Daily Health Policy Report

Wednesday, July 17, 2013

Last updated: Wed, Jul 17

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Cerner Builds Recession-Proof 'Bunker' For Health Data

KCUR's Elana Gordon, working in partnership with Kaiser Health News and NPR, reports: "This is a story about data. Lots and lots of data. And not just any data. Extremely sensitive data. The U.S. health system is undergoing a major technological shift right now. Some equate it to finally catching up to where the banking and airline industries have been for years: Doctors and hospitals are moving to electronic health records systems, and it’s not easy. Cerner, based in Kansas City, Mo., has grown into one of the nation's biggest players in the field of health information technology. Cerner's main headquarters seems like a college campus, peppered with trees and walking paths, along with some Star Trek-like architecture" (Gordon, 7/16). Read the story.

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Head Of Rx Drug Makers Group Says Obama Budget Plans Cause Concern

Kaiser Health News staff writer Mary Agnes Carey interviews John Castellani, who heads the Pharmaceutical Research and Manufacturers of America (PhRMA). He talks about the rollout of the federal health law, the sequestration cuts to federal spending and the president’s budget (Carey, 7/16). Read the interview.

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Capsules: At Hospitals You May Not Get What You Are Charged For; 9 Pioneer ACOs Jump Ship After First Year

Now on Kaiser Health News' blog, Jordan Rau reports on an analysis of the relationship btween hospital charges and quality of care: "It's well known that the listed charges hospitals set for surgeries and other procedures — recently spotlighted by Medicare – bear little resemblance to the actual prices most patients end up paying. An analysis by Castlight, a San Francisco company that helps employers and workers compare provider prices, also finds that the hospital charges bear little relationship to the quality of the care" (Rau, 7/17).

In addition, Jenny Gold offers a status update on Pioneer ACOs: "Nearly a third of the health systems chosen for the ambitious Pioneer accountable care organization program with Medicare are leaving after the first year of the three-year program. The goal of accountable care is for hospitals and doctors to save money while lowering costs" (Gold, 7/16. Check out what else is on the blog.

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Large Insurers Opt Out Of Missouri's Health Exchange

The St. Louis Post-Dispatch's Jim Doyle, working in partnership with Kaiser Health News, reports: "When the new health exchange opens for business in Missouri on Oct. 1, at least three major health insurers will not be participating. UnitedHealthcare, the nation's largest insurer, said Monday that it won't offer insurance policies this fall in the federally run health exchange in Missouri, but may enter the exchange later. The Minneapolis-based insurer also plans for the time being to stay out of Illinois' health exchange" (Doyle, 7/16). Read the story.

In a second, related story --

St. Louis Post-Dispatch: New Missouri law Imposes Hurdle For Insurance Exchange 
Advocates for uninsured people are worried a bill signed by Missouri Gov. Jay Nixon on Friday could throw a wrench into implementing the upcoming health insurance marketplace. The new state law requires insurance counselors – known as navigators — get state licenses before they begin helping consumers shop for health plans on the exchange (Young, 7/17). 

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Political Cartoon: 'Spin Doctor?'

Kaiser Health News provides a fresh take on health policy developments with "Spin Doctor?" by Jeff Darcy.

Meanwhile, here is today's health policy haiku:

AFTER THE FIRST YEAR

Nine to peel away
from ACO pioneers.
But reviews still good.
-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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Capitol Hill Watch

House Slated To Take Another Run At Scrapping The Health Law

Republican leaders in the House have scheduled votes Wednesday on bills that would delay implementation of the overhaul's employer and individual mandates. According to the Associated Press, these efforts mark the 38th time the GOP majority has tried to undo the law or major provisions.  

The Associated Press: House GOP Seek Delay In Health Care Provisions
House Republicans, politically emboldened by President Barack Obama's delay of a key requirement of his health care law, are taking another run at scrapping his signature domestic policy. The House has scheduled votes Wednesday to delay the law’s individual and employer mandates, the 38th time the GOP majority has tried to eliminate, defund or scale back the program since Republicans took control of the House in January 2011 (Cassata, 7/16).

