Daily Health Policy Report

Tuesday, July 17, 2012

Last updated: Tue, Jul 17

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Campaign 2012

Quality

Administration News

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Even After Changing Policies, Some Consumers May Get A Rebate

In her latest Kaiser Health News consumer column, Michelle Andrews answers readers' questions involving health insurance rebates, coverage for same-sex spouses and benefits for pregnancy (Andrews, 7/16). Read the column.

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Capsules: Safety Net Hospitals Could Lose Money In Medicare Changes, Study Warns

Now on Kaiser Health News' blog, Jordan Rau writes: "When Medicare begins adjusting hospital payments in October based on quality, one of the primary metrics will be patient experience ratings that cover everything from the communication skills of doctors and nurses to their promptness in responding to complaints about pain. A new study finds that this change may add to the financial troubles of safety net hospitals, which primarily serve poor patients" (Rau, 7/16). Check out what else is on the blog.

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Political Cartoon: 'Second Guessing'

Kaiser Health News provides a fresh take on health policy developments with "Second Guessing" by Harley Schwadron.

And here's today's health policy haiku:

FISCAL DENTISTRY?

Keystone Medicaid 
changes… No more root canals.
Ow, that pulls my teeth.
-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

Health Law Critics Sharpen Fight Focus On Insurance Tax Credit

According to news reports, critics have pinpointed this part of the health law in their effort to undo the sweeping overhaul. Meanwhile, USA Today reports that very few middle-income taxpayers will pay more as a result of the measure's taxes, fees and penalties.   

The Wall Street Journal: Health Law Opponents Challenge Tax Credit
Opponents of the health care overhaul are seizing on how tax credits to buy insurance are distributed as a new front in their fight against the law. Conservative critics have zeroed in on wording in the law that says state-run programs would be the vehicle for subsidizing the cost of mandatory health insurance for lower-income Americans starting in 2014 (Radnofsky, 7/16).

Politico Pro: Exchange Critics: Businesses Could Sue
The brains behind the next possible lawsuit over President Barack Obama's health law say business groups are already gearing up to challenge whether coverage subsidies could flow through exchanges set up by the feds. Case Western Reserve University’s Jonathan Adler and the Cato Institute's Michael Cannon, who argue in a new paper that the health care law only enables subsidies through state-run exchanges, say interest in challenging this major piece of the law is high (Millman, 7/16).

USA Today: Few Will Pay More Under Health Care Law
Though the law is projected to raise more than $800 billion in taxes, fees and penalties over a decade, 40 percent comes from about 3.5 million households with adjusted gross incomes above $200,000. Employers, insurers and health care providers are slated to fork over much of the rest. That leaves only a few taxes that will fall partially on middle-income taxpayers (Kennedy and Wolf, 7/17).

Other news organizations report on the health law and charity care as well as insurers' latest wave of concerns about how its minimum health benefits standards could interfere with the ability to control costs:

St. Louis Beacon:  Charity Care Remains Pressing Even If Federal Health Law Is Implemented
One question left unanswered by the health reform law is how much charity care nonprofit hospitals must provide in exchange for numerous tax breaks. These hospitals pay no federal income and capital gains taxes, no state and local property taxes and no taxes on purchases.  The issue of whether communities get enough in return for this generosity used to be hotly debated, but it isn't given much ink in the 2,400-page Affordable Care Act. Even so, hospitals will still need relatively robust charity-care budgets because of the number who will remain uninsured in spite of the ACA (Joiner, 7/16).

CQ Healthbeat:  Insurers Fear Feds' Minimum Benefits Standard Will Limit Their Ability to Control Costs
Insurers responding to a recent proposal governing the information they must provide to help federal officials set standards for minimum health benefits say they are worried the government will do it in a way that makes coverage unaffordable.  Blue Cross Blue Shield plans, which operate in every zip code in the United States, said the proposal goes too far by asking insurers not only to say what benefits they cover, but also how they limit access to covered services (Reichard, 7/16).

