Daily Health Policy Report

Friday, July 19, 2013

Last updated: Fri, Jul 19

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Health Policy Research

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obama Says Health Law Is Saving Consumers Money

Kaiser Health News staff writers Phil Galewitz and Julie Appleby report: "Ratcheting up the campaign to sell the health law, President Barack Obama delivered a speech Thursday touting how millions of individuals are already benefiting from its insurance rebates, and others who buy coverage online in states such as California, New York and Oregon will pay lower-than-projected premiums next year because of increased competition" (Galewitz and Appleby, 7/18). Read the story.

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Obama On Health Law: 'Working The Way It's Supposed To' (Video)

This Kaiser Health News video clip includes remarks by the president at the White House Thursday in which he touted lower-than-projected premiums that have been announced for health insurance marketplaces in several states (7/18). Watch it or read the transcript.

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Capsules: Survey: Latino Groups Worry About Money For ACA Enrollment

Now on Kaiser Health News' blog, Jenny Gold reports: "The Obama administration is counting on Latinos to help make the Affordable Care Act a success, but there may be troubles ahead: Hispanic health centers and community organizations say they don't have the funding or resources to carry out the complicated sign up process for the 10 million Latinos who will be eligible for new public and subsidized health coverage options" (Gold, 7/18). Check out what else is new on the blog.

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Texas Groups Work to Promote Health Insurance Exchange

The Texas Tribune's Shefali Luthra, working in partnership with Kaiser Health News, reports: "Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1" (Luthra, 7/19). Read the story.

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Political Cartoon: 'N.Y. State Of Mind?'

Kaiser Health News provides a fresh take on health policy developments with "N.Y. State Of Mind?" by Adam Zyglis.

Meanwhile, here is today's health policy haiku:


Health law opponents
are seeking strange bedfellows
in fight against law.

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

In A Major Pitch, Obama Says Health Law Is Benefiting Consumers

In a Thursday White House speech, President Barack Obama stepped into his role as the overhaul's campaigner-in-chief and talked about the millions of Americans who are already benefiting from insurance benefits.

The New York Times: Speaking Out for Health Care Act, Obama Says Millions Will Get Rebates
President Obama, slipping back into his episodic role as a vigorous campaigner for his new health care act, said Thursday that thanks to the law, more than 8.5 million Americans are getting rebates this summer from their insurance providers. Mr. Obama was joined by families who have benefited from a provision in the law, which requires health insurers to spend at least 80 percent of the revenue from premiums on medical care rather than on administrative costs (Landler, 7/18).

Kaiser Health News: Obama Says Health Law Is Saving Consumers Money
Ratcheting up the campaign to sell the health law, President Barack Obama delivered a speech Thursday touting how millions of individuals are already benefiting from its insurance rebates, and others who buy coverage online in states such as California, New York and Oregon will pay lower-than-projected premiums next year because of increased competition (Galewitz and Appleby, 7/18).

Kaiser Health News: Obama On Health Law: 'Working The Way It's Supposed To' (Video)
This video clip includes remarks by the president at the White House Thursday in which he touted lower-than-projected premiums that have been announced for health insurance marketplaces in several states (7/18).

Los Angeles Times: Obama Touts Savings From Healthcare Law
President Obama, facing a new Republican push to dismantle his healthcare law, redoubled his efforts to sell his signature achievement Thursday at a White House event with Americans who have benefited from the law. The president pledged to "blow through" GOP attacks on the law and continue working to implement it (Levey, 7/18).

CNN: Obama Says Refund Checks Show Obamacare Success
Surrounded by middle-class Americans, President Barack Obama touted the successes of his signature health care law on Thursday and the ways consumers are seeing tangible benefits. “Because of the Affordable Care Act, insurance companies have to spend at least 80 percent of every dollar that you pay in premiums on your health care; not on overhead, not on profits, but on you,” the president said during an event Thursday in the White House East Room. The president highlighted a provision in the law called the medical loss ratio policy that forces health care providers to refund money to consumers like Chicago resident Dan Hart, a father of two who got a check in the mail for $136 (Lothian, 7/18).

The Associated Press/Washington Post: Obama Touts Insurance Rebates Under Health Care Law, While GOP Vows To Keep Trying For Repeal
Facing public doubts and embarrassing setbacks to his signature health care law, President Barack Obama stepped forward Thursday to extol the program’s benefits, emphasizing that some Americans already are receiving insurance rebates and lower premiums. Obama said the program is working the way it was supposed to with "better benefits, stronger protections, more bang for your buck." The assertion was ridiculed by Republicans, with House Speaker John Boehner calling the Affordable Care Act "a train wreck" that he will keep working to repeal (7/18).

Fox News: Obama Touts Health Care Rebates, Pushing Back After House Votes To Delay Mandates
President Obama touted a provision in his Affordable Care Act on Thursday that would require health insurance providers to return money to consumers, pushing back on Republican criticism a day after the GOP-led House voted to delay key parts of the law. The president’s signature health care overhaul -- commonly referred to as ObamaCare -- has come under fire by many Republicans who have worked to defeat, delay or gut major parts of it. At the White House event Thursday, Obama highlighted more of the financial benefits tied to it -- specifically, a half billion dollars in rebates going to 9 million people under a provision of the law (7/18).

NBC News: Obama Defends Health Care Law, Slams GOP For "Re-Fighting" Old Battles
More than three years after signing a massive health care system reform into law, President Barack Obama on Thursday worked to sell the legislation’s benefits to an American public still largely skeptical about the overhaul. Highlighting nearly half a billion dollars in insurance rebates going back to consumers due to the law's requirement that insurers spend 80 cents on the dollar towards medical care, Obama said the law is "doing what it's designed to do” (Dann, 7/18).

Politico: Barack Obama Defends Health Care law, 'Glitches' And All
Obama said he was confident that, despite resistance, even hardened foes will come to like the law. There were plenty of opponents of Medicare and Social Security when those programs became law, "but once it got set up, people started saying 'it's a pretty good deal, it gives me more security,'" said the president (Epstein, 7/18).

