Daily Health Policy Report

Wednesday, July 2, 2014

Last updated: Wed, Jul 2

KHN Original Reporting & Guest Opinion

Health Reform


Administration News

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Mountainous Backlog Stalls Medi-Cal Expansion in California

Helen Shen, writing for Kaiser Health News in collaboration with the San Jose Mercury News, reports: "A massive backlog of Medi-Cal applications is well into its third  month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared. The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since.  As the state works through older applications, new ones continue each day to enter the system, which has been plagued by computer glitches and inefficient procedures for verifying applicants' personal information. There are no estimates of processing times or how long delays will persist" (Shen, 7/2). Read the story.

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Capsules: Who Shopped The SHOP Exchanges? Very Few Small Businesses

Now on Kaiser Health News' blog, WNYC’s Fred Mogul, working in partnership with KHN and NPR, reports, "New York’s new marketplace covered almost a million people, with about 600,000 people getting Medicaid, 400,000 people getting individual plans and just 10,000 getting employer-based small business plans, through the Small Business Health Options Program, or SHOP." Check out what else is on the blog.

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Political Cartoon: 'Curbed Enthusiasm?' By Nate Beeler, The Columbus Dispatch

Kaiser Health News provides a fresh take on health policy developments with "Curbed Enthusiasm?" by Nate Beeler, The Columbus Dispatch.

Meanwhile, here's today's haiku:


A narrow ruling
Expands for media gain
Truth loses big time.


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

Eligibility For Subsidies Not Properly Checked, Audit Finds

The HHS inspector general issues two reports concluding the federal health marketplace and some state exchanges had inadequate safeguards to stop people who were ineligible from getting tax credits to help pay for premiums.

The New York Times: Eligibility For Health Insurance Was Not Properly Checked, Audit Finds
An independent audit of insurance exchanges established under the health care law has found that federal and state officials did not properly check the eligibility of people seeking coverage and applying for subsidies, the latest indication of unresolved problems at HealthCare.gov. In a report to Congress on Tuesday, the inspector general for the Department of Health and Human Services, Daniel R. Levinson, said that the exchanges, which enrolled eight million people, did not have adequate safeguards "to prevent the use of inaccurate or fraudulent information when determining eligibility" (Pear, 7/1).

The Wall Street Journal: Reports Fault Controls Of Health Exchanges
The federal health exchange and some state exchanges had problems resolving inconsistencies on applications and making sure people were eligible for their insurance plans, according to two inspector-general reports released Tuesday. The problems plagued the exchanges in the early rollout of the Affordable Care Act last fall. Between October and December, the federal exchange was unable to resolve about 90% of data inconsistencies on insurance applications—2.6 million of 2.9 million—because the system for determining eligibility didn't work, according to one of the reports by the Department of Health and Human Services' inspector general (Armour, 7/1).

The Washington Post: Health-Care Exchanges Are Not Properly Ensuring Applicants’ Eligibility, Probe Finds
A pair of reports, issued Tuesday by the Department Health and Human Services’ Office of Inspector General, conclude that "internal controls" for evaluating applications were not always effective at verifying people’s Social Security numbers, their citizenship, and whether they are eligible to buy health plans through the marketplaces because they cannot find affordable insurance elsewhere (Goldstein, 7/1).

The Hill:  Inspector General Reports Find Problems With Obamacare Eligibility
Republicans have been hammering the administration over the issue, arguing many people ineligible for subsidies are nonetheless receiving them. They argued the latest reports suggest tax dollars are being wasted on people receiving federal subsidies who should not be getting them. "When ObamaCare was passed, its chief architects told us they would have to pass the bill to find out what was in it," said Sen. Orrin Hatch (R-Utah), Senate Finance Committee ranking member. "Today's report confirms what we knew was not included: safeguards to protect hard-earned taxpayer dollars from an incompetent bureaucracy" (Al-Faruque, 7/1).

Associated Press:  Health Care Coverage Signups Dogged By Data Flaws
Digging out from under the data problem is one of the top challenges facing newly installed HHS Secretary Sylvia Mathews Burwell. Spokesman Aaron Albright said more than 425,000 inconsistencies have been resolved so far, more than 90 percent of those in favor of the consumer (Alonso-Zaldivar, 7/2).