National Journal: House To Vote On Bills To Delay Key Parts of Obamacare
The House is set to vote Wednesday on two bills that would delay implementation of key pieces of the 2010 health reform law. Although the legislation isn't likely to go anywhere in the Democratic-controlled Senate—and the White House has said it would veto the measures—Wednesday's vote will reveal how many, if any, members believe that anything short of full repeal of the Affordable Care Act could damage their efforts to take the law down. Lawmakers will vote on two separate bills; one would delay the law's requirements for individuals to obtain health coverage and the other would postpone requirements for large employers to offer health insurance for their employees (Hollander, 7/16).

McClatchy: GOP To Obama: If You Can Delay Health Care, So Can We
Republicans will make another move Wednesday to damage the national health care law they derisively call Obamacare. This time, they're being aided by the champion of the measure, President Barack Obama. With Obama's recent move to postpone one part of the law as an opening, the Republican-ruled House of Representatives is expected to vote Wednesday to delay more key parts of the contentious measure before it can take full effect. The move is the latest in a sweeping legislative and political campaign to weaken the 2010 law and raise even more opposition in the eyes of an already skeptical nation, especially as it heads into 2014 elections that will decide control of the Congress and set the stage for the 2016 campaign for the White House (Kumar, 7/16).

Fox News: GOP-Controlled House To Vote Wednesday On Delaying Key Parts Of ObamaCare
The Republican-controlled House will vote Wednesday on delaying key parts of ObamaCare, the party's latest effort to dismantle the law amid distress signals from inside the administration. The lawmakers will vote on bills to delay the start of the law's separate employer and individual mandates, which respectively require smaller businesses and Americans to purchase insurance next year or face penalties. The Obama administration earlier this month delayed the start of the employer mandate, saying the decision was in response to business owners expressing concerns about the law’s complex reporting requirements (7/17).

CBS New: House GOP Keeps Pressure On With Obamacare Delay Votes
With the clear intent of once again making Obamacare a campaign issue, House Republicans on Wednesday have scheduled a pair of votes on different elements of the health care law -- votes designed to put Democrats on the spot. With one vote, the GOP-led House will consider whether to delay the so-called "employer mandate" -- the requirement for businesses with 50 or more employees provide health care coverage or pay fines of $2,000 per employee. The House will also vote on whether to delay the "individual mandate," which requires most Americans to acquire health insurance or pay a fine (Condon, 7/17).

CNN: Most House Democrats Expected To Oppose GOP Obamacare Bills
Most House Democrats are expected to oppose two House Republican bills on Wednesday that would delay key provisions of Obamacare, the number two House Democrat told reporters Tuesday. … [House Democratic Whip Steny Hoyer] called the Republican bill to delay the employer mandate to provide health care insurance "redundant" because it "doesn't do anything beyond what the president has already done." (Walsh, 7/16).

The Hill: President Threatens To Veto GOP's ObamaCare Bills To Delay Mandates
President Obama is threatening to veto Republican bills that would delay the healthcare reform law's employer and individual mandates. Obama declared the employer bill "unnecessary" — the administration announced the same delay on July 2 — and said the individual bill is harmful to consumers in a Statement of Administration Policy issued Tuesday (Viebeck, 7/16).

The Hill: Small Businesses Lobby To 'Score' Bill Delaying ObamaCare Mandate
The leading lobbying group for small businesses will score lawmakers' votes on a bill to delay the individual mandate in President Obama's healthcare law. The National Federation of Independent Business said it would consider the vote a "key vote" as it prepares its ratings of lawmakers' support for small businesses (Baker, 7/16).

Politico: 25 Unforgettable Obamacare Quotes
The House will vote on bills Wednesday that would delay both the employer and the individual mandate in Obamacare. POLITICO looks back at some of the memorable quotes from the past four years of Washington warfare over the health law (7/16).