The Wall Street Journal: Obama Tries To Woo Health-Law Skeptics
Speaking from the White House, Mr. Obama said people across the country have gotten rebates from their health-insurance companies that they can use to pay other bills and support their families (Favole and Dooren, 7/18).

Politico: The Fine Print Of Obama's Health Care Pitch
President Barack Obama said Thursday that his health care law is already providing real savings and is working as planned — despite some expected glitches and unrelenting political opposition. He painted an optimistic picture of how Obamacare is putting money back into the pockets of consumers. … And all that political opposition? Just noise, Obama said. Of course, that picture isn’t complete. The massive health care overhaul comes with enough moving parts and political baggage to make it difficult to sort through what’s actually happening (Norman and Millman, 7/18).

Reuters: Obama Steps In To Push Health Plan As Critical Date Draws Near
Fending off delays and a barrage of political criticism of his signature healthcare law, President Barack Obama on Thursday touted benefits Americans already are reaping from the law and vowed to work through setbacks to fully implement it (Felsenthal, 7/18).

PBS NewsHour: Will Health Reform Law Make Premiums More Expensive Or More Affordable? (Video)
President Barack Obama defended the benefits of the Affordable Care Act in a news conference, part of a broader effort to sell the law amid continuing criticism from Republicans. MIT's Jonathan Gruber and Avik Roy of the Manhattan Institute join Jeffrey Brown to debate the cost of coverage under the health reform law (7/18).

ABC News: Obamacare Health Insurance Rebates: Who Gets A Check (Video)
An estimated 8.5 million Americans will receive rebates from their health insurers this summer thanks to the Affordable Care Act, which says companies that fail to spend at least 80 percent of premiums on health care must refund the difference to consumers. President Obama today touted the benefit as part of his mid-summer push to educate Americans on the continued rollout of his health care law (Dwyer, 7/18).

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Obama's Health Law Speech: The Politics In Play

News outlets analyze the strategic, political and public opinion dynamics that are currently in play -- and offer some fact-checking -- as the White House works to inspire public enthusiasm for the measure's implementation.

The Washington Post: With Legacy On The Line, Obama Touts Health-Care Implementation
Transforming the nation's health-care system stands as Barack Obama's most crucial piece of unfinished business, with much of his presidential legacy riding on whether it is deemed to have succeeded or failed. While other presidents have managed to overcome intense opposition to major new social initiatives, Obama faces a degree of difficulty with health care that has no historic parallel. So there was a certain urgency in the speech that Obama gave Thursday, the morning after the Republican-led House voted for the 38th and 39th times to dismantle all or part of the Affordable Care Act (Tumulty, 7/18).

Politico: On Health Law, Obama Sells Big By Talking Small
President Barack Obama’s got a strategy for Obamacare: make the big sell by talking small. In a speech on Thursday, Obama got deep into the specifics of the sweeping health care law, from a rule that forces insurers to send rebate checks to some consumers to the price competition in its new health insurance marketplaces— all provisions designed to save Americans money (Nather, 7/18).

NPR: White House Muddles Obamacare Messaging — Again
This summer was supposed to be a time to reintroduce the public to the Affordable Care Act and teach people how to sign up for benefits this fall. But that's not what's happening. Instead, earlier this month, the Obama administration decided to delay some key pieces of the law, most notably the requirement for larger employers to provide coverage or risk fines, because they couldn't have reporting regulations ready in time for next year's rollout. Then this week, the Republican-led House voted to delay the so-called individual mandate for a year to match. … And now some are starting to worry that the White House is getting dangerously off-message (Rovner, 7/19).

USA Today: Public Relations Battle Over Health Care Heats Up
The public relations battle over President Obama's signature health care law has simmered long past the point when it became law more than three years ago. But in the days and weeks ahead, a critical deadline looms for implementation of the law, and the battle for public opinion is heating to a boil (Madhani, 7/18).

The Associated Press/Washington Post: Fact Check: Obama Injects Misleading Advertising In Claims About Health Insurance Rebates
Another year, another round of exaggeration from President Barack Obama and his administration about health insurance rebates. In his speech defending his health care law Thursday, Obama said rebates averaging $100 are coming from insurance companies to 8.5 million Americans. In fact, most of the money is going straight to employers who provide health insurance, not to their workers, who benefit indirectly (7/19).

The Washington Post's The Fact Checker: President Obama's Claim That Americans Saved $3.4 Billion In Health-Care Premiums
With the House of Representatives yet again voting to scale back President Obama’s signature health-care law, the president made a case for the law in an East Room ceremony. The rebates the president refers to stem from the "80/20 rule" or "Medical Loss Ratio rule" in the law, in which insurance companies must rebate a portion of the premiums if they spent less than 80 percent of the premium on medical care and efforts to improve care. In 2012, insurance companies shipped about $500 million in rebates to American families, according to the Department of Health and Human Services (Kessler, 7/19).

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Health Law Continues To Trigger Friction Across Party Lines, And Among Democrats

After a weekend of high-profile action related to the health law, news outlets note that polls indicate it remains a divisive issue -- a point that was evident with this week's House vote to delay the employer and individual mandates, as well as Democrats' reactions to it.  

The Washington Post's The Fix: The Health-Care Law Isn't All That Popular. And That's Not Changing
Of the opposition to the law — particularly within House Republican circles — Obama said: "We're just going to blow through that stuff and keep on doing the right thing for the American people." Judging from polls, Obama shouldn’t expect to blow through much of anything when it comes to health-care law, however. The Kaiser Family Foundation has been tracking the popularity — or, perhaps better put, unpopularity of the bill-now-law for quite some time (Cilizza, 7/18).

National Journal: Democrats' Couch Time Is Over On Obamacare
Republicans have had the Affordable Care Act battlefield to themselves for a long time, but the pro-Obamacare forces are coming off the couch. The intense back-and-forth of the past few days is a taste of what’s to come as the most contentious parts of the law start phasing in this fall (Lawrence, 7/18).

