Daily Health Policy Report

Monday, July 22, 2013

Last updated: Mon, Jul 22

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Quality

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Obamacare Delay Is A Relief For A Family Business

Kaiser Health News staff writer Jay Hancock, working in collaboration with The Philadelphia Inquirer, reports: "Like businesses across the country, Angelo's restaurant has been recovering from a miserable economy, a load of debt and a bottom line that until recently was the color of its special marinara sauce. So owner Michael Passalacqua probably speaks for many when he expresses relief about the decision to delay enforcing the Affordable Care Act's requirement for employer health insurance until 2015" (Hancock, 7/22). Read the story.

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Doctors Interested in MBAs Are Increasingly Looking For Traditional Business Programs, Not Health-Care Specific Degrees

Reporting for Kaiser Health News, in collaboration with The Boston Globe, Francine Russo writes: "When nervous dental patients make their first visit to Dr. Sree Koka, chair of dental specialties at the Mayo Clinic, they may feel calmer after watching his video on YouTube. It answers many of their questions: Is the doctor male or female? Does he speak English? Is he nice? In the video, Dr. Koka introduces himself, cracks a few jokes and suggests what patients should think about for their first appointment. He created the spot while attending MIT's Executive MBA program where he learned the benefits of focusing on personal relationships, not just technical expert" (Russo, 7/22). Read the story.

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Medicare Announces Plans To Accelerate Linking Doctor Pay To Quality

Kaiser Health News staff writer Jordan Rau, working in collaboration with The Washington Post, reports: "The changes would affect nearly 500,000 physicians working in groups. The federal health law requires large physician groups to start getting bonuses or penalties based on their performance by 2015, with all doctors who take Medicare patients phased into the program by 2017" (Rau, 7/22). Read the story.

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Consumers In Most States Unlikely To See N.Y.'s 50 Percent Reduction In Premiums In Individual Market

Kaiser Health News staff writer Julie Appleby reports: "New York's announcement this week that insurance premiums would drop 50 percent next year for individuals buying their own coverage in new online marketplaces made good talking points for proponents of the health law, but consumers in most states are unlikely to see similar savings" (Appleby, 7/19). Read the story.

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Analysis: N.Y. Insurance Market Called 'Poster Child' For Individual Mandate

Reporting for Kaiser Health News, Roni Caryn Rabin writes: "The nosedive in health insurance prices that New York officials announced earlier this week was driven by many factors, but the most important was the individual mandate, a central component of Obamacare. That's because insurers are betting they can use that often reviled requirement that takes effect Jan. 1 to nag, nudge, push and prod 2.6 million uninsured New Yorkers, especially the young and healthy, to buy coverage" (Rabin, 7/19). Read the story.

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Capsules: Humana Fills Blank Spots In Mississippi Obamacare Map

Kaiser Health News: Capsules: Humana Fills Blank Spots In Mississippi Obamacare Map
Now on Kaiser Health News' blog, Jay Hancock reports: "Filling a potential coverage void, Humana Inc. said Friday it will sell health insurance in 36 Mississippi counties that might have otherwise been left out of a marketplace for subsidized policies sold under the Affordable Care Act" (Hancock, 7/19). Check out what else is on the blog.

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Political Cartoon: 'The Tortoise And The Hair?'

Kaiser Health News provides a fresh take on health policy developments with "The Tortoise And The Hair?" by Eric Allie.

Meanwhile, here is today's health policy haiku:

SECRET PANELS AND INVESTIGATIONS

Health care rising costs
can be hard to trace -- do they
hide under a RUC
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Three Years In, GOP Leaders Have No Replacement For Health Law

Some point to the Obama administration's delay of the employer mandate as proof the measure is collapsing under its own weight. Still, even as Republicans advance votes to repeal or reverse parts of the law as part of a 'repeal and replace' strategy, they have not advanced an alternative.