Fox News: ObamaCare Coverage For Millions In Jeopardy As Watchdog Finds Widespread Data Flaws
The Obama administration is struggling to resolve data discrepancies that could jeopardize coverage for millions who sought health insurance on the federal exchange HealthCare.gov, according to a watchdog report on the still-rocky implementation of ObamaCare (7/1). 

Los Angeles Times: Federal Audit Faults California Exchange For Lax Enrollment Practices
Federal auditors found that California's health insurance exchange was lax at times in verifying consumers' eligibility for Obamacare coverage. The report issued Tuesday by the Inspector General's Office at the U.S. Department of Health and Human Services also cited the federally-run exchange and Connecticut's insurance marketplace for similar deficiencies. Auditors said lax internal controls may have limited the exchanges' "ability to prevent the use of inaccurate or fraudulent information when determining eligibility of applicants for enrollment" (Terhune, 7/1).

The CT Mirror: Federal Auditors Question Access Health CT’s Internal Controls
Federal auditors reported Tuesday that they found deficiencies in the internal controls used by the health insurance exchanges run by Connecticut, California and the federal government. The problems could have limited the marketplaces’ ability to prevent people from using inaccurate or fraudulent information when applying for coverage as part of the health law commonly known as Obamacare, the auditors said. Connecticut’s exchange, Access Health CT, inaccurately determined that several hundred applicants were eligible for federal assistance in paying insurance premiums or health care costs, failed to promptly send enrollment information from 139 customers to insurers, and didn’t always verify the identity of people who use the exchange’s call center in accordance with federal guidance, the auditors reported (Becker, 7/1).

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Hobby Lobby Ruling Creates Uncertainty About Contraceptive Mandate

The options the Supreme Court floated to extend coverage to women who work for closely held companies that object to covering contraception are opposed by some religious groups and women's rights groups. The compromise involves passing responsibility to an insurer.

The Wall Street Journal: After Hobby Lobby Ruling, Contraception-Coverage Alternatives Face Hurdles
Two options the Supreme Court floated to extend contraception coverage after its Hobby Lobby ruling face steep opposition from religious groups and women's-rights advocates, setting up a clash over how regulators rework the contraception-coverage requirement. ... Many observers took the opinions as signaling courses available to the Obama administration. It will likely have to issue regulations tweaking the contraception rule to allow some employers to opt out, and to enable their workers to obtain coverage another way. The compromise arrangement that involves passing responsibility to an insurer, however, is considered unacceptable by religious groups (Radnofsky, 7/1).

McClatchy: Hobby Lobby Ruling Fuels Political And Legal Uncertainty
Across the country, women, employers, insurers and health care advocates are trying to adjust to the new legal landscape created by the Supreme Court’s decision allowing some for-profit corporations to deny contraceptive coverage to employees, based on the owners’ religious faith. As the real-life impact of the controversial ruling Monday slowly begins to play out, questions about its breadth, scope and meaning continue to be debated. In the 5-4 decision, the high court ruled that two family-owned corporations, Hobby Lobby and Conestoga Wood Specialties, did not have to cover birth control on their employee health insurance plans as required under the so-called “contraceptive mandate” provision of the Affordable Care Act (Pugh and Haven, 7/1).

Bloomberg: Hobby Lobby Ruling Complicates Obamacare Birth Control
The U.S. Supreme Court’s suggested work-around to provide and pay for employees’ birth-control coverage at businesses whose owners have religious objections hasn’t worked in practice, say the companies administering it. While free birth-control coverage is required under Obamacare, the insurance administrators providing it for workers at religious-affiliated groups say the current solution has left them stuck with the bill. That may be further exacerbated by the court’s ruling, which exempted for-profit, closely held companies whose owners have religious objections, said Mike Ferguson, chief executive officer at the Self-Insured Institute of America, Inc. (Wayne, 7/1).

Huffington Post: The Accidental Reason Companies Like Hobby Lobby Control Our Health Care
The Supreme Court's ruling Monday that Hobby Lobby can refuse to cover contraception for workers is yet another reminder that our bosses have a lot of control over the health care we receive -- and that's not likely to change any time soon. Jobs are the most common source of health insurance in the United States, a peculiar fact that sets the country apart from its international peers. That's why losing a job typically has meant losing health coverage, and it's why workers whose needs aren't met by their company's health plan have little recourse. They can go work elsewhere, pay much more money for health insurance on the open market or shell out cash for medical care that's not covered by their benefits (Young, 6/30).