The Hill: Dem Anxiety Over Obamacare Shows In House Mandate Vote
Vulnerable House Democrats laid low Thursday after voting to delay two key Obamacare mandates over a White House veto threat. The hush from centrist Dems came after a considerable number cast ballots alongside Republicans on Wednesday for bills designed to embarrass the Obama administration (Viebeck, 7/19).

WBUR: Here & Now: Affordable Care Act Continues To Divide Obama, Lawmakers (Audio)
A day after House lawmakers voted for delays in implementing health care reform, President Obama today made a push for his Affordable Care Act, claiming that consumers will see rebates averaging around $100 from health insurance companies under the ACA. House lawmakers voted largely on party lines yesterday to delay when individuals must have health insurance. They also affirmed an Obama administration decision to delay when larger employers must offer health coverage to their workers (7/18).

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Lower Premiums -- But Only If Right People Buy; Other Health Exchange News

CBS News looks at the dynamics of the health exchanges. In the meantime, officials in Minnesota and Maryland are weighing how to educate consumers about the nuances of the marketplaces, while private organizations are filling that role in Texas.

CBS News: Health Care Exchanges Could Lower Premiums -- If They're Bought (Video)
On Thursday, the president promised what he called "more bang for your buck" when a major part of his health insurance program opens for enrollment in October. The Affordable Care Act is facing public doubts and technical setbacks, but President Obama said costs are falling and will fall even more when uninsured Americans begin enrolling in health care exchanges where insurance companies will compete for customers. There are potential savings to be had -- if the right customers buy in (Axelrod, 7/18).

The Texas Tribune: Groups Work to Promote Health Insurance Exchange
Texas officials have declined to establish a state-based health insurance marketplace, a major provision of the federal Affordable Care Act. So private organizations are working to educate Texans about coverage options through the federal health insurance exchange, which opens on Oct. 1 (Luthra, 7/18).

MinnPost: State Considers Release Of Health Insurance Rates For MNSure
Policymakers and state officials are looking at ways to shed some light on the rates consumers will pay on Minnesota's health-insurance exchange before more than a million Minnesotans are expected to begin enrolling in the complicated new health-reform program. The state Commerce Department is examining ways to provide at least a summary of the rate information before October, the federally imposed deadline on the state to begin enrolling consumers in MNsure, the backbone of the federal health-care reform law here in Minnesota (Nord, 7/18).

The Associated Press/Washington Post: Md. Official Urges Businesses To Take Part In Program For Tax Credits In Health Care Reform
The comptroller of Maryland is urging small businesses to take advantage of tax credit they could be eligible for relating to health care reform. Comptroller Peter Franchot is scheduled on Monday to talk about a pilot program to see how well mailings to more than 5,000 small businesses in Howard County will boost interest (7/18).

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Based On Preliminary Premiums, HHS Sees Lower-Than-Expected Costs

Coverage of health law implementation issues includes reports about a recent Department of Health and Human Services analysis that concluded premium costs would be less than initially projected in 11 states, as well as news about rate shock, the role of the health law in triggering a shift to part-time work and other issues.

The Wall Street Journal's Washington Wire: HHS Analysis Finds Lower Health Insurance Premiums
An analysis by the Department of Health and Human Services looked at proposed, preliminary premiums of insurance plans in 11 states that would be sold under health law in 2014, and found they were less expensive than previously projected by the administration (Dooren, 7/18).

Reuters: U.S. Sees Lower-Than-Expected Obamacare Insurance Costs
Hoping to gain the high ground in an escalating war of words over Obamacare, the U.S. administration on Thursday forecast sharply lower than expected insurance costs for consumers and small businesses in new online state health care exchanges. The exchanges represent the centerpiece of President Barack Obama's Patient Protection and Affordable Care Act, and their success could depend on the cost of so-called "silver plans" with mid-range premiums, which are expected to attract the largest number of enrollees (Morgan, 7/18).

Bloomberg: Fed Ponders Part-Time Shift As Obamacare Role Questioned
Bailey Brewer, 28, is a writer with a graduate degree in journalism. She's been employed since the start of the year as a temporary office worker, unable to find a full-time job. … Brewer isn't alone. The number of workers holding full-time positions fell in the U.S. in June as part-timers hit a record after rising for three straight months, according to the Bureau of Labor Statistics household data (Nussbaum and Smialek, 7/19).

The Wall Street Journal's Washington Wire: Hatch to Unions: Join GOP In Calling For Health Law Delay
The Affordable Care Act is upsetting some political alliances and inspiring a flurry of letter-writing among politicians. Last week, three union presidents wrote a letter to Congress's top Democrats, Senate Majority Leader Harry Reid of Nevada and House Minority leader Rep. Nancy Pelosi of California, sharply criticizing the Obama administration and the law’s impact on union-run health plans. Today, the unions got a response of sorts -- from Republican Sen. Orrin Hatch (Maher, 7/18).

CQ HealthBeat: Urban Institute Study Predicts 'Rate Shock' Would Be Temporary
If the premiums that health plans charge in the insurance exchanges opening this fall start out shockingly high, they won’t stay that way, predicts a study released by the Urban Institute on Thursday. The study also suggests that the new health care law marketplaces will prove viable in the long run because the rates that insurers charge will be reasonable (Reichard, 7/19).

Kaiser Health News: Capsules: Survey: Latino Groups Worry About Money For ACA Enrollment
The Obama administration is counting on Latinos to help make the Affordable Care Act a success, but there may be troubles ahead: Hispanic health centers and community organizations say they don't have the funding or resources to carry out the complicated sign up process for the 10 million Latinos who will be eligible for new public and subsidized health coverage options (Gold, 7/18).

The Hill: Top Treasury Official: No More Obamacare Delays Looming
A top Treasury official on Thursday suggested that his department has no current plans to delay additional provisions of the ObamaCare. J. Mark Iwry, Treasury's deputy assistant secretary for retirement and health policy, told lawmakers that the employer mandate is the only policy that has been considered for deferral (Viebeck, 7/18).