The Hill: Obama Tries To Regain ObamaCare Edge After Mandate Delay Setback
The standard line from Obama and his allies was that the law had been passed by Congress, signed by the president, upheld by the Supreme Court, and then affirmed again by Obama's reelection. But the decision to delay the employer mandate cut against that narrative of inevitability, allowing Republicans to argue that the law is collapsing on its own — and creating a double standard that rewarded business at the expense of individuals and families (Baker, 7/21).

The Associated Press: After 3 years, House Republicans Still Voting To Repeal 'Obamacare,' But Have No Replacement
Three years after campaigning on a vow to "repeal and replace" President Barack Obama's health care law, House Republicans have yet to advance an alternative for the system they have voted more than three dozen times to abolish in whole or in part. Officially, the effort is "in progress" — and has been since Jan. 19, 2011, according to GOP.gov, a leadership-run website. But internal divisions, disagreement about political tactics and Obama's 2012 re-election add up to uncertainty over whether Republicans will vote on a plan of their own before the 2014 elections (Espo, 7/21).

Fox News: House Republicans Keep Pushing Repeal
House Republicans say their goal is to repeal President Obama's health care law, not to present an alternative plan. "I don't think it's a matter of what we put on the floor right now," said Rep. Greg Walden of Oregon, who heads the party's campaign committee. He added that what is important is "trying to delay Obamacare." His remarks are in response to criticism that the Republican-led House have voted more than three dozen times over the past several years to repeal the law in part or in whole. On the larger question about the recent success of Congress, House Speaker John Boehner said Sunday it "ought to be judged on how many laws we repeal" not "by how many new laws we create." Boehner told CBS' "Face the Nation" the United States has "more laws than the administration could ever enforce" (7/21).

The Hill: Boehner: GOP Will Do 'Everything We Can' To Thwart ObamaCare
"ObamaCare is bad for America," Boehner told CBS's "Face the Nation." "We're going to do everything we can to make sure it never happens." Boehner's comments come several days after the House voted to delay the law's employer and individual mandates over a White House veto threat (Viebeck, 7/20).

Opposition continues from other corners -

The Wall Street Journal’s Washington Wire: Union Fears 'Destructive Consequences' From Obamacare
The laborers union has added to organized labor’s drumbeat of dissatisfaction with the Affordable Care Act. In a letter sent to President Barack Obama on Thursday, Laborers International Union of North America President Terry O’Sullivan wrote that the law has "destructive consequences" for the types of health plans that cover millions of unionized construction workers and their family members (Maher, 7/19).

Arizona Republic: Politics Spurs Some Ariz. Dems To Join Republicans On Health Care
U.S. Rep. Kyrsten Sinema once toured Arizona on behalf of the White House, touting the benefits of health-care reform. Last week, the freshman Democrat voted with the GOP to delay the law’s requirement that individuals and businesses buy insurance by 2014. Sinema said she still supports the law because it helps students and people with pre-existing conditions obtain coverage. … Sinema also had a political motivation for the vote. Her congressional district, which stretches from Phoenix to Mesa, is considered a toss-up seat, where enough conservative-leaning voters concerned by the health-care law could boot her out of office in the mid-term elections. That’s what happened in 2010, when voters turned out in droves to unseat Democrats in an uproar over passage of the president’s health-care law (Sanders, 7/20).

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IT Issues Pose Challenges For Health Law

News outlets also report on how other changes are affecting small business owners, hospitals and students.

Fiscal Times: Obamacare Glitch No. One: Verifying Eligibility
On Oct. 1, federal government IT specialists will fire up one of the most technologically complex government websites in history – one specially engineered to grant uninsured Americans access to a virtual market of affordable health insurance policies. And if all goes as planned, millions of people--from healthy millennials in their 20s and 30s to seniors with chronic health problems--will be able to compare the premiums being offered by a handful of insurance providers in their states, determine whether they qualify for a federal subsidy, and finally purchase a plan. As part of this “seamless,” one-stop shopping approach that President Obama has boasted about in speeches at the White House and around the country, applicants will have to enter some basic information about themselves -- their annual incomes, residency status and citizenship. Once that information has been entered, applicants will be presented with a number of potential plans and their premiums. After clicking one, a new window will open, routing the customers to the insurance company that offers the plan (Francis and Pianin, 7/22).