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Health Reform

Mandate Matters: Examining The Relationship Between The Health Law's Employer And Individual Mandates

The Associated Press reports that delaying the enforcement of the employer mandate may undermine the individual mandate, too, while the National Journal reports on a study weighing which of these provisions has the most weight.

The Associated Press: Health Law's Rule Delay Could Hamper Enforcement
There's a bit of a domino effect undercutting President Barack Obama's health care law. Enforcement of the overhaul's central mandate — that individual Americans must have coverage — could be weakened by the Obama administration's recent delay of a requirement that larger employers provide medical insurance (Alonso-Zaldivar, 7/16).

National Journal: Obamacare Study: Employer Mandate May Not Matter Much, But The Individual Mandate Does
A new study published by the Urban Institute this week finds that removing the employer mandate from the Affordable Care Act will have little impact on either insurance coverage or government spending--but that removing the individual-mandate provision would significantly increase the number of uninsured individuals and affect government spending. The study comes on the heels of the Obama administration's decision to delay the employer mandate--and just before House Speaker John Boehner holds a vote to delay both the employer mandate and the individual mandate (Novack, 7/16).

In other news, Health and Human Services Secretary Kathleen Sebelius asks the NAACP for help in making the health law work --

Politico: Help Make Obamacare Work, Kathleen Sebelius Asks NAACP Meeting
Comparing Obamacare to the struggle for civil rights, Health and Human Services Secretary Kathleen Sebelius urged the NAACP convention to focus on enrolling people in new health insurance coverage in the coming months. "Start spreading the word," Sebelius said Tuesday afternoon. "Download tool kits and customize fliers to hang up at local businesses and restaurants and barber shops and beauty salons." Sebelius called on leaders in the religious community especially to take up the Obamacare mantle (Millman, 7/17).

Also in the headlines -

The Washington Post's The Fact Checker: Are College Students Being Overcharged On Loans To Pay For 'Obamacare'?
When the health-care law was passed in 2010, Democrats slipped in massive changes to student-loan programs, essentially cutting banks out of the business. In the official score of the health-care bill by the Congressional Budget Office, ending federal guarantees for federal loans and replacing them with direct loans made by the Education Department would yield $58 billion between 2010 and 2019. All federal money is fungible, but with such a large pot of money suddenly (theoretically) available, Congress wanted to spend it on other things. Here's the breakdown of where the money went. ... [Sen. Lamar] Alexander’s opinion of the health law aside, his assertion that college students are being "overcharged" to pay for the health law doesn’t add up. (Kessler, 7/17).

Kaiser Health News: Head Of Rx Drug Makers Group Says Obama Budget Plans Cause Concern
Kaiser Health News staff writer Mary Agnes Carey interviews John Castellani, who heads the Pharmaceutical Research and Manufacturers of America (PhRMA). He talks about the rollout of the federal health law, the sequestration cuts to federal spending and the president's budget (Carey, 7/16).

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Pioneer ACO Results Include Improved Quality, Lowered Medicare Costs

Even with these marks, nine of the health systems -- nearly a third of those participating in the program -- have decided to leave after the first year. 

Politico: Obamacare Pilot Project Lowered Medicare Costs
An ambitious program under the health law to change how care is paid for lost nearly a third of its participants after the first year, but not before all were able to boost the quality of care provided to patients in an experiment that some experts say holds promise to bring down health care costs in the long run (Norman, 7/17).

Kaiser Health News: Capsules: 9 Pioneer ACOs Jump Ship After First Year
Nearly a third of the health systems chosen for the ambitious Pioneer accountable care organization program with Medicare are leaving after the first year of the three-year program. The goal of accountable care is for hospitals and doctors to save money while lowering costs (Gold, 7/16.