Stateline: Nurse Practitioners Slowly Gain Autonomy
When the federal health law takes effect in January, some 30 million more Americans are expected to have health insurance, many for the first time. An already critical shortage of primary care providers may make a doctor's appointment hard to come by. Increasingly, you might hear, "The nurse will see you now." Some states are trying to fill the primary care physician shortage with nurses who have advanced degrees in family medicine. That requires relaxing decades-old medical licensing restrictions, known as "scope of practice" laws that prevent these nurse practitioners from playing the lead role in providing basic health services. At least 17 states now allow them to work without a supervising physician, and lawmakers in five big states are considering similar measures (Vestal, 7/19).

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Capitol Hill Watch

House Panel Releases Draft Bill To Repeal Medicare's Payment System For Doctors

The proposal would get rid of the sustainable growth rate formula and replace it with a system that rewards doctors based on quality and efficiency measures, MedPage Today reports.

MedPage Today: GOP: Repeal SGR And Grant Annual Pay Raises For 5 Years
House lawmakers late Thursday released the final draft of a bill that repeals Medicare's sustainable growth rate (SGR) payment formula and replaces it with a system that incentivizes quality and efficiency starting in 2019. The bipartisan measure provides 5 years of stable Medicare payments starting next year, with reimbursements growing 0.5 percent for each year between then and 2018, according to the 70-page, yet-to-be-named bill. After those 5 years, physicians would be subject to having reimbursements based on performance on quality measures, or may opt out of that requirement if they practice in certain alternative payment models (Pittman, 7/18).

In other congressional news -

The Hill: Bill Would Exempt FDA User Fees From Cuts
A new bipartisan House bill would exempt Food and Drug Administration user fees from sequestration, the automatic federal budget cuts that took effect in March. The FDA's budget is substantially supported by user fees from the industries it regulates. The budget cuts are expected to shave about $85 million from the agency's budget in 2013 by hitting those fees (Viebeck, 7/18).

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Health Care Marketplace

Community Health Faces New Subpoena Into Medicare Admissions Practices

Community Health has received a subpoena for two executives to testify in an investigation into its Medicare admissions. The hospital operator also reports its income fell 57 percent on weak patient volume and debt.

The Wall Street Journal: Community Health Slashes Outlook, Gets Another Subpoena
Hospital operator Community Health Systems Inc. CYH +0.13%slashed its second-quarter earnings forecast and said it was served with an additional subpoena from the government as part of an investigation into Medicare admissions. The double dose of bad news sent shares of Community Health and its peers sharply lower in after-hours trading (Tadena, 7/18).

Modern Healthcare: Community Health Systems Faces New Subpoena, Reports 57% Fall In Net Income
The U.S. Justice Department hit Community Health Systems with an additional subpoena and a request to interview two high-ranking executives, escalating a two-year Justice Department investigation into the company's admissions practices from its emergency departments. The Franklin, Tenn.-based chain disclosed the revelations in an earnings preview that also showed a sharp 57.2 percent decline in net income, which it attributed to weak patient volume, higher-than-expected bad debt and an adverse payer mix (Kutscher, 7/18).

Also, a St. Louis-based drugmaker will pay federal authorities millions to end a doctor-kickback lawsuit --

The Associated Press/Washington Post: St. Louis Drug Maker Mallinckrodt To Pay Feds $3.5M To Settle Lawsuit Over Doctor Kickbacks
A St. Louis-based drug maker will pay $3.5 million to settle allegations that it paid doctors to prescribe "outdated, third rate" antidepressants and sleep aids, the U.S. attorney's office in San Francisco announced Thursday. A former employee of Mallinckrodt LLC originally filed the lawsuit in 2008 under the federal False Claims Act. The employee alleged that between 2005 and 2010, the company paid doctors consulting and speaking fees and other inducements in exchange for prescribing drugs that otherwise would not have been prescribed (7/18).

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UnitedHealth Reports Profit Up 7.4 Percent

The nation's largest health care insurer says membership is growing and medical costs have been lower than expected.

The Wall Street Journal: UnitedHealth Earnings: Company Raises Outlook As Profit Rises 7.4%
The nation's biggest managed-care company by revenue and membership posted a quarterly profit well above Wall Street expectations, and it raised the lower end of its forecast for full-year 2013 earnings. Solid membership growth and lower-than-expected medical costs are fueling the positive results. But UnitedHealth continued to be cautious about its outlook for next year, citing planned reductions in government funding of Medicare Advantage health plans for the elderly, as well as the implementation of certain provisions of the U.S. health-care overhaul law (Loftus, 7/18).

The Associated Press/Washington Post: UnitedHealth 2Q Profit Rises As Enrollment Improves, But Executives Caution On Medicare Cuts
UnitedHealth Group Inc.'s second-quarter net income rose almost 8 percent, buoyed by steady enrollment growth and slower-than-expected use of health care services. The nation's largest health insurer's earnings topped Wall Street estimates on Thursday, and it raised the low end of its full-year earnings forecast. The company’s stock jumped nearly 6 percent (7/18).

Minneapolis Star Tribune: UnitedHealth Adds Members Amid Industry Shifts
With all the fulminations in the insurance industry over the federal health care law, the mood at United­Health Group Inc. seems to have settled into business as usual now that the most sweeping changes are just months away. "Apparently it's not going to be a complete disaster," deadpanned Stifel health care analyst Thomas Carroll, as the Minnetonka-based insurance giant posted better-than-expected earnings Thursday (Crosby, 7/19).

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State Watch

Texas Gov. Perry Signs Abortion Restrictions Into Law; Fights Still Likely

Texas Gov. Rick Perry signed controversial abortion restrictions into law Thursday, even as abortion-rights supporters readied challenges and said the law will force all but five of the state's abortion providers to close. Reuters, in the meantime, reports why that might not be true.