Meanwhile, the ruling could spell trouble for a related group of lawsuits brought by nuns and religious nonprofits --

Huffington Post: Hobby Lobby Win Could Spell Trouble For Religious Nonprofits
In his opinion concurring with the Supreme Court's decision in the Hobby Lobby birth control case Monday, Justice Anthony Kennedy may have tipped his hand on a related group of lawsuits brought by nuns and religious nonprofits against the contraception mandate. ... Justice Samuel Alito wrote in the majority opinion that because the government already carves out an accommodation for religious nonprofits, it would not be a substantial burden on the government to extend that accommodation to religiously owned businesses. ... Alito deliberately left the door open for a ruling either way on the merits of the religious accommodation. ... But Kennedy, who would likely be the swing vote in a future ruling in the Little Sisters case, indicated in his concurring opinion on Monday that he would be more sympathetic to the administration than the religious groups on that particular debate (Bassett and Reilly, 6/30).

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Democrats Campaign Against High Court After Hobby Lobby Ruling

Borrowing a tactic from the GOP, Democrats use the Supreme Court ruling to energize their voters and raise money, The Los Angeles Times reports.

Los Angeles Times: Democrats Pick Up GOP Tactic: Campaign Against Supreme Court
Half a century ago, Richard M. Nixon and other Republicans boosted their political prospects by running against the Supreme Court. Now it’s President Obama’s turn. Within hours of the high court’s decision Monday that at least some companies can use religious rights to exempt themselves from paying for health insurance covering contraceptives, Democrats were seeking to energize voters, raise money and attract support by highlighting the case (Lauter, 7/1).

The Wall Street Journal: Setbacks Cast Cloud Over Obama's Second Term
The demise of immigration legislation for the year and a Supreme Court decision creating a religious exception to the health-care law are the latest setbacks casting clouds over President Barack Obama's agenda (McCain Nelson and Lee, 7/1).

McClatchy: Democrats Quick To Rip GOP On Birth Control Issues
Democrats are wasting no time trying to gain an edge from Monday’s Supreme Court ruling in a key birth control case. The 5-4 ruling exempts closely-held for-profit firms from providing government-mandated birth control services if they conflict with the owners’ religious beliefs. Democrats Tuesday were quick to pounce (Lightman, 7/1).

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Hacking Of Health Records Is 'Matter Of Time,' Say Experts

Specialists in cybercrime say the health industry "is flirting with disaster" as so much patient data goes digital, Politico reports. Also, speakers at a health care conference explore the difficulties of cutting waste and medical errors.

Politico: Big Cyber Hack Of Health Records Is 'Only A Matter Of Time'
The health world is flirting with disaster, say the experts who monitor crime in cyberspace. A hack that exposes the medical and financial records of tens of thousands of patients is coming, they say — it’s only a matter of when. As health data become increasingly digital and the use of electronic health records booms, thieves see patient records in a vulnerable health care system as attractive bait, according to experts interviewed by POLITICO. On the black market, a full identity profile contained in a single record can bring as much as $500 (Pittman, 7/1).

Politico: Waste, Errors In Health Care Remain Huge Issues, Experts Agree
Despite health care industry concerns about wasteful and unnecessary care, it’s nearly impossible for patients to overrule their doctors when they think they’re getting a procedure they don’t need, a prominent patient care advocate argued Tuesday. “I’ve had four unnecessary EKGs,” Daniel Wolfson, executive vice president of the ABIM Foundation, said at a POLITICO Pro Health Care breakfast briefing at the Newseum. “I think it’s an uphill battle for the patient to talk a physician out of a procedure.” Overtreatment and preventable medical errors are huge drivers of health care costs and lead to thousands of unnecessary deaths every year, but action to reverse both continues to lag, noted Leah Binder, CEO of The Leapfrog Group, a health safety advocate that represents employers (Cheney, 7/1).

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Indiana Seeks OK For Medicaid Expansion Alternative; Calif. Wrestles With Medi-Cal Backlog

Indiana Gov. Mike Pence on Tuesday requested a waiver from the federal government to expand Medicaid coverage using a state plan that he says would promote personal responsibility. Developments in California, Oregon, Georgia and Washington state are also tracked.

