaden's Medicaid managed care plan stopped paying last fall for the expensive nutritional drink, saying it was not 'medically necessary'" (Bergal, 7/15). Read the story.

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Capsules: 7 States, Governors Team To Tackle Hospital 'Frequent Flyers'; State Insurance Exchanges Launching TV Ads To Encourage Enrollment

Now on Kaiser Health News' blog, Kelsey Miller writes about hospital frequent flyers: "Seven states and the National Governors Association are teaming up to find ways to save money and better coordinate the care of Medicaid and uninsured patients who frequently use hospital emergency rooms and other costly health services" (Miller, 7/12).

In addition, Phil Galewitz reports on state insurance exchanges' efforts to encourage enrollment: "A folk singer playing guitar in front of a mountain stream. A Disney-like animated video about how 'a new day is coming.' An announcer talking about "change is here." A woman jumping up and down in celebration in a baseball team locker room. These images are from the first television advertisements being aired by state-run health insurance exchanges created under the federal health law. Oregon, Kentucky, Colorado and Connecticut produced them. Several more states, including Hawaii and Vermont, are expected to launch ads in the coming weeks, ahead of the Oct. 1 start of open enrollment" (Galewitz, 7/15). Check out what else is on the blog.

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Political Cartoon: 'Swing Vote?'

Kaiser Health News provides a fresh take on health policy developments with "Swing Vote?" by Adam Zyglis.

Meanwhile, here is today's health policy haiku:


Is it "wonderful?"
Or "massive, complicated?"
Eye of beholder

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

Health Exchange Countdown: Insurers, Regulators Test Drive New Plans, TV Ads

News outlets report on how the health law's online health insurance marketplaces will work, the products that will be available through them and the efforts to enroll millions of uninsured or underinsured people.

Reuters: Analysis: Obamacare Struggles To Meet Make-Or-Break Deadline
With time running out, U.S. officials are struggling to cope with the task of launching the new online health insurance exchanges at the heart of President Barack Obama's signature health reforms by an October 1 deadline. ... Current and former administration officials, independent experts and business representatives say the three priorities are the creation of an online portal that will make it easy for consumers to compare insurance plans and enroll in coverage; the capacity to effectively process and deliver government subsidies that help consumers pay for the insurance; and retention of the law's individual mandate, which requires nearly all Americans to have health insurance when Obama's healthcare reform law comes into full force in 2014 (Morgan, 7/14).

Dallas Morning News: Medicare Chief: Things Are On Track In Carrying Out Health Care Law
We’re less than three months away from the start of open enrollment for the health insurance exchanges created by the Affordable Care Act, and Marilyn Tavenner is busily trying to spread the word. Tavenner manages the Centers for Medicare & Medicaid Services, the $820 billion federal agency charged with implementing the rollout of the exchanges. The state-based exchanges will enable individuals and small businesses to shop for health plans. … Tavenner came to Dallas last week to address a conference of the National Association of County and City Health Officials and to enlist members’ help in spreading the word about the exchanges. She also visited with business and health care leaders (Yip, 7/14).

The Wall Street Journal: Insurers Test Drive New Health Plans
The federal health overhaul's big requirement that most people carry health insurance is still months away, but already insurers like Blue Cross & Blue Shield of Rhode Island have a sense of what will matter most to consumers: price. "To me, it's all about money," said Rob Roy, who compared plans in a consumer test for the insurer. Currently uninsured and working as a cook in a pub, Mr. Roy said he found the choices too expensive. He ended up opting for a competitor's plan instead of Blue Cross (Mathews, 7/14).

The Wall Street Journal: Insurers Seek Right Balance Of Risk, Reward
In the insurance business, some customers are more desirable than others—and insurers will be seeking to woo them in preparation for the health law's new marketplaces. Customers not only bring revenue in the form of the premiums they pay. They also come with costs, since the insurer will be on the hook for medical expenses (Mathews, 7/14).

The Wall Street Journal's Corporate Intelligence: How Will Health Insurance Exchanges Work?
This fall, people in every state are supposed to be able to buy health insurance through new online marketplaces, or exchanges, instituted by the federal health-care law. Insurers have been preparing for the rollout with research, trying to figure out what products to offer and how to market them. For consumers, here are some important questions and answers about the exchanges (Mathews, 7/14).