Kaiser Health News: Obamacare Delay Is A Relief For A Family Business
Like businesses across the country, Angelo's restaurant has been recovering from a miserable economy, a load of debt and a bottom line that until recently was the color of its special marinara sauce. So owner Michael Passalacqua probably speaks for many when he expresses relief about the decision to delay enforcing the Affordable Care Act's requirement for employer health insurance until 2015 (Hancock, 7/22). 

The Los Angeles Times: Healthcare Overhaul Leads Hospitals To Focus On Patient Satisfaction
For years, the check-in process in the urgent care center of this city's large, downtown hospital was reminiscent of a visit to the DMV. The ailing and sick walked in, pulled a number, took a seat and waited to be called. Many grew impatient and exasperated. Now, patients at San Francisco General Hospital are greeted by a smiling face and a helping hand to guide them along the path to getting care. It's one of a series of customer-friendly touches being added at the 156-year-old institution by a newly named "chief patient experience officer." ... Under the national healthcare overhaul, patient experiences matter. Federal payments are being tied to surveys that gauge patient attitudes about such things as a hospital's noise and cleanliness, communication and pain management (Gorman, 7/20).

The Los Angeles Times: National Healthcare Reform Sparks Concern About Scams
The national health reform law is expected to open the door for identity theft and insurance scams when millions of uninsured Americans begin enrolling in coverage this fall, officials and advocates warn. The Federal Trade Commission said dozens of consumers have reported fraud since last summer's Supreme Court ruling upholding the law, and officials predict widespread abuse when enrollment begins in October (Gorman, 7/20).

The Wall Street Journal: Student Health Plans Boost Coverage And Price
Student health-insurance plans are getting better—and pricier. Under the Affordable Care Act, the minimum annual benefits limit of such plans will jump to $500,000 for the 2013-14 school year, up from $100,000 in 2012-13. And the cap will disappear for the 2014-15 school year. Also starting next year, student plans can't exempt pre-existing conditions and will be expected to cover the same 10 essential benefits as other individual health plans, including prescription drugs, preventative services and mental-health care. But the plans cost more, too (Blumenthal, 7/21).

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What Will Insurance Premiums Under Obamacare Look Like?

Kaiser Health News and The Washington Post parse the significance of recent announcements in New York and Indiana.

Kaiser Health News: Consumers In Most States Unlikely To See N.Y.'s 50 Percent Reduction In Premiums In Individual Market
New York's announcement this week that insurance premiums would drop 50 percent next year for individuals buying their own coverage in new online marketplaces made good talking points for proponents of the health law, but consumers in most states are unlikely to see similar savings (Appleby, 7/19).

Kaiser Health News: Analysis: N.Y. Insurance Market Called 'Poster Child' For Individual Mandate
The nosedive in health insurance prices that New York officials announced earlier this week was driven by many factors, but the most important was the individual mandate, a central component of Obamacare. That's because insurers are betting they can use that often reviled requirement that takes effect Jan. 1 to nag, nudge, push and prod 2.6 million uninsured New Yorkers, especially the young and healthy, to buy coverage" (Rabin, 7/19).

The Washington Post: Indiana Says Health Plan Costs Will Spike To $570. That's Not The Full Story
The average health insurance plan in Indiana will increase by 72 to percent next year and hit $570 under the 2010 health-care law, the state announced Friday. What does that tell us? It certainly doesn’t tell us insurance coverage in Indiana will be cheap; that much is obvious. But it doesn’t really tell us that Indiana’s premiums are outrageous – in fact, when you dig into the documents insurers’ filed, it turns out Indiana’s rates look a lot like the rest of the country (Kliff, 7/20).