Associated Press:  Pence Submits Request For Medicaid Alternative
Gov. Mike Pence on Tuesday asked that the federal government expand health care coverage for Indiana’s low-income residents using a state-run alternative to traditional Medicaid. Pence’s proposal, dubbed the Healthy Indiana Plan 2.0, would still rely on billions in federal aid to cover residents earning up to 138 percent of the federal poverty level, like states that approved the Medicaid expansion included in the federal health care overhaul. But Pence and his supporters contend it supports personal responsibility in a way Medicaid doesn’t because it would rely on health savings accounts and patient input (LoBianco, 7/1).

Kaiser Health News: Mountainous Backlog Stalls Medi-Cal Expansion In California
A massive backlog of Medi-Cal applications is well into its third  month, and California officials have provided little information about how and when the largest such bottleneck in the nation might be cleared. The California Department of Health Care Services in Sacramento first reported 800,000 pending applications in April. By May, that number had grown by 100,000 and has not budged much since (Shen, 7/2).

Associated Press:  Oregon Hires Firm To Connect To Federal Health Site
Oregon has hired a tech firm to help transfer the botched Cover Oregon health insurance exchange to the federal exchange website and finish building the state’s Medicaid system. The Oregon Health Authority will pay Deloitte Consulting LLC up to $18.4 million to be the “system integrator” that oversees the transition. It’s the same company that was hired to do an analysis and build a road map for the transition. In April, Deloitte recommended the state abandon its troubled exchange because it would be cheaper to switch to the federal site than to fix it. Cover Oregon officials heeded its call and decided to switch to the federal portal (7/1).

Georgia Health News: State Announces New Choices For 2015 Benefits Plan
Addressing months of controversy and protests, state officials Tuesday announced that state employees and school personnel will get a wider array of insurers and choices in their 2015 health plan. Some employees and teachers have been vocal in their criticism of their current plan options since Jan. 1, when the plan took effect. The changes made for 2014, plus the use of just one insurer, sparked widespread complaints about a lack of choice of insurance providers and higher health care costs (Miller, 7/1).

Kitsap Peninsula Business Journal: Naturopaths Not Signing Up To Be Medicaid Providers
The expansion of Medicaid in Washington state includes a change allowing licensed naturopathic physicians to function as primary-care providers for patients in the state’s Apple Health (Medicaid) program. In Kitsap County, however, naturopaths are passing on the opportunity to enroll as Medicaid providers. Washington is one of only three states that allow Medicaid patients to choose naturopaths for their care. The inclusion of naturopaths is regarded as one way to help meet the need for more primary-care physicians since many more people now have health insurance under the Affordable Care Act and its expansion of Medicaid, the federal program that covers mainly lower-income people (Kelly, 7/1). 

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Medicare Proposes Home Health Payment Reductions, Savings

Officials say the moves would save the agency $58 million next year by changing how much it pays for some services and requiring agencies to prove their effectiveness.

The Hill: CMS Proposes Changes To Reduce Medicare Home Payments 
The Centers for Medicare and Medicaid Services (CMS) has proposed several new changes to how it pays for Medicare home health services which the agency says will save it $58 million next year. The agency is proposing to save money by toughening requirements to be eligible for home health services, setting a minimum requirement on home health agencies to prove their effectiveness and revising how much CMS pays for certain services (Al-Faruque, 7/1).

Modern Healthcare:  CMS Agrees To Drop Narrative Requirement For Home Health Claims 
The CMS plans to eliminate a regulatory hurdle that was intended to reduce fraud and abuse in Medicare home health claims but appeared to be stopping some elderly patients from getting care they need.  The policy change is included in a proposed Medicare payment rule for home health agencies for 2015. The CMS estimates that the home health providers would get paid $58 million ... less under the revised payment system, a reduction of about 0.3 percent. In 2013, Medicare paid about 12,000 home health agencies $18 billion to provide services to 3.5 million beneficiaries (Dickson, 7/1).

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Administration News

Despite Management Background, VA Nominee Faces Even Bigger Challenge

Robert McDonald, the VA secretary nominee, is facing a huge bureaucracy with more than 300,000 employees. Elsewhere, a new poll finds most veterans say getting care at VA hospitals is "very" or "somewhat" difficult.