Finally, one HHS official offers his take on the health law's future --

Kansas Health Institute News: Affordable Care Act Will Survive Elections, Regional HHS Official Predicts
Talk of repealing the Affordable Care Act is partisan bluster that won’t come to pass even if Republicans sweep the November elections, a top Obama administration health care official predicted at a forum here today.  "Even those people who are talking about repealing, privately, they acknowledge that no, the law is here to stay," said Jay Angoff, director of the U.S. Health and Human Services Department region that includes Missouri, Kansas, Nebraska and Iowa. Angoff said that even if Republicans control the White House and U.S. House following the election, they would not have a large enough majority in the Senate to push through legislation to overturn the law. Senate rules require 60 votes to advance most legislation (Sherry, 7/16).

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Capitol Hill Watch

Drug Coverage Issues, Dual Eligibles Program Draw Democrats' Interest

According to these stories from Politico and Politico Pro, some House Democrats are calling on the Department Of Health and Human Services to use the Medicare prescription drug program as a model for the health law's essential health benefits drug coverage requirement. Also, Sen. Jay Rockefeller, D-W.Va., is joining the chorus of voices concerned about a Centers for Medicare & Medicaid Services demonstration program for dual eligibles -- they say it’s a classic example of the right idea but the wrong execution.

Politico Pro: House Members Urge Broader EHB Drug Coverage
More than two dozen House Democrats are urging HHS to abandon its skimpy drug coverage requirement for the essential health benefits package and instead use the popular Medicare prescription drug program as a model. The Obama administration's December essential health benefits bulletin proposed requiring coverage for just one drug per class, which at least one study has shown would be less than what possible EHB benchmark plans actually cover (Millman, 7/16).

Politico: Groups To CMS: Slow Down
Is the push to change how "dual eligibles" get their health care going too far, too fast? That's a question that's beginning to be heard from lots of quarters -- including the Medicare Payment Advisory Commission, the American Medical Association, some analysts and now at least one key lawmaker (DoBias, 7/16).

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Campaign 2012

Obama Defends Health Law In Ohio Town Hall Meeting

President Obama says he doesn't mind the "Obamacare" label and is chastising Republican Mitt Romney for not championing the Massachusetts health overhaul.

Politico: President Obama Highlights Health Care Law On Campaign Trail
President Barack Obama on Monday gave a strong defense of his health care law, weaving multiple mentions of health reform into answers at an Ohio town hall and saying he doesn't mind the "Obamacare" label "because I really do care." Drawing attention to the parallels between his controversial legislation and the Massachusetts reform signed into law by Mitt Romney, Obama said, "It's working really well there. He should be proud of it instead of running away from it" (Smith, 7/16).

A new poll finds that Republicans' view of Chief Justice John Roberts has shifted after the health care ruling:

Los Angeles Times: Poll: Republicans Turn Against Supreme Court, Chief Justice Roberts
What a difference a single court decision can make. In the wake of the Supreme Court's monumental decision on President Obama's health care reform law, Republican opinions of the court and Chief Justice John G. Roberts have plummeted, while Democrats now view both more favorably, according to a new Gallup poll (Little, 7/16).

Politico: Poll: GOP Down On John Roberts, Dems Up
John Roberts's favorability rating has plummeted among Republicans and spiked among Democrats since the Supreme Court's chief justice voted to uphold President Barack Obama's health care reform law, according to a new Gallup poll. Shortly after his appointment in September 2005, Roberts was astoundingly popular among Republicans: 67 percent had a favorable view of him, versus 4 percent unfavorable. Now, those numbers are 27 percent and 44 percent, respectively (Robillard, 7/16).

Meanwhile, congressional Democrats are opening a campaign salvo on the law --

The Hill: DCCC: GOP Backed Health Law Repeal To Guard Lawmaker Benefits
A Democratic campaign committee [video] accused Republicans of voting to repeal the health care law to maintain their own government-subsidized health benefits, in part. The health care law mandates that members of Congress receive coverage through the new insurance exchanges rather than the current Federal Employees Health Benefit Program. Repealing the law would return lawmakers to the program, which allows officials to keep their policies after they retire. In a Web video, the Democratic Congressional Campaign Committee (DCCC) sought out GOP lawmakers, asking "Why did you vote to give yourself health care for life" (Viebeck, 7/16)?