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Anthem Blue Cross Won't Join California's Small Business Exchange

The move by California's largest insurer for small businesses raised concerns about the state's ability to offer competitive rates. Meanwhile, Humana will step in to fill a potential insurance void in Mississippi, offering coverage in 36 counties where no other plans had been slated to be sold.

Los Angeles Times: Anthem Blue Cross Shuns Insurance Market For Small Businesses
Health insurance giant Anthem Blue Cross is spurning California's new insurance market for small businesses, a potential setback in the state's rollout of the federal health care law. Anthem, a unit of WellPoint Inc., is California's largest insurer for small employers. The company's surprising move raised concerns about the state's ability to offer competitive rates and attract businesses to its new Covered California exchange that opens Jan. 1 (Terhune, 7/19).

Kaiser Health News: Capsules: Humana Fills Blank Spots In Mississippi Obamacare Map
Filling a potential coverage void, Humana Inc. said Friday it will sell health insurance in 36 Mississippi counties that might have otherwise been left out of a marketplace for subsidized policies sold under the Affordable Care Act (Hancock, 7/19).

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D.C., Minnesota March Forward With Online Insurance Marketplaces

Meanwhile, Medicaid expansion plans continue to be hot topics in Arizona and New Hampshire.

The Washington Post: Obamacare Already Working In D.C., Officials Say
With less than three months until its go-live date, District officials say the city's health insurance exchange is already functioning as planned by one important measure: prices. City insurance regulators announced Friday that they have finishing granting approval to the plans set to be offered on the exchange, known as D.C. Health Link, starting Oct. 1. Four insurers are offering 301 different plans, and three of the four lowered their prices from their initial proposals after learning what their competitors were planning to charge (DeBonis, 7/19).

MPR News: Legislative Panel Reviews MNsure Operations
On Monday, 10 members of the Minnesota House and Senate will receive updates on [the online insurance marketplace] MNsure's progress from its board chair and executive director. They are expected to discuss MNsure's budget; the status of its grants and spending; plans to explain how the public will enroll in coverage; and the progress of the information technology infrastructure development (Stawicki, 7/21).

The New York Times: Republicans In Arizona Are At Odds On Medicaid
For Gov. Jan Brewer, the passage last month of a Medicaid expansion was a major coup. Despite a Republican majority in the Legislature, where she faced significant opposition from Tea Party members, she rallied the entire Democratic delegation to her side and made a progressive issue palatable to just enough conservatives, casting the expansion as the right decision for the state, morally and monetarily. ... Ms. Brewer’s maneuvering ... has sparked ire among the Republican rank and file. In interviews, many of its most loyal members conceded that the party's once cohesive ideology has been tainted by the governor’s stance, and they are arming themselves for payback (Santos, 7/21).

The Associated Press: N.H. Governor To Open Medicaid Expansion Options
Gov. Maggie Hassan says she's open to considering alternatives to enrolling an estimated 58,000 poor adults into the state's existing Medicaid program if a different way to expand the program is better for New Hampshire. In an interview with The Associated Press, Hassan said she's confident a special commission established to study whether expanding Medicaid is right for New Hampshire will address reluctant lawmakers' concerns. She said she wants to hear what model the commission believes is best for the state (Love, 7/21).

Meanwhile, in the news from Oregon -

The Associated Press: Oregon Medical Community Gears Up For Expansion
With 400,000 uninsured Oregonians expected to get health insurance in the coming years, the state and medical community are scrambling to make sure there are doctors, nurses and other health care providers available to treat them. Many of Oregon's rural and minority communities already are short of the recommended doctor-patient ratios — a problem that will only get worse when most Americans are required to have health coverage beginning Jan. 1 (Cooper, 7/21).

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Federal Judge Grants Hobby Lobby A Stay Against Birth Control Coverage Mandate

District Court Judge Joe Heaton gave Department of Justice lawyers until Oct. 1 to appeal.