Bloomberg: Hospitals Withdraw From Key Obamacare Cost Savings Plan
Nine of 32 hospitals and health systems dropped out of a U.S. pilot program created through the Affordable Care Act to reduce medical costs by moving away from a traditional fee-for-services model, the government said. The costs of caring for those enrolled in the "Pioneer" program increased 0.3 percent in 2012, less than half the rate of other beneficiaries in Medicare, the Centers for Medicare and Medicaid Services said today in a statement (Adams, 7/16).

CQ HealthBeat: Pioneer ACO First-Year Results Include Savings and Losses
The first-year report card for the Medicare Pioneer Accountable Care Organizations shows that more plans saved money than lost, but also that some providers have decided to either exit the program or take a step back and move to the less risky traditional shared savings model. The Pioneer ACO model was designed for more-advanced, higher-performing organizations (Bunis, 7/16).

Medpage Today: Top ACOs Get Good Marks, CMS Reports
Costs for the 32 pioneers grew by only 0.3 percent in 2012, while costs for similar Medicare patients who were not in ACOs grew by 0.8 percent last year, CMS said. But only 18 of the 32 pioneer ACOs lowered costs for Medicare patients they treated in 2012. That includes the 13 pioneer plans that were able to share savings with Medicare, plus an additional five ACOs which also lowered costs, but not enough to be able to share in the Medicare savings (Pittman, 7/16).

Modern Healthcare: Why One Medicare Pioneer ACO Failed To Save Money
Atrius Health, an alliance of an eastern Massachusetts hospital and several physician practices in the region, is one of nearly two dozen accountable care organizations that agreed to stick with Medicare's test of the promising but unproven model. Atrius is also one of two organizations to see a financial loss during the experiment's first year, according to preliminary results (Evans, 7/16).

Minneapolis Star Tribune: Lower Costs Elude Hospitals
Hitting the bull’s-eye on a "triple aim" of improvements under the federal health law promises to be a major challenge for the nation’s hospitals. Initial results from a federal pilot program released Tuesday showed that hospitals excelled at improving the quality of medical care and in getting high marks from patients. But a majority struggled with the third goal -- lowering the cost of care (Crosby and Spencer, 7/16).

Detroit Free Press: U-M System Pulls Out of ACO Health Care Program
Patient health may have improved within the nation's 32 Pioneer Accountable Care Organization (ACO) programs, but the results were mixed after the first full year, the U.S. Centers for Medicare & Medicaid Services (CMS) said Tuesday. And one of the three Pioneer ACOs in Michigan -- the University of Michigan Health System -- is withdrawing from the program designed to test a tenet of federal health care reform: that coordinated care keeps chronic conditions under control and drives down costly trips to the hospital (Erb, 7/16).

The Denver Post: Denver Physician Group Drops Out Of Medicare Cost-Cutting Program
A Denver physician group hailed as one of the "pioneers" in a U.S. effort to cut Medicare costs is backing away from the program, after spending more and saving less than expected in the effort. Physician Health Partners, one of 32 health systems named by federal officials in 2012 to share in savings from caring for 25,000 Medicare patients, said it was switching to a less-risky program (Booth, 7/16).

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States, Feds Continue To Scramble On Health Exchanges, Medicaid Expansion

The Obama administration hires a credit reporting agency to verify the incomes of people who apply for federal subsidies to buy health insurance. Meanwhile, Missouri Gov. Jay Nixon signs a bill that could make it more difficult to do enrollment outreach there, as federal officials consider ways to implement the law in states led by officials opposed to it.

The New York Times: Credit Reporting Agency Hired To Verify Incomes For Insurance Subsidies
The Obama administration has hired a credit reporting agency to help verify the incomes of people who apply for federal subsidies to buy insurance under the new health care law (Pear, 7/16).

CQ HealthBeat: Certified Counselors May Help Uninsured Enroll In Exchanges In States Hostile To Overhaul
There’s little reason to assume that states whose leaders opposed passage of the health care law are now going to do much to promote the availability of coverage for the uninsured when exchanges open in the fall. Nor is there much evidence officials in those states will do much to help guide consumers through what likely will be a complex process of weighing coverage options, applying for tax credits to cut premium costs, and filling out applications. And federal funds to promote the law will be meager in those states (Reichard, 7/16).