The Washington Post: Robert McDonald, Obama's VA Nominee, Faced Own Challenges At Procter & Gamble
Robert A. McDonald’s last big challenge was to push a proud, slow-moving and sometimes bureaucratic company to change. He resigned under pressure as chief executive of Procter & Gamble amid criticism from investors and former executives that he wasn’t moving fast enough. Now McDonald is President Obama’s choice to run the Department of Veterans Affairs. His new job: Push a proud, but battered, slow-moving bureaucracy to change (Jaffe and Mufson, 7/1).

The Associated Press: New VA Secretary Nominee Not A Health Care Expert
Veterans groups worry that the longtime corporate executive, nominated by President Barack Obama to lead the VA, may have trouble adjusting to a far-flung bureaucracy of more than 300,000 employees, where hundreds of hospital directors and other career executives wield great power far from the agency's Washington headquarters. "Procter & Gamble is going to feel like a Ferrari compared to the VA," said Paul Rieckhoff, CEO of Iraq and Afghanistan Veterans of America (Daly, 7/2).

The Washington Post: Poll: Most Veterans Say Getting Access To VA Care Is Difficult
More than half of American veterans say it is "very" or "somewhat" difficult to get access to health care through a Department of Veterans Affairs facility, according to a new Gallup poll released Tuesday (Sullivan, 7/1).

Politico: Veterans Poll: Most Say VA 'Difficult’'A majority of veterans say they find it difficult to access medical care through the Department of Veterans Affairs, according to a new poll from Gallup. Asked to rate their opinion of the VA’s medical care, 55 percent of veterans polled said it was either "very difficult" or "somewhat difficult" to access services made available by the embattled federal department. Thirty percent of respondents said they find it very or somewhat easy to access VA care, and 14 percent had no opinion (Sneed, 7/1).

NPR: VA Offers Doctor's Appointment To Man Who Died In 2012
Nearly two years after her husband died, a Massachusetts woman received a letter saying that a Veterans Affairs hospital was ready to see him. Suzanne Chase's husband, Doug, was a Vietnam veteran who died of a brain tumor; the agency is apologizing over the mistake (Chappell, 7/1).

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Public Health & Education

Prescription Drug Deaths Drop In Fla. After Crackdown On Doctors

Deaths involving narcotic painkillers dropped 26 percent over two years in Florida after stricter doctor scrutiny, according to a report from the federal Centers for Disease Control and Prevention.

The New York Times: Prescription Overdose Deaths in Florida Plunge After Tougher Measures, Report Says
Prescription drug overdose deaths in Florida fell sharply after the state began strengthening its prescribing laws and stepping up enforcement. Federal researchers said Tuesday that it was the first significant documented decline in the nation since the epidemic of prescription drug abuse took hold more than a decade ago (Tavernise, 7/1).

Los Angeles Times: Crackdown On Florida Clinics Leads To Decline In Deaths, Report Finds 
Public health officials have identified a sharp decline in overdose deaths involving prescription painkillers for the first time in a decade. Deaths involving OxyContin, Vicodin and other narcotic painkillers dropped by 26 percent over two years in Florida after a crackdown on pain clinics that dispensed high volumes of the medications, according to a government study released Tuesday. Lawmakers there barred doctors in these "pill mills" from selling the drugs they prescribed (Girion, 7/1).

The Associated Press: The South Prescribes More Painkillers, CDC Says 
Powerful painkillers have been driving the nation's rising rate of overdose deaths, and now the government is singling out the states where doctors write the most prescriptions. A second report released Tuesday spotlights how a crackdown in Florida led to hundreds fewer overdose deaths from prescription painkillers in just a few years. The reports are part of a campaign by the Centers for Disease Control and Prevention to combat deaths from prescription opioids like Vicodin and OxyContin. In 2011, drug overdose deaths reached 41,000 and 41 percent of them involved prescription painkillers (Stobbe, 7/1).

The Boston Globe: Mass. Ranks Low Overall In Prescribing Opioids
Massachusetts physicians rank among the top 10 nationally in prescribing OxyContin and other long-acting painkillers, according to a government report released Tuesday that highlighted wide state-by-state variation in the rates of use of addictive opioid medications. But the state ranked low, 41st nationally, for overall prescribing of opioids, which have become a major concern because of rising rates of abuse and overdose deaths. Long-acting pain medications such as OxyContin are only one of several types of opioids, which also include methadone, codeine, and hydrocodone (Abutaleb, 7/1).