Reuters: Hobby Lobby Wins A Stay Against Birth Control Mandate
A federal judge has temporarily exempted Hobby Lobby Stores Inc from a requirement in the 2010 healthcare law that it offer workers insurance coverage for birth control, which the retailer said violated its religious beliefs. The preliminary injunction issued by U.S. District Judge Joe Heaton in Oklahoma City, where Hobby Lobby is based, covers the arts and crafts chain and its affiliated Mardel Christian bookstore chain (Stempel, 7/19).

CQ HealthBeat: Hobby Lobby Wins Injunction In Birth Control Mandate Case
A federal judge Friday gave the craft store chain Hobby Lobby a temporary injunction that allows the company’s Christian owners to continue defying an Obama administration regulation that employers must provide contraceptive coverage for their employees. Ruling from the bench, Oklahoma District Court Judge Joe Heaton granted the injunction and gave Department of Justice lawyers until Oct. 1 to appeal (Bunis, 7/19).

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Capitol Hill Watch

New Life For 'Death Panel' Bill, But Same Fights Loom

One lawmaker has reintroduced his bill that would pay Medicare doctors for having "end-of-life" conversations with patients -- an idea that has bitterly divided Congress in the past. In the meantime, another lawmaker wants to change -- and simplify -- Medicare's reimbursement coding system.

Politico: The 'Death Panel' Bill Lives
The bill is back. Or rather, it's never gone away. Each Congress, [ Rep. Earl] Blumenauer [D-Ore.] reintroduces it. He's even added a few new elements, for instance to make sure that care preferences are incorporated into electronic medical records, not just stuffed in someone's bedside table. He's picked up 15 co-sponsors, including a few Republicans. Among them is Tennessee Rep. Phil Roe, an outspoken member of the conservative House GOP Doctors Caucus, which helps drive an unwavering opposition to Obamacare (Kenen, 7/21).

The Hill: Citing Turkeys, House Republican Seeks To Change Medicare Policy
A Texas Republican is seeking to change a new Medicare reimbursement system that has different payment categories for a turkey bite and a turkey peck. An international coding system, which medical professionals must adopt by October of next year, has at least nine reimbursement codes for treating "turkey contact" injuries (Hooper, 7/21). 

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Quality

Investigating One Of The 'Fundamental Flaws' In The Pricing Of Health Care

The Washington Post investigates how the use of data plays into what some view as a distortion in physician pay.

The Washington Post: How A Secretive Panel Uses Data That Distorts Doctors' Pay
Twelve colonoscopies and four other procedures was a typical day for [physician Harinath Sheela], according to Florida records for 2012. If the American Medical Association’s assumptions about procedure times are correct, that much work would take about 26 hours. [Physician Harinath] Sheela’s typical day was nine or 10. "I have experience," the Yale-trained, Orlando-based doctor said. "I'm not that slow; I’m not fast. I'm thorough." This seemingly miraculous proficiency, which yields good pay for doctors who perform colonoscopies, reveals one of the fundamental flaws in the pricing of U.S. health care, a Washington Post investigation has found (Whoriskey and Keating, 7/20).

Meanwhile, Medicare plans to accelerate the link between payment and quality -

Kaiser Health News: Medicare Announces Plans To Accelerate Linking Doctor Pay To Quality
Medicare had already decided that large physician groups -- those with 100 or more doctors, nurses, social workers or other health professionals -- will gain or lose as much as 1 percent of their pay starting in 2015. Those incentives would double to 2 percent the following year under draft regulations Medicare released this month. The proposal also would phase mid-sized physicians groups—those with between 10 and 99 health professionals—into the program in 2016 instead of in 2017. While they would be eligible for bonuses up to 2 percent, they would be shielded from any penalties for that first year (Rau, 7/22). 

Also in the news, a study finds financial incentives for medical trainees leads to a jump in end-of-life discussions -

Reuters: Incentives May Encourage End-Of-Life Discussions
Offering medical trainees a financial incentive to write hospital patients' end-of-life wishes in their medical records led to a spike in the proportion of records with such notations, a new study found. Past studies have suggested that although many elderly people prefer to die at home instead of in the hospital receiving aggressive treatment, some never have a discussion about end-of-life care with their doctors or have such wishes recorded (Pittman, 7/19).