Bloomberg: Obama's Employer Health Care Delay May Goose Exchange Enrollment
Freeing companies from a U.S.- government mandate to offer employees health care is setting off a chain of events that may enlarge the pool of uninsured Americans. That may be good for President Barack Obama’s health-care overhaul. The success of the 2010 Affordable Care Act is largely dependent on how many people are willing to buy subsidized health plans through government exchanges (Wayne, 7/15).

Kaiser Health News: Capsules: State Insurance Exchanges Launching TV Ads To Encourage Enrollment
A folk singer playing guitar in front of a mountain stream. A Disney-like animated video about how "a new day is coming." An announcer talking about "change is here." A woman jumping up and down in celebration in a baseball team locker room. These images are from the first television advertisements being aired by state-run health insurance exchanges created under the federal health law. Oregon, Kentucky, Colorado and Connecticut produced them. Several more states, including Hawaii and Vermont, are expected to launch ads in the coming weeks, ahead of the Oct. 1 start of open enrollment (Galewitz, 7/15).

MPR News: Health Care Town Hall Meeting Set For Tuesday
Several DFL lawmakers will hold a health care town hall meeting Tuesday to explain how the new health care law will affect Minnesotans and answer their questions. One of those lawmakers, Sen. Bobby Joe Champion of Minneapolis, said there has been a lot of anxiety surrounding the health care law and he hopes the forum will quell some of those fears. … The marketplace, MNSURE, will allow Minnesotans to enroll in health coverage including government programs and commercial insurance starting this fall for coverage that begins Jan. 1 (Stawicki, 7/14).

CQ HealthBeat: Debate Over Abortion Moves To Coverage In New Marketplaces
Abortion rights advocates are fighting on two fronts right now: the public abortion debates in statehouses that have drawn national attention, and a more quiet initiative intended to ensure that the procedure is covered in the new health law marketplaces opening this fall (Adams, 7/12).

Also in the news, the latest on navigators --

The Hill: HHS Releases Final Rules For ObamaCare 'Navigators'
The Health and Human Services Department on Friday finalized rules for the "navigators" who will help people make sense of their options under ObamaCare. In a 145-page regulation, HHS finalized standards for training and certifying navigators (Baker, 7/12).

CQ HealthBeat: Final Navigator Rule Calls For 30 Hours Of Training
The Centers for Medicare and Medicaid Services released a final regulation late Friday that calls for 30 hours of training for "navigators," the people who will be charged with providing expert advice on a wide range of issues to people signing up for insurance coverage under the health law. The rule also outlines standards for certified application counselors, who will also help people with their questions about how to get coverage (Reichard, 7/12).

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Ripple Effect Of Employer Mandate Delay Seen On Policies, Politics

Politico reports on how the Obama administration's decision may create some difficulties for employers. Other media outlets detail how Republicans will try to capitalize on it this week on Capitol Hill.

Politico: Mandate Delay A 'Full Time' Headache For Employers
Restaurants and other employers essentially got an extra year to push for Obamacare changes when the administration delayed the law's employer mandate. But it isn't as good as it sounds. The decision to delay the mandate until 2015 left two big sticky issues standing in the way for employers: a lowered sense of urgency in Congress to enact the changes they want and sharp divisions among House Republicans over how to approach the law (Cunningham, 7/15).

The Hill: Week Ahead: GOP Focuses On Employer Mandate Delay
Congressional Republicans this week will continue trying to capitalize on the Obama administration's decision to delay part of ObamaCare. The House is set to vote this week on bills to delay both the employer mandate and the individual mandate (Baker, 7/15).

Fox News: House Republicans To Vote On ObamaCare, Say Obama's Delay Of Employer Mandate Unfair
House Republicans will vote this week to delay the part of ObamaCare requiring Americans to buy health insurance by next year, arguing that President Obama recently delaying the part of the law requiring employers to offer health insurance is a corporate favor that slights struggling, average Americans. In announcing the vote last week, House Speaker John Boehner said the Republican-controlled chamber also will vote to delay the so-called employer mandate because such decisions require congressional authority, then rattled off a list of reasons why delaying only the employer mandate is unfair (7/14).