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Group That Once Supported Healthier School Lunch Program Has About-Face

The School Nutrition Association now says the new rules are too costly. Meanwhile, NPR looks at the difficulties for employers to deal with workers' weight problems and the increasing number of obese seniors.

The New York Times: Nutrition Group Lobbies Against Healthier School Meals It Sought, Citing Cost
When the Obama administration in 2012 announced long-awaited changes to require more fruits and vegetables and less sugar and salt in government-subsidized school meals, no group celebrated more than the School Nutrition Association. The group had anticipated the changes for three years ... Two years later, the association has done an about-face and is leading a lobbying campaign to allow schools to opt out of the very rules it helped to create, saying that the regulations that have gone into effect are "overly prescriptive" and too costly for schools that are trying to replace hamburgers and fries with healthier alternatives (Nixon, 7/1).

NPR: Targeting Overweight Workers With Wellness Programs Can Backfire
Employers say obesity is a top health concern for their workers. But health is a sensitive and personal issue. Some employees say these wellness initiatives can go too far. ... Obesity can lead to medical complications like diabetes and heart disease, and can increase absenteeism and the risk of injury on the job. Helping overweight employees nudge the scale in the other direction might be good for their health and for the company's bottom line. ... It's difficult to address obesity because wellness programs must be voluntary, says Laurel Pickering, the executive director of Northeast Business Group on Health, a nonprofit focused on reducing health care costs. Employers can offer incentives, but they can't directly talk to an employee about a weight problem. Preserving medical privacy is also a concern. And laws prohibit employer discrimination based on a person's genetic makeup (Noguchi, 7/2).

NPR: Older Adults Are Fatter Than Ever, Increasing Their Risk Of Illness
Older people are working more, voting more and drinking and smoking less than they used to. That's the good news. But nearly three-quarters of older men and about two-thirds of women over age 64 are overweight or obese, making them more likely to have to deal with diabetes, arthritis and impaired mobility (Jaffe, 7/1).

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State Watch

State Highlights: Ore. Mediation For Medical Errors; Mich. Home-Help Aides

The Oregonian: New Oregon Program Allows Mediation For Medical Errors Instead Of Suing
A mediation program spearheaded by Gov. John Kitzhaber went into effect Tuesday, giving patients and their families an option besides suing when medical errors happen. But questions remain over how the mediation program will develop, including whether hospitals, doctors and other providers will take advantage of the program, or candidly discuss errors if they do. The result of a compromise between trial lawyers and the Oregon Medical Association approved in SB 483 last year, the Early Discussion and Resolution program is intended to cut down on lawsuits and boost the reporting of medical errors to help improve health care practices (Budnick, 7/1).

Associated Press: Michigan Can't Bar All Home-Help Aides With Felonies 
Michigan’s plan to conduct criminal background checks on 60,000 workers hired to help disabled Medicaid recipients live in their homes will not lead every ex-felon to be disqualified as an aide, top state officials said Monday. Gov. Rick Snyder’s administration said the U.S. government -- which helps fund the state-federal Medicaid program -- automatically excludes people from being independent-living workers only if they have been convicted of patient abuse or neglect, health care fraud, drug offenses or a Home Help Program-related crime (Eggert, 6/30).

The Washington Post's Wonkblog: Oklahoma Is Winning Its Medicaid Standoff With The Feds — For Now 
Oklahoma and the federal agency overseeing Medicaid are still wrestling with the fate of a decade-old state program covering almost 20,000 low-income adults. For the second straight year, the feds and Oklahoma have worked out a deal to keep the program alive after it was supposed to close at the end of 2013. The program, known as Insure Oklahoma, is partially funded by federal dollars. It covers adults earning up to 200 percent of the federal poverty level ($23,340 for an individual) and has some features, such as enrollment caps, that fail to meet Medicaid expansion requirements that took effect the beginning of this year. Because of this, the federal Centers for Medicare and Medicaid Services warned Oklahoma early last year that the state would have to shutter the program if it didn't align the program with the Medicaid expansion (Millman, 7/1). 