The New York Times: Abortion Restrictions Become Law In Texas, But Opponents Will Press Fight
Six months after declaring his goal to make abortion at any stage "a thing of the past," Gov. Rick Perry signed a bill into law Thursday giving Texas some of the toughest restrictions on abortion in the country, even as women's rights advocates vowed to challenge the law's legality in court (Fernandez, 7/18).

Los Angeles Times: Texas Gov. Rick Perry Signs Bill To Curb Abortions; Challenges Likely
The bill passed over the strong protests of Democrats and abortion-rights supporters. Abortion-rights activists and clinic operators say the measure will force the closure of all but five of the state's 42 abortion providers. In a signing ceremony at the state Capitol in Austin attended by more than 100 Republican lawmakers, the Republican governor praised the measure as a landmark in protecting unborn children and women's health (Kelly, 7/18).

Texas Tribune: Perry Signs Abortion Bill Into Law
The law, which would impose several new regulations on abortions and abortion providers, has drawn criticism from abortion advocates and incited demonstrations from both sides. HB 2 would ban abortions after 20 weeks of gestation, impose new regulations on how the abortion drug RU-486 is administered, require abortion providers to have admitting privileges at nearby hospitals and require all abortion facilities to meet the regulatory standards for ambulatory surgical centers (Luthra, 7/18).

Reuters: Why Many Abortion Clinics In Texas Stay Open Despite New Law
Most of the Texas clinics that abortion rights advocates predict will close because of a new law requiring tighter health and safety standards likely will remain open -- at least if history is any guide. ... Twenty-six states have laws that require abortion clinics to meet varying levels of hospital standards, according to the Guttmacher Institute, which supports abortion rights. Pennsylvania, Virginia and Missouri passed strict health and safety rules similar to Texas, it said. In those three states, however, most clinics were able to stay open after the laws passed, some by reallocating dollars to comply with building upgrades, according to abortion providers and state health department officials interviewed by Reuters (Garza, 7/18).

Meanwhile, in other news on Texas women's health --

Texas Tribune: Family Planning Clinics to Close, Citing Reduced Funds
Three Planned Parenthood family planning clinics in Southeast Texas announced plans Thursday to close at the end of August. The closures result from reduced family planning funds and the removal of Planned Parenthood from the state Women’s Health Program, said Melaney Linton, CEO of Planned Parenthood Gulf Coast. While the closures were announced the same day as Gov. Rick Perry’s signing of omnibus abortion legislation, House Bill 2, the closures are “a completely separate issue” from that new law, Linton said (Luthra, 7/18).

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State Highlights: Court Hears Arguments On Fla. 'Gun-Gag' Law

A selection of health policy news from Florida, Minnesota, Utah, Oregon, Georgia, Wisconsin and California.

Medscape: Appeals Court Hears Arguments On Physician Gun-Gag Law
The top attorney for the state of Florida asked a federal appeals court today to reinstate a Florida law that regulates what physicians can ask patients about gun ownership, asserting that the law does not actually stifle such questions. Yes, it does, countered a lawyer representing several Florida medical societies and individual physicians who challenged the law as an infringement on their First Amendment right to free speech (Lowes, 7/18).

MPR News: U Of M Wants To Scale Back Employee Health Care Coverage
One of the state's largest employers is proposing to scale back its employee health plans to avoid a massive tax penalty under the new federal health care law. The University of Minnesota is considering changes for 2014 that would increase copays for primary and specialty care, require employees to pay deductibles, and establish a cheaper, but more limited plan for Twin Cities area employees, among other things. The changes would apply to employees but not students (Richert, 7/18).

The Associated Press: Fewer Utah Doctors Caring For Medicaid Patients
Fewer Utah doctors are willing to care for a growing number of Medicaid patients, according to analysts at the Utah Legislature. The latest figures show the number of Utah medical providers willing to take Medicaid patients has dwindled to 2,517, down by 25 percent from 3,366 in 2008 (7/18).

The New York Times: Heroin In New England, More Abundant And Deadly
Heroin, which has long flourished in the nation’s big urban centers, has been making an alarming comeback in the smaller cities and towns of New England (Seelye, 7/18).

The Lund Report: Legislation Failed, Yet Dental Integration Moves Forward
Coordinated care organizations have started the tricky work of integrating dental care into their health care delivery system for the Oregon Health Plan, now that legislation pushed by dental organizations has failed, and the ground rules have become more settled. Senate Bill 373, pushed most ardently by Advantage Dental, would have guaranteed contracts for all the existing dental organizations through 2017, but the CCOs resisted that demand, and the bill died in the budget committee after clearing the Senate Health Committee (Gray, 7/19).

Georgia Health News: Doctors Blast Slow Pace of Medicaid Raise
The delay in a pay raise for Medicaid doctors in Georgia is "inexcusable and unacceptable,"’ physician groups say. On Thursday, an email letter to Jerry Dubberly, the state Medicaid chief, urged the state Department of Community Health and vendor HP "to accelerate the process to resolve the IT readiness problems that are reportedly responsible for this significant delay" (Miller, 7/18).

Milwaukee Journal Sentinel: Lawmaker Seeks Bill To Rein In Podiatrist's Practices
A Wisconsin lawmaker is calling for a bill that protects patients from unexpected medical fees by requiring podiatrists to disclose if they are in a patient's health insurance network before treatment. The proposed legislation comes three days after the Journal Sentinel reported on Milwaukee-area foot doctor John Lanham, who over the course of 12 years has triggered 92 formal complaints with the state regulatory agency, most related to excessive fees or fraudulent billing practices. Lanham told the Journal Sentinel that he survived on the "ignorance" of patients who don't know the details of their insurance plans and said he would not be able to make a living as an independent physician if he was forced to disclose his fees before treating clients (Koran, 7/18).