And how the initial advertising campaign is sidestepping the issue of the mandate --

Politico: Obamacare's Missing Mandate
The massive coast-to-coast campaign to get people to sign up for Obamacare is light on mentions of one central element: the widely disliked individual mandate. Poll after poll has found that Americans don't like being told they have to get insurance or face a penalty. So the groups doing outreach don't plan to draw much attention to it. ... The early stages of the enrollment push has been all honey and no vinegar (Millman, 7/13).

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Health Law Opponents Using Campaign-Style Maneuvers

NBC News looks at the political tactics of conservatives hoping to derail the health overhaul. Meanwhile, one senator's attempt fails to cut funding and stop implementation. 

NBC News: Campaign-Style Tactics Used In Obamacare Implementation Fight
Campaign-style ads, legislative votes to get politicians on the record, and bitter rhetoric are nothing new when it comes to electioneering. But these partisan plays are being utilized in the battle over Obamacare; a fight centered on the implementation of an already-passed law, not a congressional seat up for grabs . ... In reaction to the delay and the change in income verification, Republicans are arguing that the Obamacare rollout is turning out to be the "train wreck" that Senate Finance Committee Chairman Max Baucus, D-Mont., warned of last April (Curry, 7/14).

Kansas Health Institute: Moran Fails To Block Key Parts Of Health Reform Law
Democrats on the U.S. Senate Appropriations Committee rejected several attempts Thursday by Kansas Sen. Jerry Moran to block implementation of key parts of the federal health reform law. Moran, a Republican, attempted to rescind funding needed by the Department of Health and Human Services to establish new online insurance marketplaces in every state and implement the controversial coverage mandates in the Affordable Care Act, or Obamacare (McLean, 7/12).

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Health Overhaul Scam Opportunities Emerge

As the health law roll-out continues, more attention is being paid to the opportunities it may create for scammers and fraudsters.

McClatchy/The Washington Post: Little Understanding Of Health-Care Law Opens Door For Scams
If a stranger claiming to be from the government calls to offer you an "Obamacare card" or threatens to throw you in jail unless you buy insurance, hang up the phone. It's a scam. Fraudsters are poised to take advantage of widespread confusion over the Affordable Care Act -- also known as Obamacare -- to steal Americans' credit cards, Social Security numbers and other personal information, consumer advocates and government officials say (7/14).

CNN Money: Scamming Obamacare Harder Than You Think
The way some people have interpreted the latest Obamacare rule change, you'd think the administration was inviting people to steal from the government. Officials announced on July 5 that insurance exchanges could relax how they verify the income of people who apply for federal financial help in the first year. But experts say the temporary change won't necessarily make it easier to scam the system. The subsidies at issue are meant to help people who can't afford to pay full freight for health insurance. Generally speaking, the less you make, the bigger the subsidy you get (Sahadi, 7/15).

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Insurers Could Be Caught In Health Law's Smoker Glitch

As the health overhaul's implementation marches on, the Obama administration has limited a provision relating to the cost of smokers' premiums and one news outlet looks at the effects on plans available to college students.

The Wall Street Cheat Sheet: Watch Out Insurers, This Obamacare Glitch May Be A Challenge
Obamacare regulations intended that older insurance enrollees could be charged up to three times more than younger people, while a smoker could be hit with a surcharge of up to 50 percent. At least that was how the system was supposed to work. A glitch in in the code running the federal computer systems that operate the health insurance exchanges could limit the penalties charged for most smokers, proportionally increasing the insurance costs for younger tobacco users. This error will only add to the problems bogging down the implementation of Obamacare as it will prevent the system from functioning as it was designed (Foley, 7/13).

The Wall Street Journal: A Cure For Student Health Woes?
Student health-insurance plans are getting better—and pricier. Just a few years ago, such plans were under fire for skimpy annual benefit limits that often topped out well below $100,000. Some plans didn't cover prescription drugs or treatment for mental-health or substance-abuse problems. Those days are gone. Under the Affordable Care Act, the minimum annual benefits limit will jump to $500,000 for the 2013-14 school year, up from $100,000 in 2012-13 (Blumenthal, 7/13).

In other health care news --

Marketplace: Affordable Care Act May Free Some From Working For Health Insurance
There are lots of predictions the Affordable Care Act will force employers to lay off employees, reduce hours, and cut seasonal positions. But a report released Monday from the National Bureau of Economic Research finds that up to nearly 1 million workers may voluntarily leave their jobs because of the new health care law. For empirical evidence of this, the authors point to something dramatic that happened in Tennessee back in 2005. Finances forced state officials to kick 170,000 people off the Medicaid program, which primarily serves low-income residents (Gorenstein, 7/15).