The Hill: Once-Vulnerable Dem Doubles Down On Health Care Reform
One Democratic congressman from Northern Virginia isn't shy about proclaiming his support for "ObamaCare." Rep. Gerry Connolly kept his Fairfax-based seat by a mere 981 votes in 2010 as Tea Party Republicans swept the House. Now, facing easier odds this cycle, he is making President Obama's health care law a centerpiece of his campaign -- again. "I'm unapologetic about it," he told The Hill. "I am running on it. I am proud of my vote for the law" (Viebeck, 7/16).

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Quality

Study: Medicare Payment Adjustments Could Take Toll On Safety Net Hospitals

A change in Medicare hospital payments, which is based on quality and scheduled to kick in this October, could add to the financial problems faced by facilities that treat largely the poor and uninsured.    

Kaiser Health News: Capsules: Safety Net Hospitals Could Lose Money In Medicare Changes, Study Warns
When Medicare begins adjusting hospital payments in October based on quality, one of the primary metrics will be patient experience ratings that cover everything from the communication skills of doctors and nurses to their promptness in responding to complaints about pain. A new study finds that this change may add to the financial troubles of safety net hospitals, which primarily serve poor patients (Rau, 7/16). 

Reuters: Poorer Hospitals May Suffer From Medicare Changes
Under upcoming changes in Medicare and Medicaid payment policies, hospitals largely treating the poor and uninsured may be hit extra hard if patients continue to rate their experiences there lower than at other hospitals, according to a new study. So-called safety-net hospitals take in a lot of patients on government insurance -- which doesn't pay as much for services as private insurance -- or without any insurance at all, leaving them often under financial stress and struggling to stay open, researchers said (Pittman, 7/16).

Modern Healthcare: Value-Based Purchasing Program Could Sock Safety Net Facilities: Study
The CMS' fast-approaching value-based purchasing program could spell trouble for financially strapped safety net hospitals, whose patient-experience scores tend to lag behind those of other hospitals, according to a study published online in the Archives of Internal Medicine. The program, set to begin Oct. 1, will link a portion of hospitals' payment update to performance on a set of 12 clinical quality measures and a composite measure of patient experience (McKinney, 7/16).

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Administration News

Grassley: FDA Officials OK'd Surveillance On Groups Of Doctors Wary Of Medical Device Safety

The Washington Post: FDA Lawyers Authorized Spying On Agency's Employees, Senator Says
Congressional investigators said Monday that the chief counsel's office at the Food and Drug Administration authorized wide-ranging surveillance of a group of the agency's scientists, the first indication that the effort was sanctioned at the highest levels. In a letter to the FDA, Sen. Charles E. Grassley (R-Iowa) said that his staff had learned that the spying was "explicitly authorized, in writing" by the agency's top legal office. … The disclosure marked the latest turn in an investigation of the FDA's past efforts to monitor the communications of a group of its doctors who were expressing concerns about the safety of medical devices (Nakashima and Rein, 7/16).

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Public Health & Education

Truvada Gains FDA Approval As HIV Preventive

The daily pill is the first aimed at reducing the risk of contracting HIV in healthy people who are at high risk of contracting AIDS. It will have a boxed warning that it should be used only by people whose HIV-negative status is confirmed prior to prescription and at least every three months after.

NPR: Deciding On Truvada: Who Should Take New HIV Prevention Pill
There's something new to prevent HIV infections. The Food and Drug Administration on Monday approved a one-a-day pill that can drastically lower a person's risk of getting the AIDS virus. It's called Truvada — the first HIV prevention pill (Knox, 7/17).

Bloomberg: Gilead Wins U.S. Approval For First HIV Prevention Pill
Gilead Sciences Inc. (GILD) won U.S. approval to market its HIV treatment Truvada to prevent the virus that causes AIDS in healthy people who are at high-risk of contracting the disease. The daily drug is the first aimed at reducing the risk of HIV in uninfected people as part of a strategy that includes other prevention methods such as safe sex practices, risk reduction counseling and regular HIV testing, the Food and Drug Administration said today in a statement. Truvada will carry a boxed warning to physicians and patients that the drug should only be used by those confirmed HIV-negative prior to prescribing the drug and at least every three months during use (Edney, 7/16).