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Health Care Marketplace

Health Care Professionals Face Workplace Risks, On-The-Job Injuries

Also in the news, a report about trends in physicians' educational pursuits.

Medpage Today: Workplace May Be Unsafe For Health Care Professionals
Healthcare workers -- particularly nurses, nurses' aides, orderlies, and attendants -- suffer more musculoskeletal injuries than those working in any other field, a Public Citizen report found. Those injuries cost the U.S. about $7 billion each year, according to the Public Citizen report, which was written by Keith Wrightson and Taylor Lincoln, both of the organization's Congress Watch division. The increased number of on-the-job injuries may be the result of comparatively sparse rates of safety inspections at healthcare facilities, according to 2010 data from the Occupational Safety and Health Administration (OSHA) (Petrochko, 7/19).

Kaiser Health News: Doctors Interested in MBAs Are Increasingly Looking For Traditional Business Programs, Not Health-Care Specific Degrees
When nervous dental patients make their first visit to Dr. Sree Koka, chair of dental specialties at the Mayo Clinic, they may feel calmer after watching his video on YouTube. It answers many of their questions: Is the doctor male or female? Does he speak English? Is he nice? In the video, Dr. Koka introduces himself, cracks a few jokes and suggests what patients should think about for their first appointment. He created the spot while attending MIT's Executive MBA program where he learned the benefits of focusing on personal relationships, not just technical expert (Russo, 7/22). 

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State Watch

Detroit Seeks Retiree Pension, Health Care Cuts In Bankruptcy Filing

Detroit and its retirees begin a court fight this week over how much the city can cut its pension and health care benefits as it seeks to discharge $19 billion in debt.

The New York Times: Cries Of Betrayal As Detroit Plans To Cut Pensions
Gloria Killebrew, 73, worked for the City of Detroit for 22 years and now spends her days caring for her husband, J. D., who has had three heart attacks and multiple kidney operations, the last of which left him needing dialysis three times a week at the Henry Ford Medical Center in Dearborn, Mich. Now there is a new worry: Detroit wants to cut the pensions it pays retirees like Ms. Killebrew, who now receives about $1,900 a month (Yaccino and Cooper, 7/21).

The Washington Post: After Detroit Bankruptcy Filing, City Retirees On Edge As They Face Pension Cuts
The battle over the future of Detroit is set to begin this week in federal court, where government leaders will square off against retirees in a colossal debate over what the city owes to a prior generation of residents as it tries to rebuild for the next. … Orr has promised that retired city workers, police officers and firefighters will not see pensions or health benefits reduced for at least six months. But on Sunday, he said those retirement benefits will have to be cut down the road (Goldfarb, 7/21).

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Defining '20 Weeks' Of Pregnancy -- States and Doctors Don't Agree

NPR reports that the way most states define what constitutes 20 weeks of pregnancy in their abortion laws isn't the same way most doctors define it. In the meantime, Mexican abortion pill sellers just across the border from Texas expect a boon after that state's new abortion restrictions.

NPR: State Abortion Laws Differ From Doctors In Defining 20 Weeks
Texas last week became the 12th state to ban most abortions after 20 weeks. But most of the state laws don't define 20 weeks the same way doctors do (Rovner, 7/22).

WBUR: Here & Now: Abortion Pill Sellers In Mexico Expect Boom From Texas (Audio)
Texas Governor Rick Perry signed a new law yesterday that bans abortion after 20 weeks, and increases the standards for clinics and doctors who provide abortions. Clinics have a little more than a year to upgrade to ambulatory surgical centers, and critics say it will force as many as 37 of the state's 42 clinics to close. Women in rural and poor areas of Texas will be the most affected. From the Here & Now Contributors Network, Joy Diaz of KUT in Austin, traveled to the border town of Laredo, Texas, where women haven't had access to abortion clinics for years. She found that right across the border in Mexico, those who supply abortion-inducing drugs are bracing for a business boom (Diaz, 7/19).