California Healthline: Scope Of Practice A Hot Topic Across U.S.
A panel of health care experts, outlining proposed and pending changes in scope-of-practice laws across the country yesterday, said California's advancement of four bills in the current session is just the tip of the national legislative iceberg. "There could never be more state activity at this level, because every single state is under pressure in terms of needing to solve workforce issues," said Kavita Patel, an internist at Johns Hopkins and the managing director for clinical transformation and delivery at the Engelberg Center for Health Care Reform at the Brookings Institution. … Patel said 827 bills were proposed nationwide to change scope of practice last year. She said 124 of them were enacted in 29 states (Gorn, 7/18).

California Healthline: Treatment Trends Pushing Diabetic Amputations Down List Of Options
Diabetes is on the rise in California and the nation, but one of the most feared outcomes of the disease -- amputation -- may be waning. Advanced complications of diabetes, such as nerve damage, gangrene and infection, can lead to the need to amputate legs and feet. But the decision to amputate may be moving down and sometimes off the list of treatment options. At podiatry clinics and wound care centers in California, patients with advanced diabetes who might be candidates for amputation are being treated with alternatives aimed at making amputation a last -- rather than primary -- option (Gorn, 7/18).

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Health Policy Research

Research Roundup: The Cost To States Opting Against Medicaid Expansion

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

Spine: Medicaid Status Is Associated With Higher Complications Rates After Spine Surgery – After analyzing 2003-2004 data of patients who underwent spinal surgery at two medical institutions, they found that Medicaid beneficiaries were at much higher risk of experiencing any type of complication than patients who are privately insured. “The results of our study further support the growing body of literature that Medicaid patients have higher rates of complications,” the authors write. When evaluating patients and considering the likelihood of complications, “Medicaid status should be considered as well,” they concluded (Hacquebord et al., 7/15).

Annals Of Family Medicine: Care From Family Physicians Reported By Pregnant Women – With national survey data from 2000 to 2009, researchers looked at how family physician use for maternity-related care varied by geographic region. “Even though provision of maternity care by family physicians has decreased during the past decade, a substantial and steady proportion of pregnant women (34.4%) received care from a family physician, underscoring the importance of family physicians as providers of clinical services for childbearing women, before and during pregnancy,” the authors write, concluding: "Trends in family medicine care for pregnant women have remained steady for the nation as a whole, but they differ by region of the United States. Most pregnant women reported care from multiple clinicians, highlighting the importance of care coordination for this patient population" (Kozhimannil and Fontaine, 7/15).

JAMA Ophthalmology: Socioeconomic Disparity In Use Of Eye Care Services Among US Adults With Age-Related Eye Diseases: National Health Survey, 2002 And 2008 – Among U.S. adults, age-related eye diseases, such as glaucoma and cataracts, are the leading causes of vision impairment. Early detection and treatment can prevent permanent damage. Researchers analyzed 2002 and 2008 survey data of adults ages 40 years and older and found that: "Many issues affect the use of eye care services, including an individual’s ability to pay for the services, accessibility of eye care professionals and facilities, vision and eye care insurance coverage, high insurance deductibles, provider and patient education, and beliefs about health. However, we found that eye care in the United States is suboptimal, especially among [groups with low socioeconomic status]. This calls for continued efforts to improve access to and use of eye care services among socioeconomically disadvantaged groups" (Zhang et al., 7/18).

Urban Institute and The Kaiser Family Foundation: The Cost Of Not Expanding Medicaid – "As of July 2013, 24 states were moving forward with the Medicaid expansion, 21 states were not moving forward with the expansion and debate was on-going in the remaining 6 states. The decisions by as many as 27 states not to adopt the Medicaid expansion will leave many more uninsured; these states would also forgo billions in federal funds," the authors write. They add that 64 percent “of all consumers who were originally slated to receive coverage under Medicaid expansion live in states that are not moving forward or are still debating the expansion – 6.3 million and 2.1 million, respectively. Texas, Florida and Georgia account for half of the enrollees in the states not moving forward" (Holahan, Buettgens and Dorn, 7/17).

In a related report, researchers highlight "five key ways that state decisions will shape the outcome of Medicaid expansion" (Rudowitz and Stephens, 7/17).

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

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 healthcare 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 (Lowes, 7/12).

Reuters: Half Of Parents Aware Of CT Scan Risks
Just under half of parents in a recent survey understood that radiation from a computed tomography (CT) scan is tied to an increased risk of cancer for their child. There has been a growing understanding among the medical community in the past decade that children who have had a CT scan are slightly more likely to develop cancer later in life, researchers said. ... About 47 percent of parents correctly believed that undergoing a CT scan is tied to a greater cancer risk over a child's lifetime, according to findings published in Pediatrics (Grens, 7/17).

MedPage Today: Dementia Screening Gets Thumbs Down
Population screening to detect Alzheimer's disease or other dementia can't currently be recommended because there isn't enough evidence to show it offers practical benefits, researchers reported here at the annual Alzheimer's Association International Conference. In addition to this "gap in evidence," even when the screening programs identify possible dementia patients, only about half those people undergo follow-up testing, according to Carol Brayne, MD, professor of public health medicine at the Cambridge University Institute of Public Health in England (Susman, 7/18).

MedPage Today: Misdiagnosed Dementia Adds $$$ To Healthcare Bill
When patients with vascular or Parkinson's disease-related dementias are initially misdiagnosed as having Alzheimer's disease, their cost of care rises dramatically, a researcher said here. In an analysis of anonymous Medicare beneficiary records, about one in eight individuals receiving diagnoses of vascular dementia had previously been diagnosed with Alzheimer's disease, incurring average Medicare claims of about $12,000 to $14,000 during the year of diagnosis change over and above the costs recorded for individuals with unchanged vascular dementia diagnoses, said Noam Kirson, PhD, of Analysis Group (Gever, 7/17). 

Boston Globe: Small Number Of Doctor Shoppers Have Big Impact
They make up a very small percentage of people filling prescriptions but the amount of opioids they buy, feeding their own addiction or others’, is alarming. “Doctor shoppers,” or people who visit multiple physicians’ offices and pharmacies soliciting the highly-addictive drugs, accounted for about 7 of every 1,000 people who filled a prescription for narcotic painkillers in 2008. But they purchased nearly 4 percent sold that year, according to a study by Cambridge researchers published Wednesday evening on PLOS ONE (Conaboy, 7/18).