San Francisco Chronicle: FDA Approves Truvada As HIV Preventive
The U.S. Food and Drug Administration on Monday approved the marketing of the first drug shown to curb the transmission of the HIV virus, a development heralded by AIDS advocates and physicians as a turning point in the battle against the decades-long epidemic. Truvada, made by Gilead Sciences in Foster City, was approved in 2004 to treat people already infected with HIV, but studies have shown the drug is also effective at reducing the risk of contracting the virus. "It's a huge milestone that could change the course of the epidemic," said Dr. Robert Grant, a UCSF professor and a researcher with the Gladstone Institute for Virology and Immunology who led one of the two studies on which the FDA approval was based (Colliver, 7/16).

KQED:  FDA Approves First Drug To Help Prevent HIV Infection
The Food and Drug Administration has approved Truvada, the first drug shown to reduce the risk of HIV infection in people who are at high risk of acquiring HIV, the virus that causes AIDS (Aliferis, 7/16).

Medscape:  FDA Approves Drug To Prevent HIV Infection
The US Food and Drug Administration (FDA) today approved tenofovir disoproxil fumarate/emtricitabine (Truvada, Gilead) to reduce the risk for HIV infection in uninfected individuals at high risk of catching the virus, possibly through sexual activity, the agency announced.  The antiretroviral agent is now the first drug approved for prophylactic use. It is currently indicated — in combination with other antiretrovirals — to treat HIV-infected adults and children aged 12 years and older (Lowes, 7/16).

The Associated Press: FDA Approves First Pill To Help Prevent HIV
The Food and Drug Administration on Monday approved the first drug shown to reduce the risk of HIV infection, the latest milestone in the 30-year battle against the virus that causes AIDS. The agency approved Gilead Sciences' pill Truvada as a preventive measure for healthy people who are at high risk of acquiring HIV through sexual activity, such as those who have HIV-infected partners. The decision comes less than two weeks after the agency approved another landmark product: the first over-the-counter HIV test that Americans can use in the privacy of their homes (Perrone, 7/16).

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State Watch

Minnesota Finalizes $41 Million Contract For Online Health Exchange

The state announced the two-year contract with Maximus, a Virginia-based company, to design and maintain a state-run insurance exchange.  

MinnPost:  Minnesota Announces $41 Million Contract To Set Up Health Exchange
Minnesota announced a $41 million contract on Monday with the Virginia-based Maximus firm to design and maintain a state-run health insurance exchange mandated in the federal health insurance reform law.  The state is one of at least 15 to move forward with a health insurance exchange using executive branch authority, and Gov. Mark Dayton has been a strong proponent for a state-run exchange rather than the more rigid federal option (Nord, 7/16).

(St. Paul) Pioneer Press: Minnesota Signs Online Health Exchange Deal For $41 Million
The Minnesota Department of Commerce has signed a $41 million contract with a Virginia-based company to develop the state's health insurance exchange -- a key piece of the federal overhaul of the nation's health care system. Maximus Inc. will design and develop technical capabilities, including a consumer-friendly website, for the health exchange as well as Minnesota's Medicaid health insurance program, according to a Monday, July 16, news release. "We can now move forward on developing the technology backbone of the exchange, a user-friendly tool that will help more than 1.2 million Minnesotans," Mike Rothman, the state's commerce commissioner, said in the release (7/16).

Minneapolis Star Tribune: Minn. To Pay Va. Firm $41 Million To Build New Health Exchange Website Minnesota has awarded Maximus Inc. a two-year, $41 million contract to create the state's new health insurance exchange website. Reston, Va.-based Maximus is a government outsourcing company focused on health and human services agencies around the world and has more than $900 million in annual revenue. The exchange -- one local lawmaker likened it to a Travelocity for health insurance -- will be a one-stop shop on the Web for individuals and businesses to buy health insurance and enroll in Medicaid coverage. It's expected to launch in the fall of 2013 (Bjorhus, 7/16).

Minnesota Public Radio: Firm Chosen To Build Tech Side Of Minn. Insurance Exchanges
The state Commerce Department has chosen a Virginia company to build the technical part of its health insurance exchange. The state-based exchanges are a cornerstone of the federal health care law and in about a year and a half, will allow individuals and small groups to comparison shop for health insurance. Commerce awarded the $41 million contract to MAXIMUS of Reston, Va., which with several subcontractors, will create the Minnesota's exchange. Maximus bills itself as the leading administrator of Medicaid services in the U.S. The subcontractors include IBM, Connecture based in Waukesha, Wis., and Florida-based EngagePoint (Stawicki, 7/16).