Reuters: U.S. Community Health Centers Eye Obamacare's Newly Insured
Community health centers expect to sign up millions of newly insured patients under President Barack Obama's health reform law, but U.S. budget cuts just as they need to beef up services may make it hard to keep the newcomers. ... with scant funding to improve their services and level of care, the centers are scrambling to ensure they can keep the new patients. The fear is that, over time, many of the insured patients will look for better service at private practices and hospitals, diverting a fresh source of much-needed income for the centers (Abutaleb, 7/14). 

Minneapolis Star Tribune: Health Insurers To Soon Refund Excess Non-Medical Premiums
Checks will be going out to more than 8,000 Minnesotans and a number of businesses in the coming weeks in a rebate program established as part of federal health care reform. The Affordable Care Act requires health insurance companies to spend at least 80 cents of every dollar collected in premiums on medical care, as opposed to marketing, commissions, administration and profits. Insurers that fall under the mark must return the difference to consumers and businesses in a check or premium rebate (Crosby 7/12).

NBC News: Breastfeeding Venture Aims To Milk Obamacare
An Obamacare rule that entitles moms to free breast pumps and breast-feeding services from their insurers is opening new business opportunities for breastfeeding supporters—and encouraging healthier babies and mothers at the same time. The venture's pitch to insurance companies and big firms that self-insure: Use their service to obtain electric breast pumps for new moms, and then to provide those moms with lactation consulting services that will support them in the goal of continuing to breastfeed their babies (Mangan, 7/14).

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ACO Pioneers Face Decision Deadline

Modern Healthcare reports that Medicare Pioneers have until July 15 to let the Centers for Medicare & Medicaid Services know if they plan to stay in the program for a second year. Meanwhile, the Connecticut Mirror offers a picture of how accountable care organizations work.  

Modern Healthcare: Reform Update: Pioneer ACOs Face July 15 Decision Deadline
Medicare Pioneer accountable care organizations have until the end of the business day July 15 to inform CMS officials whether they plan to remain in the program for a second year. Also next week, the CMS is supposed to offer results of the program's first year, details about year two, and the names of those Pioneer participants that won't continue (Zigmond, 7/12).

CT Mirror: Trying To Find A New Way To Pay For And Deliver Health Care
One of the patients in Doug Arnold's new medical network received care from 99 different health care providers in the past three years, costing Medicare $375,000. And although that care might not have been optimal or cost-effective, from a financial perspective, no one in the health care system had an incentive to do things differently. "In a case like that, this person or their family members are just left to deal with all these providers on an episodic, uncoordinated basis," said Arnold, CEO of a Middletown-based group of doctors known as MPS ACO Physicians. … MPS ACO Physicians is one of a handful of Connecticut-based medical networks known as Accountable Care Organizations, or ACOs, an initiative for Medicare patients created by the federal health reform law (Becker, 7/12).

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Health Care Marketplace

Freestanding ERs, Urgent Care Centers, Frequent Flyers Change Marketplace

News outlets offer various reports on how emergency and urgent care facilities are affecting how America delivers health care.

Kaiser Health News: 'Wildfire' Growth Of Freestanding ERs Raises Concerns About Cost
In this fast-growing Houston suburb, six ERs are just a short drive away. She chose Texas Emergency Care Center, a facility that feels like a Western lodge with its earth-toned brick walls, leather chairs and coffee bar. The eight-bed ER that opened last year has almost everything -- except, that is, an attached hospital (Galewitz, 6/15).

Medscape: Urgent Care Centers Divert Patients From PCPs, EDs Alike
Urgent care centers (UCCs) save money by treating patients who otherwise may land in a more costly hospital emergency department (ED), but they also boost health care spending by diverting patients from primary care practices (PCPs), according to a new study published online today by the Center for Studying Health System Change (HSC). Given these findings, UCC executives, ED directors, and health plan network managers interviewed in the study are uncertain about the overall effect of UCCs on cost, write lead author Tracy Yee, PhD, and coauthors. On a more positive note, these health care industry figures generally perceive UCCs as improving access to some services for privately insured patients "without significantly disrupting continuity of care," according to the study, which focused on 6 metropolitan areas (Lowes, 7/12).