Texas Tribune:  Injured, Dead Workers Are Casualties Of 'Texas Miracle'
The statistics tell a compelling story about the workers who are building the "Texas miracle" economy: Hundreds of thousands of them have no occupational insurance coverage. Just as many have stripped-down plans and limited legal rights. And people who try to claim benefits in the bewildering workers’ compensation bureaucracy often face denials, disputes they can’t win and a government that does little to protect them (7/2).

The Boston Globe: Undiagnosed-Diseases Center To Open In Boston
In medicine, it’s called the diagnostic odyssey: the difficult months and years that patients and families spend trying to figure out the cause of a baffling collection of symptoms. The National Institutes of Health announced Tuesday it will expand its efforts to solve such medical mysteries by creating a network of six centers, including one in Boston, that will each receive $7.2 million over the next four years. The new Harvard Center for Integrated Approaches to Undiagnosed Diseases will combine the resources of Brigham and Women’s, Massachusetts General, and Boston Children’s hospitals. A coordinating center at Harvard Medical School will help route patients to centers across the country and facilitate the sharing of data among the programs (Johnson, 7/1).

Houston Chronicle:  Lawmakers Launch Committee After Spike In Foster Child Abuse 
State lawmakers launched a special effort Tuesday to explore how to reduce child deaths after a year in which a record high number of kids died of abuse and neglect in foster care. Child Protective Services, a frequent target of criticism, has been under intense scrutiny lately. While overall Texas child deaths from abuse and neglect decreased from 212 in 2012 to 156 last year, abuse and neglect deaths of foster kids spiked from two to 10. A recent review found CPS front-line caseworkers spend just 26 percent of their time with families. The agency is also in the middle of a once-a-decade examination by the state Sunset Advisory Commission (Rosenthal, 7/1).

Georgia Health News: Experts On a Roll …To Help Rural Doctors 
"Meaningful use." It’s another confounding term in the often opaque lexicon of health care. But it represents a concept that is important for health care providers’ bottom lines. The basic idea is that Medicare and Medicaid will pay incentives for hospitals and doctors to demonstrate “meaningful use” of electronic health records (EHRs) to improve patient care. And to help rural doctors get up to speed with education and technical assistance on meaningful use, a two-day bus tour swept through central and eastern Georgia last week (Miller, 6/30).

Kansas Health Institute News Service:  Surprise Halt To Health Home Program Dismays Medicaid Providers
Kansas Medicaid providers with expansion plans ready to go after spending months and thousands of dollars preparing for the state’s new health homes initiative said they were “shocked” and “disappointed” that state officials abruptly chose to indefinitely delay much of the program’s implementation while giving the providers less than 24 hours' notice of the state’s decision to hit the pause button (Shields, 7/1). 

The Associated Press: AIDS Scientist Pleads Not Guilty To Faking Study 
A former Iowa State University scientist pleaded not guilty Tuesday to charges alleging that he falsified research for an AIDS vaccine to secure millions of dollars in federal funding. Dong-Pyou Han, 57, entered his not guilty pleas to four counts of making false statements during his initial court appearance in Des Moines federal court. Each count carries a maximum sentence of five years in prison and a $250,000 fine (Pitt, 7/1).

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Editorials and Opinions

Viewpoints: Court And Women's Health Care; Decouple Work And Coverage

Bloomberg: Who Really Lost In Hobby Lobby
The 5-4 decision, which runs 89 pages (including a 35-page dissent), is a messy, sprawling affair. The majority insists that its reach is narrow, while the dissent holds otherwise. What's clear is that the ruling will needlessly complicate not only constitutional and corporate law but also -- at least as significant -- health care for women who work at such companies (6/30).

Bloomberg: A Few Things The Hobby Lobby Ruling Won't Do
Does the court's ruling -- in which a majority held that Hobby Lobby Stores Inc. and other private employers can be exempted from a requirement in Obamacare to cover contraceptives in their health-care plans -- represent a terrible blow to women's rights? Not really. Women have the same rights they had all through President Barack Obama's first term. At that time, federal law did not require most employers to cover contraceptives (Ramesh Ponnuru, 6/30).