St. Louis Post-Dispatch: New State Law Imposes Hurdle For Insurance Exchange
Advocates for uninsured people are worried a bill signed by Missouri Gov. Jay Nixon on Friday could throw a wrench into implementing the upcoming health insurance marketplace. The new state law requires insurance counselors – known as navigators — get state licenses before they begin helping consumers shop for health plans on the exchange (Young, 7/17).

St. Louis Post Dispatch: Large Insurers Opt Out Of Missouri's Health Exchange
When the new health exchange opens for business in Missouri on Oct. 1, at least three major health insurers will not be participating. UnitedHealthcare, the nation's largest insurer, said Monday that it won't offer insurance policies this fall in the federally run health exchange in Missouri, but may enter the exchange later. The Minneapolis-based insurer also plans for the time being to stay out of Illinois' health exchange (Doyle, 7/17).

Seattle Times: State Readying To Sign Up 1 Million Uninsured
The hundred-plus people who showed up at Tuesday’s “coverage is here” event — meant to kick off the effort to sign up uninsured Washington residents for health insurance through a new federal law — were one enthusiastic bunch. At a meeting room in downtown Seattle, they stood to cheer as Gov. Jay Inslee, a key Affordable Care Act advocate, took the podium, and they listened raptly as speakers from various health agencies and nonprofits detailed their best ideas for signing up the uninsured (Ostrom, 7/16).

Oregonian: Oregon Receives $2.9 Million To Hire Advisers For Health Exchanges
The federal government is granting Oregon health centers nearly $2.9 million to inform people about health insurance exchanges. The U.S. Department of Health and Human Services announced last week that it will distribute $150 million in grants to more than 1,000 clinics serving poor and uninsured people across the country. The funds will be used to hire nearly 3,000 people who will help advise patients on how to enroll with health insurance marketplaces mandated by the Affordable Care Act. The 28 Oregon health centers receiving the funds are set to hire 49 additional works, who are expected to assist 71,493 people with enrollment with health insurance exchanges, according to the health department (Karlamangla, 7/16).

On Medicaid expansion -

Modern Healthcare: Reform Update: States Scramble To Submit Application For Medicaid Expansion Following Late CMS Rule
A CMS rule issued in early July has set off a scramble among state officials to finalize and submit an application needed to implement their Medicaid expansions allowed by the healthcare reform law. The delay in the rule may push states hard up against the Oct. 1 start of the Medicaid enrollment process for 2014 (Daly, 7/16).

Huffington Post: Blame States For Not Expanding Medicaid, Obama Administration Will Tell Poor Residents
The federal government wants poor residents of states not expanding Medicaid under President Barack Obama's health care reform law to know who's denying them health coverage -- and the administration has a plan to make sure they find out. When Americans begin shopping for benefits on the law's health insurance exchanges on Oct. 1, the people who would qualify for Medicaid but live in the 20-plus states where Republican governors or state legislators won't approve the expansion will see a note explaining that federal law allows them to get coverage that their states' leaders won't provide them. A senior administration official told reporters about the note Friday (Young, 7/15).

The Associated Press: Panel Prepares To Discuss Effects Of Expanding Medicaid
A special commission exploring whether expanding Medicaid under the federal health care overhaul law is right for New Hampshire spent its meeting Tuesday reviewing the existing program. The Department of Health and Human Services reviewed who currently qualifies for Medicaid in the state, the pending change from a fee-for-service payment model for the program to managed care, and what program changes require federal waivers (Love, 7/17).

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Study Finds Health Law Likely To Push Up Premium Prices In Mass.; New York Health Plan Costs Set To Fall

The Massachusetts analysis, funded by the insurance industry, predicts the law will add an average of 3.7 percent to premiums, while in New York, state officials will likely announce Wednesday the expected premium tumble.