Kaiser Health News: Capsules: 7 States, Governors Team To Tackle Hospital 'Frequent Flyers'; Now on Seven states and the National Governors Association are teaming up to find ways to save money and better coordinate the care of Medicaid and uninsured patients who frequently use hospital emergency rooms and other costly health services (Miller, 7/12).

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Women's Health

Reid Says He's Open To Senate Abortion Ban Vote

But the Senate leader warns that Congress shouldn't focus on "fringe" issues. Meanwhile, political analysts say the Republican push to limit abortions scores points with the party's conservative base, but could widen its "gender gap" in the 2014 elections.

The Washington Post: Reid Open To Vote On 20-Week Abortion Ban Senate 
Majority Leader Harry Reid (D-Nev.) said Sunday that he was open to allowing a vote on a House bill that would ban abortions after the 20th week of pregnancy. But he also suggested Congress shouldn't be focusing on such "fringe issues."... Reid is one of a few Democrats in the Senate who identifies as being against abortion rights (Blake, 7/14).

The Associated Press/Washington Post: Republicans Return Abortion To Front Burner For 2014 Elections, Democrats See Gain As A result
With no immediate hope of overturning the U.S. Supreme Court's decision legalizing abortion, Republicans around the country are increasingly pushing legislation to restrict the procedure, and Democrats say they'll make the GOP pay in coming elections. From statehouses to Congress, Republicans have advanced a range of ideas: banning nearly all abortions beyond the 20th week after conception; making abortion clinics follow regulations for surgical care; mandating that clinic physicians have admitting privileges at local hospitals; requiring women to get ultrasounds before terminating a pregnancy (7/15).

NBC News: Abortion Fights Risk Worsening GOP's Gender Gap 
Republicans may be tirelessly working to rebrand their party since losing last year's race for the White House, but a recent slew of state initiatives to restrict access to abortion isn't doing this effort any favors – and may only widen the party's so-called "gender gap" in attracting women voters. ... Yet despite the risk of alienating female voters, the campaigns have undoubtedly energized conservatives, particularly opponents of abortion rights who compose a cornerstone of the Republican base (O'Brien, 7/14). 

And Politico looks at a major anti-abortion player --

Politico: The Force Behind EMILY's List
Ask around about EMILY's List President Stephanie Schriock and two things become clear: She delivers results and isn't afraid to knock heads in the process. ... EMILY's List was a natural fit for Schriock: she said she first wanted to get involved in politics when she saw NARAL Pro-Choice America President Nancy Keenan, then the Montana Superintendent of Public Instruction, speak at her high school in Montana (Schultheis, 7/13).

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State Watch

Texas Senate Passes Abortion Restrictions, Opponents Vow Legal Fight

Texas Senate lawmakers have followed their House counterparts in approving a series of abortion restrictions. The move has opponents vowing to take their fight to the courtroom and doctors at abortion clinics are worried the legislation could force them to shut down.

The Washington Post: Texas Abortion Vote Joins Growing Legal Frenzy 
A sweeping set of abortion restrictions adopted by the Texas state Senate on Saturday is the latest in a series of state-level political fights triggering a frenzy of legal action that could determine how much access to abortion services American women have in the future. Abortion opponents hope that eventually some of cases will reach the U.S. Supreme Court (Eilperin, 713).

Fox News: Texas Dems Vow To Fight Abortion Bill Passed By Republican-Led Senate
Texas Democrats vowed to fight one of the most restrictive abortion bills in the nation passed by the state legislature late Friday in front of more than 2,000 protesters. "There will be a lawsuit. I promise you," Dallas Sen. Royce West said on the Senate floor, raising his right hand as if taking an oath. Democrats offered 20 amendments to the bill, which will ban abortions after 20 weeks, require abortion doctors to have admitting privileges at a nearby hospital and require all abortions to take place in surgical centers. They ranged from exceptions for rape and incest to allowing doctors more leeway in prescribing abortion-inducing drugs. But Republicans would have none of it (7/13).