In exchange news from California --

Sacramento Bee: California Health Exchange Seeks To Make Buying Insurance A Breeze
Peter V. Lee wants to make buying health insurance "as easy as buying a book on Amazon."
He heads the nascent California Health Benefit Exchange, the cornerstone of the state's effort to put in place the federal health care overhaul. Lee envisions that 15 months from now, uninsured California residents will log onto any computer to shop for health care the same way they purchase novels. The poorest residents will receive Medi-Cal. Those above the poverty line will find a menu of subsidized private options at different prices, from a "platinum" plan with higher premiums but lower deductibles down to a "bronze" selection that has lower premiums but requires the buyer to accept more risk (Yamamura, 7/17).

California Healthline: How Active Should Exchange Be In Defining Market?
A new issue brief from the Pacific Business Group on Health urges exchange board members to play an active role in promoting the quality and affordability of health care in California. Rather than acting as a passive online clearinghouse with a variety of plan options, PBGH urges the exchange to establish quality standards for plans and useful tools to help consumers pick the plan that is right for them. In essence, PBGH is urging the exchange, as it navigates the middle road, to lean more toward the first option as market definer and organizer. We asked stakeholders how the exchange should steer down this path (7/16).

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Medicaid Expansion Unsettles Governors' Meeting

Governors express sharp disagreements about whether to expand Medicaid, as mandated by the health law. Meanwhile, a pediatric expert warns congressional staff that state efforts to roll back Medicaid eligibility could cut coverage to millions of poor children.

Stateline:  Health Care Ruling, Elections Dominate Governors' Meeting
The typical low-key summer gathering of the nation's governors was anything but subdued this year.  The U.S. Supreme Court's recent decision leaving it up to the states whether to expand their Medicaid programs topped headlines coming from the National Governors Association's two-day meeting held in Williamsburg, Va., that began July 13. ... The NGA, an organization made up of governors of both parties, historically strives for bipartisan agreement, but with this topic, that seems unlikely (Prah, 7/16).

CQ Healthbeat: 'Maintenance of Effort' Provisions Critical To Coverage For Children
If governors do not have to abide by the health law requirement that they maintain current eligibility policies to enroll children in Medicaid and CHIP, gains made in insuring those youngsters would be lost, according to an American Academy of Pediatrics expert speaking to congressional staff on Monday.  The health care law will reduce the number of children who do not have insurance from about 7.4 million to 4.2 million if funding for coverage is provided as expected, Renee Fox, said. … But if lawmakers were to get rid of requirements that states maintain eligibility for the Children's Health Insurance Program (CHIP) until 2019, the number of kids without insurance would be around 7.9 million to 9.1 million, according to Fox (Adams, 7/16).

Health Policy Solutions (a Colo. news service): Colorado Hospitals Want Medicaid Expansion
Burdened with providing $1.5 billion in care for the uninsured a year, Colorado hospitals support an expansion of Medicaid to help reduce health care costs. "As of now, the Medicaid expansion is the best solution we know of to get health insurance for the people who need it most," said Julian Kesner, spokesman for the Colorado Hospital Association. Kesner said the association’s financial analysts are calculating how much a failure to expand Medicaid would cost hospitals, but he doesn’t have an estimate yet (McCrimmon, 7/16).

The Associated Press/CBS News: Texas Medicaid Debate About Politics, Ideology
The debate in Texas over whether to fully implement the new federal health care law has little to do with health care, and a lot to do with ideology and politics. Texas Health and Human Services Commissioner Tom Suehs summed it up best last week when he said the question is not whether to pay for poor people's health care, but who will pay (7/16).

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Va. AG Cuccinelli Clashes With State Board Of Health Over Abortion Clinic Regulations

The attorney general maintains that the board went beyond its authority by removing a provision from the regulations that would have required existing clinics to meet new hospital construction standards. Also in Virginia, Gov. Bob McDonnell appointed an anti-abortion physician to the board of health. Meanwhile, in other state news, Planned Parenthood has filed suit against Arizona.