Boston Globe: National Health Care Overhaul Apt To Push Up Costs
Rule changes stemming from the national health care law are likely to drive up average insurance premiums for small businesses and individuals next year, according to a study funded by the insurance industry. The analysis, by Wakely Consulting Group, projects President Obama's health care law — supported by the Patrick administration — will tack an average of 3.7 percent on to premiums. That would be on top of typical base rate increases, driven by hospital and doctor's fees and demand for medical care, which have ranged from 2 to 4 percent in recent years (Weisman, 7/17).

The New York Times: Health Plan Cost For New Yorkers Set To Fall 50%
Individuals buying health insurance on their own will see their premiums tumble next year in New York State as changes under the federal health care law take effect, state officials are to announce on Wednesday (Rabin and Abelson, 7/16).

In other news --

Health News Florida: $54 Million In Rebates In Mail
Insurers for more than 600,000 Floridians will have to rebate some of the premium from last year because they didn't comply with the spending rules in the Affordable Care Act, according to federal health officials. The amount that must be refunded in this state by Aug. 1 tops $54 million, according to the Center for Consumer Information & Insurance Oversight. That's only half of what insurers had to pay in rebates to Floridians last year (Gentry, 7/17).

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Health Information Technology

Health Law Computer Database 'Hub' Links 7 Agencies, Spurs Privacy Concerns

A computer system designed to determine which Americans get what subsidies to help them buy health coverage will be hugely important to the success or failure of Obamacare, Bloomberg reports. And new federal data show doctors have filed more than 190 million prescriptions electronically.

Bloomberg: Obamacare Privacy Fears Loom As Computer Links Agencies
The biggest overhaul of the U.S. health-care system in 50 years has spawned one of the most complex computer projects in the government's history.  Dubbed the Hub, the $267 million computer system built by a unit of UnitedHealth Group Inc. is one of the most important determiners of whether the Affordable Care Act succeeds. The hub ties together the databases of seven U.S. agencies, ranging from the Internal Revenue Service to the Peace Corps, to determine which Americans can buy medical coverage and get U.S. subsidies through the new government-run insurance exchanges (Wayne, 7/17).

USA Today: Most Health Records Now Are Electronic
An ever-expanding amount of the nation's medical records -- millions of prescriptions, medical reports and appointment reminders -- are now computerized and part of an ambitious electronic medical records program, the Obama administration reports. Since the start of a 2011 program in which the government helps finance new health records systems, doctors or their assistants have filled more than 190 million prescriptions electronically, according to data provided by the Centers for Medicare & Medicaid Services (Jackson, 7/16).

In the meantime, Kaiser Health News looks at a Health IT "bunker" where patient data is closely guarded --

Kaiser Health News: Cerner Builds Recession-Proof 'Bunker' For Health Data
This is a story about data. Lots and lots of data. And not just any data. Extremely sensitive data. The U.S. health system is undergoing a major technological shift right now. Some equate it to finally catching up to where the banking and airline industries have been for years: Doctors and hospitals are moving to electronic health records systems, and it’s not easy. Cerner, based in Kansas City, Mo., has grown into one of the nation's biggest players in the field of health information technology (Gordon, 7/16).

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State Watch

State Highlights: Poll Says N.C. Abortion Bill Hurting Governor Support

A selection of health policy stories from North Carolina, California and Virginia.

Politico: North Carolina Abortion Bill Hurts Gov. Pat McCrory, Poll Finds
There's little support for a controversial abortion bill in North Carolina, and voters are directing some of their anger at Gov. Pat McCrory, a new poll on Tuesday shows. Only 34 percent of voters support the abortion measure, which would bar so-called sex-selective abortions and impose additional regulations on abortion clinics, while 47 percent oppose it, the Public Policy Polling found. And 80 percent of voters disapprove of how the bill was brought to the floor and passed -- it was attached to unrelated motorcycle safety legislation (Gold, 7/16).