The Associated Press: Texas Abortion Providers Fear Major Shutdowns
Dr. Howard Novick winces as he recalls treating two and three women a week for infections and complications from botched abortions. It was the early 1970s, before the procedure was legalized, and the experience persuaded him to devote his life to this area of medicine. Now, more than 40 years later, new abortion restrictions passed by the Texas Legislature could force Novick to close the Houston abortion clinic he opened in 1980 because, he says, he does not have $1 million to $1.5 million to convert his run-of-the-mill medical office into a fully loaded surgical center with wide corridors and sophisticated air-flow systems (Plushnick-Masti, 7/13).

Bloomberg: Texas Abortion Clinics Need Million-Dollar Fixes To Stay Open
Requirements for wider hallways, janitor closets and back-up generators will likely be the downfall of Amy Hagstrom Miller's abortion business in Texas. Texas lawmakers last week approved a law requiring that abortion clinics become hospital-like outpatient surgical centers, with detailed rules for how the buildings are designed (Deprez and Mildenberg, 7/15).

One option for women who want an abortion in Texas may be in Mexico --

The New York Times: A Pill Available In Mexico Is A Texas Option For Abortion 
At the Whole Woman's Health center here [McAllen, Texas], a young woman predicted what others would do if the state's stringent new abortion bill approved late Friday forces clinics like this one to close: cross the border to Mexico to seek an "abortion pill." ... In Nuevo Progreso, only yards past the Mexican border, pharmacists respond to requests for a pill to "bring back a woman's period" by offering the drug, misoprostol, at discount prices: generic at $35 for a box of 28 pills, or the branded Cytotec for $175 (Eckholm, 7/13).

Lawmakers in Missouri and North Carolina also passed abortion-related bills --

Reuters: Doctor Must Be Present For Drug-Induced Abortion In Missouri
A doctor will have to be present for any drug-induced abortion in Missouri starting on August 28 because Governor Jay Nixon on Friday allowed a measure passed by the state legislature to become law without his signature. Nixon, a Democrat, said he decided not to sign the law and made no further comment (Murphy, 7/12).

North Carolina Health News: House Approves Abortion Bill After Marathon Debate
With only one Republican dissenting from the majority, members of the North Carolina House of Representatives voted Thursday afternoon to enact sweeping changes to the state's abortion regulations. Senate Bill 353, a bill originally dealing with motorcycle safety, was quickly amended Wednesday to add a number of provisions carried over from a bill passed by the Senate just before the July 4th holiday (Hoban, 7/12).

North Carolina Health News: Interactive: Women's Reproductive Health And Abortion
For the past two weeks, North Carolina lawmakers have been debating bills that would change the state's regulation of abortion clinics, change the ability of health plans to cover the procedure, and ban the sex-selective abortions. This interactive map gives readers an idea of who and how many women in the state have had abortions (Hoban, 7/14).

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State Roundup: Ore. Seniors Get Special Medical Deduction, But Less Generous Than Hoped

A selection of health policy stories from Oregon, Connecticut, Kentucky, Texas and California.

Oregonian: Oregon Special Senior Medical Deduction Survives, Albeit Less Generously
Oregon Gov. John Kitzhaber and Democrats wanted to do away with it. Oregonian columnist Susan Nielsen opined against it. Even AARP was OK with its demise. But when the smoke cleared this week, the Oregon Legislature merely curtailed it. Beginning this tax year, only seniors age 62 or older can deduct out-of-pocket medical expenses, not their entire households (Hunsberger, 7/12).

Los Angeles Times: Six People Fired From Cedars-Sinai Over Patient Privacy Breaches
Five workers and a student research assistant at Cedars-Sinai Medical Center have been fired over privacy breaches involving patient medical records. Cedars-Sinai officials said in a statement that 14 patient records were "inappropriately accessed" between June 18 and June 24. Six people were fired over the breach: four were employees of community physicians who have medical staff privileges at the hospital, one was a medical assistant employed by Cedars-Sinai, and one was an unpaid student research assistant (Gorman and Sewall, 7/12).

The Lund Report: Workforce Demands Strain Health Care Reform In Ore.
Concern is growing about the pressure Oregon's health care workforce will experience once approximately 1.3 million Oregonians either become eligible for Medicaid or be required to purchase health insurance privately or through Cover Oregon, the state's developing health insurance exchange, when the federal Affordable Care Act is fully implemented in January 2014. "We've got a steam engine coming down the tracks in January 2014," said Dr. Lisa Dodson, chair of the Oregon Healthcare Workforce Committee and director of Oregon Health & Science University's Oregon Area Health Education Centers program (Waldroupe, 7/15).