Richmond Times-Dispatch: Cuccinelli Won't Certify Abortion Clinic Rules
Attorney General Ken Cuccinelli is refusing to certify new abortion clinic regulations that were made less burdensome for existing clinics under a version passed last month by the Virginia Board of Health. The decision sets up another potential battle between those on both sides of the issue, as well as moderates and conservatives on the board, to which Gov. Bob McDonnell on Friday added Dr. John W. Seeds, a staunch anti-abortion physician. The certification decision came Monday in a memo to Health Commissioner Karen Remley. The Attorney General's Office said the board exceeded its authority when it amended the regulations to remove a provision that would have required existing clinics to comply with building standards for new hospital construction (Nolan, 7/17).

The Associated Press: Virginia AG Won't Certify Abortion Clinic Rules
Virginia's attorney general has refused to certify new abortion clinic regulations, saying the state Board of Health unlawfully stripped a hotly contested provision requiring clinics to meet the same strict architectural standards as new hospital construction. Republican Ken Cuccinelli's office sent a memo to Health Commissioner Karen Remley on Monday saying the board exceeded its authority (O’Dell, 7/16). 

Richmond Times-Dispatch: McDonnell Appoints Anti-Abortion Doctor To Board Of Health
Gov. Bob McDonnell has appointed an outspoken opponent of abortion to sit on the Virginia Board of Health. The appointment of Dr. John W. Seeds, an obstetrician at VCU Medical Center and vice chairman of the anti-abortion group OBGYNS for Life, comes just one month after the board voted 7-4 to grandfather the state's existing abortion clinics from stringent new regulations that would require the facilities to meet building standards for new hospital construction. The clinic regulations were passed by the General Assembly in 2011 as part of a last-second amendment by anti-abortion Republicans to an emergency preparedness bill that went undetected by Democrats and abortion rights advocates (Nolan, 7/16).

Also in the news --

Reuters: In New Abortion Battle, Planned Parenthood Sues Arizona
Planned Parenthood sued the state of Arizona on Monday in an effort to overturn a law that blocks funding for its health clinics because the organization also performs abortions. The law, signed by Governor Jan Brewer in May, is part of a national campaign against Planned Parenthood orchestrated by conservative Republican lawmakers who oppose abortions. In the past two years, 13 states have taken steps to eliminate funding for Planned Parenthood, and the organization has filed lawsuits in six of them, including Arizona (MacLaggan, 7/16).

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State Roundup: Mass. To Allow Coupons For Some Branded Drugs

A selection of health policy stories from Maryland, Massachusetts, Kansas, Washington state, California, Minnesota, New Jersey and Wisconsin.

Baltimore Sun: Johns Hopkins Falls To No. 2 For First Time In More Than 20 Years On U.S. News & World Report Hospital Rankings
Johns Hopkins Hospital lost its coveted spot as the nation's top-ranked hospital for the first time in 22 years, edged out by Boston's Massachusetts General Hospital in the latest analysis by U.S. News & World Report to be released Tuesday. Hopkins still ranked No. 2, and marketing experts said falling one spot will hurt the hospital's ego more than its reputation. "They'll survive this, I'm sure," said Roger Gray, founder and partner of GKV, an advertising and marketing firm in Baltimore. "Johns Hopkins is iconic." Executives at Hopkins are awaiting more detailed data so they can better understand why the institution fell in the annual rankings (Walker, 7/17).

CommonHealth/WBUR: Mass., 50th State, Now Allows Drug Coupons
For years, the small print at the bottom of prescription drug coupons offered by magazines and Websites has included the words "not valid in Massachusetts." But the next batch that's printed won't need that language, because when Gov. Deval Patrick signed his 2013 budget into law last week, it included a provision legalizing the use of drug coupons here -- at least on medications for which no generics are available. Massachusetts is the last state in the nation to make coupons legit (Weintraub, 7/16).

Kansas Health Institute News: Watching The Court … And Watching And Watching And Watching
The Kansas Supreme Court has had a case of major importance for more than three years now with no clear indication yet when the justices might rule on it. "There may be other cases that have taken this long" to be decided, said Bill Rich, a professor of constitutional law at Washburn University School of Law. "But if there are, I'm not aware of them." At stake in the justices' pending decision is a long-standing cap or limit on the amount juries can award people injured as the result of medical malpractice or accidents. Since 1986, with strong backing from Kansas doctors, state law has limited awards for pain and suffering resulting from physician error or personal injury to $250,000 (Ranney, 7/16).