Oregonian: Oregon Elderly Live Healthier, Longer Lives Than In Other States
Because they stay physically active and eat smart, Oregon's seniors have more healthy years ahead of them than folks in most other states. The Centers for Disease Control released a report Thursday that put Oregon's healthy-life expectancy after 65 -- the length of the time after retirement-age that one can expect to stay healthy -- at 15 years, ranking it with the top quarter of U.S. states (Karlamangla, 7/18).



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Weekend Reading

Longer Looks: Immigrant Health Tied To Their Status

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Atlantic: The Immigrant Healthcare Imperative
I didn't know much about my patient, a young man originally from Tibet, other than that he worked in a restaurant in Queens.  For most of my patients, their coming-to-America story is an intrinsic part of their medical history. It's certainly medically relevant in terms of what diseases they might have been exposed to, what nutritional, environmental and genetic factors might play a role in their health, but it's also such a key part of who they are that it's usually a central part of our initial interview. … As my patient's story slowly unfurled from him I realized that there was so much I did not know about him. He was not a loner at all. He was married, with two young children. His parents lived with him, as well as an aunt. But no one was getting any medical care because they were undocumented and worried about deportation. ... As immigration reform wends its way through a fractious and polarized House of Representatives, many are thinking about the implications for health care. From the medical perspective, bringing people into a primary care system is beneficial for our entire society, both from the public health standpoint and the moral standpoint (Danielle Ofri, 7/16).

The New York Times: A Life-Or-Death Situation
If Margaret Pabst Battin hadn't had a cold that day, she would have joined her husband, Brooke Hopkins, on his bike ride. Instead Peggy (as just about everyone calls her) went to two lectures at the University of Utah, where she teaches philosophy and writes about end-of-life bioethics. Which is why she wasn't with Brooke the moment everything changed. Brooke was cycling down a hill in City Creek Canyon in Salt Lake City when he collided with an oncoming bicycle around a blind curve, catapulting him onto the mountain path. His helmet cracked just above the left temple, meaning Brooke fell directly on his head, and his body followed in a grotesque somersault that broke his neck at the top of the spine. … Suffering, suicide, euthanasia, a dignified death — these were subjects she had thought and written about for years, and now, suddenly, they turned unbearably personal. Alongside her physically ravaged husband, she would watch lofty ideas be trumped by reality — and would discover just how messy, raw and muddled the end of life can be (Robin Marantz Henig, 7/17).

Scientific American: Poem: Asymmetry
We met on my birthday and
your age trailed mine by a week.
Your past medical history bare,
you let me see you sick.
You let me feel the margins
of your spleen,
your sexual history,
your confusion over why this
and why you
and what now
and what next (Shara Yurkiewicz, 7/9).

Kaiser Family Foundation: The YouToons Get Ready for Obamacare: Health Insurance Changes Coming Your Way Under the Affordable Care Act
2014 is coming–are you ready for Obamacare? Join the YouToons as they walk through the basic changes in the way Americans will get health coverage and what it will cost starting in 2014, when major parts of the Affordable Care Act, also known as “Obamacare,” go into effect. Written and produced by the Kaiser Family Foundation. Narrated by Charlie Gibson, former anchor of ABC’s World News with Charlie Gibson and a member of the Foundation’s Board of Trustees. Creative production and animation by Free Range Studios (7/17).

Time: Sick Before Their Time: More Kids Diagnosed With Adult Diseases
Diabetes, obesity and elevated blood pressure typically emerge in middle-age, but more young children are showing signs of chronic conditions that may take a toll on their health.  The latest report on the trend, from researchers at Harvard Medical School found that children and adolescents are increasingly suffering from elevated blood pressure. Published in the American Heart Association journal Hypertension, the study showed a 27% increase in the proportion of children aged 8 years to 17 years with elevated blood pressure over a thirteen-year period (Alexandra Sifferlin, 7/18).

The New York Times: Talking Female Circumcision Out Of Existence
Like every other girl of her era in her part of southern Ethiopia — and most girls in the country — Bogaletch Gebre was circumcised. …Today, however, cutting has vanished from Kembata-Tembaro, as have bride abduction and widow inheritance. A study done for the Innocenti Research Center, a research arm of Unicef, found that cutting had only 3 percent support in 2008 — down from 97 percent in 1999. This is a remarkable achievement. There is nothing more difficult than persuading people to give up long-held cultural practices, especially those bound up in taboo subjects like sex (Tina Rosenberg, 7/17).

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Editorials and Opinions

Health Law Views: Responding To 'Farcial Bit Of Political Theater;' Senators Call For Revision Of Law's Definition Of Full-Time Job

The recent announcement of the premium cuts in New York and President Barack Obama's health speech has galvanized opinion writers.

Bloomberg: The Pointless Debate Over Obamacare
President Barack Obama's remarks this week on the Affordable Care Act had the trappings of importance: members of Congress in the audience, ordinary citizens on stage. All that was missing, as is too often the case in the health-care debate, was anything important to say. ... In his defense, Obama was responding to an even more farcical bit of political theater staged by House Republicans, who voted to delay the health law’s mandate that individuals buy insurance. It was the 38th time the House has voted, futilely, to stop or slow Obamacare. Such posturing only contributes to public confusion over the law -- and keeps Republicans and Democrats alike from addressing essential steps toward health-care reform (7/18).

The Wall Street Journal: ObamaCare's Definition Of A Full-Time Job Needs Revising
In Lafayette, Ind., a school district cut the hours of 200 support staff to no more than 29 per week. In Bangor, Maine, the school system is preparing to track and cap the number of hours worked by substitute teachers to ensure that they don't work more than 29 hours a week. Elsewhere, in Portland, Maine, a small business reduced a part-time employee's hours from 35 to 29. We are hearing reports like this from across the country. Why is this happening? (Sen. Joe Donnelly, D-Indiana, and Sen. Susan Collins, R-Maine, 7/18).