CT Mirror: Malloy Vetoes Bills Regulating Medical Spas, Noncomplete Agreements
Gov. Dannel P. Malloy vetoed two bills Friday that would have limited the use of noncompete agreements by employers and imposed new standards on "medical spas" providing cosmetic medical procedures. With the two vetoes, Malloy was negating bills passed with the support of trial lawyers and labor lawyers and associations representing dermatologists and plastic surgeons. In his veto messages, the governor said both bills were deficient (Pazniokas, 7/12).

Kaiser Health News: Kentucky's Rush Into Medicaid Managed Care: A Cautionary Tale For Other States
Kaden Stone loves playing baseball, riding his bike and watching Duck Dynasty on TV at his red-brick ranch-style house in rural south central Kentucky. Despite his energy, the tiny boy of eight with a crewcut and missing front tooth can't eat much, the result of congenital bowel problems that have required dozens of surgeries and procedures. He needs PediaSure, says his mother, who was shocked when Kaden's Medicaid managed care plan stopped paying last fall for the expensive nutritional drink, saying it was not "medically necessary" (Bergal, 7/15). Read the story.

The Texas Tribune: Health Care Providers Bracing For Medicaid Enrollment
Under Gov. Rick Perry’s leadership, Texas will not expand Medicaid eligibility to poor adults. But enrollment in the state’s health program for indigent children and the disabled will still swell in 2014 under new rules created by the federal Affordable Care Act (Aaronson, 7/15).

Los Angeles Times: California Prisons Sterilized 148 Women Without Approval, Report Says
Dozens of women in California prisons were sterilized without the required approval of a state medical committee, officials said Friday. Some of the women say they felt coerced to undergo the surgery, and now state lawmakers are calling for an investigation (McGreevy and Willon, 7/13).

The Lund Report: OHSU Receives Higher Medicare Payments Than Other Oregon Hospitals
Sick Oregonians without health insurance regularly receive bills for two to three times what Medicare or private insurers are willing to pay to cover treatment, newly released medical billing data appears to indicate. The data, from the Centers for Medicare & Medicaid Services, shows how much hospitals are paid for treating Medicare patients (Sherwood, 7/15). 

California Healthline: Workforce Training, Stop-Loss Bills OK'd
The Assembly Committee on Health last week passed SB 20 by Sen. Ed Hernandez (D-West Covina), a bill that proposes to repay physician-training loans for doctors who choose to practice in medically underserved areas. "This bill is a modest attempt at [addressing] one of our biggest dilemmas -- not enough staff to care for the existing patients," Hernandez said. … The Assembly Committee on Health last week also approved another Hernandez bill, SB 161, the stop-loss insurance coverage measure. … Stop-loss insurance protects small employers and self-funded health plans from catastrophic losses (Gorn, 7/12).

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Editorials and Opinions

Viewpoints: Disability Insurance 'Time Bomb;' Leavitt On The Lessons Of Medicare Part D's Rollout; Boys And Eating Disorders

The Wall Street Journal: The 2016 Disability Insurance Time Bomb
Social Security for retirement and Medicare are the best known of the major entitlement programs with looming financial disasters. While some argue about when they will run out of money, their projected 75-year unfunded liabilities grow larger every year and now total $40 trillion, much worse thereafter. But the ticking time bomb of entitlement reform is Social Security's Disability Insurance Fund (Michael J. Boskin, 7/14). 

The Wall Street Journal: Why the President's ObamaCare Maneuver May Backfire
President Obama's announcement on July 2 that he is suspending the Affordable Care Act's employer health-insurance mandate may well have exposed his actions to judicial review—even though that is clearly what he sought to avoid (David B. Rivkin Jr. and Lee A. Casey, 7/14). 

The Washington Post: To Implement Obamacare, Look To Bush's Medicare Reform
This past spring, Sen. Max Baucus (D-Mont.) called the impending implementation of the Affordable Care Act "a huge train wreck." His words caught my attention because the last time the federal government delivered a new health-care benefit to more than 40 million people, I drove the train. As secretary of health and human services during President George W. Bush's second term, I faced the daunting task of rolling out Medicare’s new prescription drug benefit (Michael O. Leavitt, 7/12). 