Los Angeles Times: California Hospital Workers Get Training In Surviving Shootings
Between 2000 and 2011, there were 91 shootings inside U.S. hospitals, and another 63 outside on hospital grounds, according to a Johns Hopkins study. Emergency departments were the most common site of hospital shootings, and hospital employees accounted for 20 percent of those killed or injured. The study, published last year in the Annals of Emergency Medicine, was one of the catalysts for workshops that the California Hospital Assn. began offering to help medical workers prepare for the worst: a shooter in the workplace (Susman, 7/16).

The Washington Post: Ad Targets Cuccinelli On Medicare, Social Security
The Democratic Party of Virginia released a new television ad Tuesday that focuses on Republican gubernatorial candidate Ken Cuccinelli II's criticism of Medicare and Social Security. The 30-second spot, titled "Peggy," features a senior citizen from the suburban Richmond swing territory of Henrico County (Vozzella, 7/16).

KQED/State Of Health: California Bill Would Lift Restrictions On Egg Donation
A bill awaiting Gov. Brown's signature would end a decade-old disparity in California law regarding egg donation. Under current law, it is legal to pay a woman who provides her eggs, called oocytes, to a couple going through in-vitro fertilization. But there is a ban on paying the same woman for the same eggs if they are to be used in medical research. AB 926, a bill by Assemblywoman Susan A. Bonilla (D-Concord), would lift that ban on payment for research oocytes. Bonilla said the bill will create equity in the field of medical research compensation (Korry, 7/16).

Los Angeles Times: Health Care Law May Close Gaps In Mental Health Coverage
A disjointed financing system for mental health services in California has led to gaps in care, but the national health care law is expected to help close some of those holes, according to new research by the California HealthCare Foundation. Half of the state's adults and two-thirds of the adolescents with mental health issues aren't receiving treatment, according to the study (Gorman, 7/17).

California Healthline: S.F. Alzheimer’s Pilot Results Released
Pilot project results from California were presented yesterday at the Alzheimer's Association International Conference in Boston. A six-month coordinated care study involving Alzheimer's patients and their caregivers based in San Francisco yielded impressive reductions in use of emergency department services along with other care improvements. "Emergency room services were significantly reduced, almost cut in half," said Elizabeth Edgerly, chief program officer for Alzheimer's Association of Northern California. "It was at about 40 percent.” The reduction in emergency care indicates not only that patients are getting better care, but also that the project has the potential to save a lot of money, Edgerly said (Gorn, 7/16).

Los Angeles Times: USC Buys Verdugo Hills Hospital In Glendale
The University of Southern California has purchased Verdugo Hills Hospital in Glendale, one of numerous mergers occurring around the country as hospitals prepare for the national health care overhaul. Keck Medicine of USC, which already had two hospitals, a medical school, a physician group and numerous clinics, wanted to expand its reach into the foothill communities and add an emergency room to its network. For its part, Verdugo Hills, a community hospital, wanted to become more competitive and gain access to the expertise and specialized services offered through USC (Gorman, 7/16).

North Carolina Health News: Health Care Advocates Examine Tax Plan, Wait For Budget
Members of the North Carolina Hospital Association breathed a collective sigh of relief as Republicans lawmakers rolled out their budget plan on Monday afternoon. The tax plan agreed upon by Gov. Pat McCrory, Senate leader Phil Berger and House Speaker Thom Tillis restored a sales tax refund for not-for-profit organizations. Several hospitals are the largest not-for-profits in the state and would have lost tens of millions of dollars in tax refunds under plans proposed by the Senate (Hoban, 7/17).