The New York Times: The Good News On Insurance Premiums
Individuals and families who buy health insurance on their own will pay significantly lower premiums next year in New York and many other states. It is the most impressive evidence yet that the Affordable Care Act, through its mandates and competition-promoting health insurance exchanges, can hold previously rising premiums in check. The encouraging news underscores the vital importance of the health law’s “individual mandate" (7/18).

Reuters: The Obamacare Plot Twist 
If this much-reviled bill proves to work for tens of millions in select states, it will change the current narrative dramatically. It will demonstrate that collective action is not just desirable for optimal collective outcomes; it is essential. Fight all you want to prevent laws you dislike from passing; work all you wish to amend laws that have passed; but once those laws exist and have been validated, work together to implement them. Sounds oddly naïve in today’s jaded world, but it’s the only way forward (Zachary Karabell, 7/18).

The Wall Street Journal: A Health Scare For Democrats
What if waking up is more terrifying than the nightmare? Democrats for three years have comforted themselves with the thought that 2014 would be the year they broke free of the ObamaCare night sweats. Their political washout in 2010, their failure to take back the House last year, all was the result of their having to defend a law that had yet to take effect. Once the law was up and running, Americans would wake up to its benefits. Or so they believed (Kimberly A. Strassel, 7/18).

The Wall Street Journal: ObamaCare's Eroding Support
The Washington refrain is that Wednesday night's House votes delaying ObamaCare mandates were a pointless dead end, but the White House shouldn't be too confident. Opposition to more of the Affordable Care Act is becoming bipartisan. The first measure, which sailed through 264 to 161 with 35 Democrats in favor, codified President Obama's decision to suspend the Affordable Care Act's employer mandate to extend insurance benefits to workers or else pay a penalty. The White House lacks the legal authority to delay the mandate by fiat, so the vote was a vindication of the rule of law (7/18).

The New York Times: Economix: What Makes U.S. Health Insurance Exchanges So Complicated
Americans insist on choice and pluralism among insurance products, enabling them to find coverage they believe will fit their personal needs. That choice, desirable though it may be, comes at a stiff price, with two dimensions. First, it adds considerably to monetary outlays on administrative functions, which in the United States run about twice per capita what they are in other countries. And to make careful and responsible choices takes a great deal of a person’s time (Uwe E. Reinhardt, 7/19).

Fox News: 5 Problems With The President's Spin On ObamaCare
President Obama claimed that consumers in states such as Maryland received a windfall as a result of refunds issued by insurance companies who failed to meet the requirements. These requirements tried to enforce insurance companies to spend at least 80 cents on every dollar towards medical care and not administrative costs. If, in fact, the Affordable Care Act was working the way the President claims, insurance companies should be staying above the 80 percent threshold, and not providing refunds (Dr. Sreedhar Potarazu, 7/18).

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Viewpoints: Expanding Abortion Restrictions; Lift The Ban On Gay Blood Donors; Medicare's Price Schedules

Minneapolis Star Tribune: Women's Health At Stake In 2014
What's going on in Wisconsin, North Dakota, South Dakota and Iowa ought to be a wake-up call to Minnesotans who prefer that physicians, not politicians, guide an individual's medical care. Minnesota's neighbors have moved with alarming alacrity to cripple women's access to a safe and legal medical procedure — abortion (7/18).

NBC News: Ease US Blood Supply Shortage By Lifting Gay Donor Ban
The United States is facing a health care crisis. Our supply of blood is dangerously low. The American Red Cross reports that across the nation blood donations were down an estimated 10 percent in June -- about 50,000 fewer donations than in May. In the face of a blood supply shortage that is bad and likely to get worse, there is a group of people -- gay men -- who might ease the situation, if only they were allowed to help (Art Caplan, 7/17).

St. Louis Post-Dispatch: As Whooping Cough Returns, Trust Science, Not Opinion
People who listen to bogus science and deny facts from legitimate scientific studies are pushing an agenda that a wise parent should back away from. In fact, backing away is too slow. Turn and run. ... It comes down to this: Who would you rather get medical advice from — Jenny McCarthy, former nude model turned childhood development expert, or the Journal of Pediatrics? Ms. McCarthy is convinced that her son’s autism is linked to childhood vaccinations. But in April, pediatric researchers published a study that looked at nearly 1,000 children and concluded that exposure to vaccines during the first two years of life was not associated with an increased risk of developing autism (7/19).

Forbes: Why Medicare Is A Crummy Business Partner
Medicare unveiled a series of regulations this month that make annual adjustments to various price schedules that set out what the program pays providers. The proposals confirm why the agency makes for such a crummy business partner. The new rates will hit some healthcare businesses with cuts of as much as 25%. If the reductions stand, it will throw some providers over a proverbial cliff, disrupting their businesses and ultimately impacting patient care (Scott Gottlieb, 7/18).

Los Angeles Times: Genetic Screening: Every Newborn A Patient
This year marks the 50th anniversary of routine newborn screening in the United States. Since 1963, tens of millions of babies have had blood drawn from their heels to be tested for rare diseases. The program has unquestionably prevented tragedies. ... But routine screening is now being expanded in ways that demand scrutiny (Stefan Timmermans, 7/19).

Los Angeles Times: New York Mayor Bloomberg May Also Cure Dementia
New York Mayor Michael Bloomberg announced his latest health initiative this week: He's banning elevators! OK, not really. But he did say he was planning to introduce legislation that would inspire New Yorkers to take the stairs by making staircases in buildings more accessible. As with all of Bloomberg’s noble health-conscious initiatives, which have included banning trans-fats and trying to curb super-sized, nutrition-less sodas, the announcement was met with a contingent of eye-rolls (Alexandra Le Tellier, 7/18).

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Andrew Villegas

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Shefali Luthra

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