Sacramento Bee: The Conversation: Take Employers Out Of The Insurance Business
President Barack Obama's recent decision to delay enforcement of penalties on employers who don't provide health insurance for their workers is a move that Democrats and Republicans should applaud and voters should welcome as a step in the right direction. The administration last month announced that it would postpone penalties of $2,000 per employee on companies with 50 or more workers who don't offer affordable insurance for their workforce. The official reason was that implementing the system on schedule Jan. 1 was going to be too complex for many employers to handle. The unofficial reason might be that Obama's advisers feared a major pushback from employers in a big congressional election year (Daniel Weintraub, 7/14).

Milwaukee Journal Sentinel: Walker's Obamacare Decision Looking Better
In mid-February of this year, as soon as Gov. Scott Walker announced that his budget would not use funds under the federal Affordable Care Act to expand Medicaid in Wisconsin, liberal groups began hyperventilating. "If Governor Walker turns down billions in federal money for BadgerCare, there is no doubt that many Wisconsinites will die as a consequence," said Citizen Action of Wisconsin Executive Director Robert Kraig. ... But while efforts abound to cast the governor as a chainsaw wielding madman ("Hide the kids! Scott Walker's on the loose!"), Walker's recently-passed budget actually expanded health coverage beyond his Democratic predecessor, Jim Doyle (Christian Schneider, 7/13).

NKY.com: Beshear Did Right Thing On Medicaid
We are so accustomed to complaining about the short-sightedness of our elected officials that sometimes we don't notice when a politician does a great thing. Let's consider Gov. Steve Beshear's decision that Kentucky will participate in Medicaid expansion under the Affordable Care Act (Obamacare). ... Medicaid expansion will insure some 308,000 Kentuckians, nearly 50 percent of Kentucky's uninsured (Richard Cullison, 7/13).

The New York Times: Do Clinical Trials Work?
[A]t the annual meeting of the American Society of Clinical Oncology last month, much of the buzz surrounded a study that was anything but a breakthrough. To a packed and whisper-quiet room at the McCormick Place convention center in Chicago, Mark R. Gilbert, a professor of neuro-oncology at the University of Texas M. D. Anderson Cancer Center in Houston, presented the results of a clinical trial testing the drug Avastin ... Gilbert's study found no difference in survival between those who were given Avastin and those who were given a placebo. ... The centerpiece of the country's drug-testing system — the randomized, controlled trial — had worked. Except in one respect: doctors had no more clarity after the trial about how to treat brain cancer patients than they had before (Clifton Leaf, 7/13). 

Los Angeles Times: Leveling The Field For Human Egg Donors
In the United States, there is a competitive market in human eggs provided for reproductive purposes. An "extraordinary" egg donor can earn as much as $50,000 when she offers her eggs to an infertile couple. In California, however, that same "extraordinary" individual would receive nothing, aside from payment for her direct expenses, if she provided those same eggs for research purposes. That could change soon (Naomi Cahn and June Carbone, 7/13). 

Boston Globe: Male Eating Disorders: Excessive Workouts To Blame?
Binging, purging, and diet-supplement abuses are traditionally viewed as women's-health issues. But recently, the Los Angeles Times reported that in Los Angeles county, young men are just as likely as women both to induce vomiting and abuse diet pills. This is part of a growing pool of evidence that eating disorders are affecting more men every year. Indeed, a 2011 Centers for Disease Control and Prevention study shows that around 3 percent of teenage boys in Boston have induced vomiting, and over 8 percent have fasted to control their weight (compared to 4 percent and 15 percent among girls). But while parents and teachers are on alert for signs of eating disorders in girls, they often fail to notice similar signs in boys (7/15).  

Texas Tribune: The Policy And The Politics Of The Abortion Debate
The Texas Capitol, quiet for most of the year, has been full of protesters and demonstrators off and on for the last month as lawmakers consider abortion legislation. Like all activists and partisans, they bring their props with them, including, in some cases, props who are related to them: kids. ... Children show up at all sorts of functions, even political ones. But even after all the years and all the fights, they can be an uncomfortable presence at a rally on this subject (Ross Ramsey, 7/15).

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Stephanie Stapleton

Andrew Villegas

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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.