Politico: Hobby Lobby's Unintended Consequences
Which would you prefer: to have the ability to decide for yourself and your family the type of coverage you want to purchase on a health insurance exchange—and having your premiums subsidized by a defined contribution or voucher from your employer—or to cede that ability to your employer entirely, having them pick your insurance for you, but empowering them to decide, based on their personal religious beliefs, which services to cover and which to exclude? After Monday’s Hobby Lobby decision, this is exactly the type of choice that more and more Americans will face (Ezekiel Emanuel, 7/1).

The New York Times: The Illogic Of Employer-Sponsored Health Insurance
The argument is that the premiums ostensibly paid by employers to buy health insurance coverage for their employees are actually part of the employee's total pay package – the price of labor, in economic parlance – and that the cost of that fringe benefit is recovered from employees through commensurate reductions in take-home pay. Evidently the majority of Supreme Court justices who just ruled in Burwell v. Hobby Lobby case do not buy the economists' theory. These justices seem to believe that the owners of "closely held" business firms buy health insurance for their employees out of the kindness of their hearts and with the owners’ money. On that belief, they accord these owners the right to impose some of their personal preferences – in this case their religious beliefs — on their employee’s health insurance (Uwe E. Reinhardt, 7/1).

The New York Times: Hobby Lobby Is Only The Beginning
The United States Constitution speaks of the Supreme Court’s jurisdiction over "cases" and "controversies." But when social controversies do come before the court, its powers are limited. In Burwell v. Hobby Lobby Stores, which concerned the dispute over the Affordable Care Act's contraceptive mandate, the court may have decided the case. The larger controversy, however, won't be settled so easily (Paul Horwitz, 7/1).

Los Angeles Times: The Hobby Lobby Case Proves The Necessity Of Single-Payer Healthcare
Is there anything more absurd than the American way of delivering healthcare coverage? Most Americans receive coverage through their employers. In the wake of Monday's Hobby Lobby decision by the Supreme Court, businesses accounting for about 52% of all privately employed workers now have the option to discriminate among their employees and among the healthcare benefits they offer, based on their owners' religious beliefs (Michael Hiltzik, 7/1).

Los Angeles Times: Post-Hobby Lobby, Congress Should Cut Health Insurance's Ties To Work
By ruling that private corporations can shape their employee insurance plans to fit their religious beliefs, the Supreme Court has given Congress another reason to take a step it refused to take in 2010: decouple insurance benefits from employment (Jon Healey, 6/30).

And on other health issues -

The New York Times: Gov. Cuomo’s Plan To Fight AIDS In New York
New York City was ravaged by AIDS after the first cases were reported more than 30 years ago, and the plague soared to about 14,000 new cases in the state and nearly 8,000 deaths a year in the city in the early 1990s. Since then, medication and prevention programs have lowered new infections with H.I.V., the virus that causes AIDS, to about 3,000 a year and far fewer deaths. Now Gov. Andrew Cuomo has announced that he wants New York to reduce new infections to 750 by 2020, about the same as the number of new tuberculosis cases each year (7/1).

The Wall Street Journal: How Affordable Is The Affordable Care Act?
The Department of Health and Human Services recently released a report making the case for how Obamacare’s premium subsidies have made health insurance more affordable for individuals. But those who do not qualify for federal subsidies appear to find exchange coverage anything but affordable (Chris Jacobs, 7/1).

The Washington Post: Was GOP Control Of The State Senate In Virginia 'Purchased' With A Quid Pro Quo?
The more circumstances emerge about the deal that flipped control of the Virginia state Senate to Republicans, the seamier it looks. And there’s plenty we still don’t know. ... Puckett's resignation dashed Gov. Terry McAuliffe's (D) hopes of forging a legislative compromise to expand Medicaid under Obamacare and extend health insurance to hundreds of thousands of low-income Virginians (7/1).

Los Angeles Times: The Meningitis Outbreak We Weren't Ready For
During the last two years, there have been a couple of outbreaks and sporadic cases of bacterial meningitis that federal health agencies failed to address with sufficient aggressiveness. It could have been much worse, and the experience should serve as a wake-up call. Meningitis is a devastating infectious disease, often misdiagnosed as flu, and it can become debilitating so quickly that by the time it is recognized, the patient may be too sick for effective treatment (John J. Cohrssen and Henry I. Miller, 7/1).

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Stephanie Stapleton

Andrew Villegas

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.