The Seattle Times: Insurance To Cover Autism Therapy For Kids Of Public Workers
Children with autism whose parents have health insurance through the state's Uniform Medical Plan may be covered for an intensive type of therapy, under a settlement announced Monday. A class-action lawsuit was filed in King County Superior Court in 2010 against the state's Health Care Authority (HCA) on behalf of several children with autism and autism-spectrum disorders. There are more than 860 members of the class, according to the lawsuit (Ostrom, 7/16).

The Bay Citizen/KQED: Alameda County Takes On Drug Companies Over Medication Disposal
Alameda County is poised to make drug companies pay for the safe collection and disposal of residents' unused medications. The measure would apply to prescription drugs like penicillin as well as tightly controlled substances like OxyContin. Supporters say the ordinance would help prevent overdoses and accidental poisonings and reduce water pollution -- claims the pharmaceutical industry insists are not true (Mieszkowski, 7/16).

The Minneapolis Star Tribune: Mentally Ill -- And Now Worried, Too
Theresa Dolata first thought about suicide at age 5. … Today, at 37, she's living on her own and even counseling other patients, thanks to a caseworker who comes to her home to provide therapy, skills training and help with medications. But mental health advocates worry that the program serving Dolata -- and nearly 15,000 other mentally ill Minnesotans -- is in danger of unraveling because of low state reimbursement (Hernandez, 7/16).

California Watch: Study: African Americans Concerned About Mental Health Services
African Americans across the state have concerns that their mental health assessment and diagnoses are inadequate, according to a state-commissioned report issued today. These inaccurate psychiatric assessments are a "part of the problem that leads to disparate outcomes," the report said (Yeung, 7/17).

Modern Healthcare: Aetna, N.J. Group To Launch ACO
Hunterdon HealthCare Partners, Flemington, N.J., will launch an accountable care organization this summer with the insurer Aetna. … The ACO will cover 2,200 Hunterdon HealthCare employees and 5,700 Aetna enrollees, said Jeffrey Weinstein, executive director and CEO of Hunterdon HealthCare (Evans, 7/16).

California Healthline: Important Bills On Horizon For CMA
The California Medical Association, which keeps an eye on all health-related legislation in California, last week released its "Hot List" of proposed health care bills in the next legislative session. … One of the bills that might be overlooked, [a CMA media relations spokeswoman] said, is AB 589 (Henry Perea, D-Fresno), which is similar to previous loan-repayment legislation, but instead targets potential medical school students from underserved areas, rather than medical school graduates (Gorn, 7/16).

California Healthline: Appeals Decisions Due From DHCS
The Department of Health Care Services will issue a decision this week on the first "test case" appeal hearings to decide eligibility for the new Community-Based Adult Services program, according to DHCS officials. The first appeal hearings were held May 30. After judges submit rulings to the state, the DHCS director has 30 days to decide whether or not the department accepts those rulings. … The state has said that the first 10 to 12 cases heard May 30 and 31 are being seen as test cases for the estimated 1,800 appeal hearings scheduled so far. The number of appeal hearings is expected to rise as DHCS continues its eligibility determination process (Gorn, 7/17).

Milwaukee Journal Sentinel: Diabetes Management Using Electronic Medical Records
If you've received a reminder call about a missed appointment or a missed flu shot, then it came as a result of an electronic health record system. The systems widely implemented in Wisconsin are improving coordination and making health care more efficient, lowering costs and identifying and treating at-risk patients to improve their health. More hospitals and clinics are using in-house data to reach out to patients with chronic diseases, such as diabetics (Qidwae, 7/16).

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Editorials and Opinions

Viewpoints: Calif. Could Take A Lesson From Wis. Reforms; Republican Advocates A 'Nixon To China' Embrace Of Medicare For All

Los Angeles Times: California, Look To Wisconsin
The state's teachers union, Wisconsinites learned, had used its power to collectively bargain for healthcare benefits to demand that local school districts provide coverage through a nonprofit insurer affiliated with the union. Once the state ended bargaining on healthcare, school boards began competitively bidding out their health insurance. By the opening of the new school year in September, just two months after the budget bill went into effect, 23 districts had rebid their contracts, saving $16 million, or an average of $211 per student (Steven Malanga, 7/17).