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Editorials and Opinions

Viewpoints: Running Out Of Money In Old Age; GOP Favors The Pentagon Over Americans' Health Care; Texas Senator's Support On Abortion Stand Doesn't Reflect American Attitudes

Los Angeles Times: A Crisis For The Very Old: They're Outliving Their Assets
Nearly half of all Americans will outlive their assets, dying with practically no money at all. Even more worrisome, that's true even among households that met the traditional standards for secure retirement income. ... The results can be measured in more than merely dollars and cents. [MIT Economist James] Poterba's paper found that this group is "disproportionately in poor health," in part because they have no resources to cover medical expenses outside Medicare. Most shocking, many of these households were considered to have entered retirement in good financial shape; they didn't count on outliving their plans (Michael Hiltzik, 7/16). 

The Washington Post: The Appalling GOP
Republicans in the House passed a 2014 budget guideline. They know the Senate won't accept it. They refuse even to enter into negotiations with the Senate to find a compromise. What does their bill do? It would deprive millions of health care with deep cuts in Medicaid and, of course, the repeal of Obamacare. It not only continues the mindless and damaging sequester cuts, but it exacts them all from domestic services – education, environmental protection, clean water, food and drug testing, head start, infant nutrition – while exempting the Pentagon (Katrina vanden Heuvel, 7/16). 

Fiscal Times: How The Doctor Cartel Sets Medical Prices
If policymakers are serious about trimming Medicare and other health care costs, they need go no further than a secretive doctors' committee called the AMA/Specialty Society Relative Value Scale Update Committee, also known as the "RUC" (pronounced "ruck"). Run by the American Medical Association, the physicians' trade group, the RUC meets three times a year in private "to develop new or relative values for revised CPT codes." CPT codes, or "current procedural terminology," are used to determine prices for specific procedures in Medicare and other medical billing. In other words, doctors are setting their own prices (John F. Wasik, 7/17).

Politico: Media Disconnect On Abortion
According to abortion advocates, Wendy Davis is a voice for America's silent pro-choice majority. The Texas state senator's recent filibuster of a bill to outlaw abortions after five months of pregnancy won her media plaudits and catapulted her from obscurity to political stardom. But the frenzy over Davis's failed quest to defeat the legislation -- which most likely ended last week when the bill passed the Texas Legislature -- is hardly proof of a national reservoir of support for late-term abortion. Rather, it is evidence of the deep disconnect between perception and reality when it comes to U.S. citizens' attitudes about the procedure (Gary Bauer, 7/16).

The Washington Post's Post Partisan: The Tricky Line Between Obamacare And The ACA
"Obamacare" is (from the Republican perspective) a socialist abomination, the government takeover of health care, a budget-buster that involves hiring thousands of IRS agents to force people to eat broccoli until death panels put them out of their misery. The Affordable Care Act? Well, over time, my guess is that it's going to be part of the status quo -- that eventually, we'll have irate conservatives with funny hats marching under signs telling the government to keep Obamacare out of the private health insurance they buy through exchanges. Oh, and don't touch their subsidies either (Jonathan Bernstein, 7/16).

Forbes: States Use Federalism To Protect Poor, Sink Obamacare's Medicaid Expansion
[Pennsylvania] Governor Tom Corbett has successfully pointed out that the debate over expansion is ultimately a debate between political expediency vs. economics and morality. The former counsels Medicaid expansion; the latter shows it to be a bad move for the state’s working poor as well as its taxpayers. The most obvious argument against Medicaid expansion is Medicaid itself (Matthew Brouillette, 7/17). 

The New Republic: Obamacare's Individual Mandate Can't Wait
Without the individual mandate, most likely, Obamacare would struggle. That's not to say it would fall apart completely: The law's tax credits, which reduce the cost of insurance for people with incomes below four times the poverty line, would entice many people to get insurance anyway. And that would probably be enough to keep the system functioning. But without the individual mandate, fewer people would sign up for insurance, which means more people would be exposed to the financial shock of illness. Insurers would seek new premium increases, beyond those necessary already, adding significantly to the government's cost of insuring each new person. The law as a whole would become less stable and effective -- which, of course, is precisely what the Republicans want (Jonathan Cohn, 7/15).

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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.