Richmond Times-Dispatch: Public Opinion: Ruling? What Ruling?
If you're reading these words, then you probably know how the Supreme Court came down in its landmark health-care ruling. But a surprising — or, perhaps, not so surprising — number of people do not. According to the Pew Research Center, 45 percent of Americans either did not know that the high court had upheld the Affordable Care Act or thought it had struck down the law. You can take that as yet further proof that the American proletariat is a bunch of slack-jawed ignoramuses — adding it to other data points, such our country's low rate of voter turnout or the fact that about twice as many Americans can name two characters on "The Simpsons" as can name two liberties protected by the First Amendment (7/17).

Des Moines Register: Head-In-The-Sand 'Solution' Is Killing GOP
We Republicans have ourselves to blame for the Affordable Care Act, or Obamacare. Our reaction to the Clinton health reform proposals in the early 1990s was to have conservative think tanks come up with a free competition model based on expansion of private insurance and Medicaid. That idea became Romneycare, which evolved into Obamacare. It is our baby, ugly or not (Jack Bernard, 7/16).

Boston Globe: Reducing Payments To Hospitals Doesn't Reduce Health Care Costs, It Just Shifts Them To Someone Else
Piloting a glider successfully requires learning how to avoid over steering, otherwise a flight can quickly turn into a crisis. That same common-sense principle should apply to our state's health care reform efforts. We are on the right course. But over steering by government could send the system spinning off course. We believe there is a valid role for government in transforming the health care system. But successful reform is about collaboration between government and stakeholders, not government exerting control over them (Lynn Nicholas, 7/16).

Richmond Times-Dispatch: Rejecting A Medicaid Expansion
To encourage Virginia and other states to expand, the federal government is offering to pick up more than 90 percent of the cost of insurance for those newly eligible. But even with that giant carrot, the Kaiser Family Foundation estimates that Virginia will spend an additional $863 million just by 2019. Worse yet, the president's own budget proposal this year included a section forcing states to pick up a larger share of the cost. Virginia can't afford the additional spending (Audrey Jackson and Nicole Kaeding, 7/17).

Georgia Health News: All Fooling Aside, The Health Law Is Expensive
Only political junkies really care about the difference between taxes and penalties contained in Obamacare. What Americans care about is "What is it going to cost me?" Sure, the Republicans can holler that the president lied when saying that the health reform costs were not taxes. And the Democrats can stick with the falsehood that the now constitutionally defined taxes are still penalties. The reality is that are no new costs in Obamacare. They have been there all along. But most Americans never knew (Ronald Bachman, 7/16).

Des Moines Register: Palmer Will Have A Big Medicaid Role
When Iowans elected Gov. Terry Branstad, they got his political appointees, too. … But the appointment of Chuck Palmer to head the Department of Human Services a second time was a gift to the people of Iowa. … Palmer stands out as someone who understands the challenges people face in the real world — beyond the politics and bureaucracy that sometimes plague government (7/16).

St. Louis Beacon:  Missouri Should Say 'No' To Medicaid Expansion
The federal government is offering a grace period of several years in which it will pick up essentially all of the cost of the Medicaid expansion, scheduled to begin in 2014, if individual states commit to spending money of their own in years to follow.  Over 10 years, Missouri would need to commit to spending about $430 million to qualify for $8.4 billion in additional Medicaid grants from the federal government.  If that looks and sounds almost too good to be true, it is because it literally is too good to be true (Andrew B. Wilson, 7/16).

The Hill: Medicine Today: A Battle On Two Fronts
I have growing concerns that personalized medicine will not be fully realized. The Patient Protection and Affordable Care Act (ACA) and its progeny are likely to reduce funding just where it is needed the most: for research on molecular pathways associated with cancer, inflammation, and chronic diseases. These research areas are often not the exciting, romantic fields that attract the most funding, yet their funding is critical. Worse, the ACA will entomb "the centuries-old diagnostic practice of empirical medicine" (and, unfortunately, an extremely poor version of that) so that personalized medicine is never allowed to fully blossom. It will die on the vine, its full potential left unrealized (Dr. Timothy Craig Allen, 7/16).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.