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State Highlights: Del. Caps Co-Pays For Some Prescription Drugs

A selection of health policy stories from Delaware, Virginia, California, New York, Washington, North Carolina and Kansas.

The Associated Press/Washington Post: Delaware Governor Signs Bill Capping Co-Pays For Specialty Prescription Drugs
Gov. Jack Markell is signing legislation that caps co-pays for prescription drugs used to treat certain complex and chronic health problems. The legislation to be signed Monday limits patients’ co-insurance or co-payment fees for certain prescription drugs to $150 per month for up to a 30-day supply (7/22).

The Washington Post: Cuccinelli, McAuliffe Spar At Va. Gubernatorial Debate
After months of assailing each other’s integrity from afar and by proxy, Attorney General Ken Cuccinelli II and businessman Terry McAuliffe traded direct attacks on stage Saturday in the opening debate of their heated race for Virginia governor. ... Cuccinelli reiterated his opposition to President Obama's health care plan, but he also criticized Obama for not following his own law by postponing the legislation's employer mandate for one year. McAuliffe, meanwhile, made clear that he still supports the law and stressed that he thinks Virginia should accept the measure's invitation to expand the state's Medicaid program, which Cuccinelli opposes (Pershing and Vozzella, 7/20).

Los Angeles Times: Health Centers Vary Widely In Quality Of Medical Management
California's community health centers -- a key resource for people without medical insurance -- vary widely in their ability to control their patients' chronic diseases, including diabetes and high blood pressure, according to federal data (Gorman, 7/21).

The New York Times: Legal Battles Continue As Hospital In Brooklyn Nears Closing Date
As Long Island College Hospital in Brooklyn edged closer to shutting its emergency room and transferring its few remaining patients to other hospitals, those who want to close the hospital and those fighting to keep it open skirmished over the weekend in a flurry of legal maneuvers and bitter accusations (Yee and Vadukul, 7/21).

Los Angeles Times: 16 Medi-Cal Substance Abuse Treatment Centers Are Under Investigation
Sixteen drug and alcohol treatment centers that provide rehabilitative services to Medi-Cal patients are suspected of fraud and of hiring providers with felonies on their records, officials from the California Department of Health Care Services announced this week (Kumeh, 7/19).

Bloomberg: Patients ID'd From Hospital Records Trigger State Reviews
Some U.S. states are reviewing their policies around the collection and sale of health information to ensure that some patients can't be identified in publicly available databases of hospital records. Washington suspended distribution of the information and developed a confidentiality agreement that all buyers must now sign, according to Donn Moyer, a spokesman for the state’s Department of Health (Robertson, 7/22).

Healthy Cal: Should I Stay Or Should I Go Now? Glittering Laguna Honda Hospital Helps San Francisco’s Aging, Underserved
Below Twin Peaks' epic views of San Francisco rests a city health icon dating back to the Gold Rush era that today offers high-tech health services for underserved San Franciscans in a glittering facility brimming with art, light and individualized care. The dazzling Laguna Honda Hospital and Rehabilitation Center has proved so inviting after its three-building expansion in 2010 -- with spacious hallways, sun-drenched rooms, and sophisticated technology -- it has visitors gaping in jaw-dropping admiration (Perry, 7/21).

North Carolina Health News: Frustrations Mount Over NCTracks System
After two weeks of frustrating phone calls, an estimated 20 hours on hold and error messages telling her she had submitted her claims incorrectly, Kathy Tobias got in her car and drove from Sanford to Raleigh. Her mission: to get to the bottom of why the health care company she works for wasn't being paid by NCTracks, the new Medicaid computer system that rolled out July 1 (Hoban, 7/22).

Kansas Health Institute: KDHE Begins Day-To-Day Duties Of HIE Regulation
The day-to-day duties of regulating network-based, digital exchange of patient information in Kansas were fully passed off to the state this week, and the previous regulatory body -- the Kansas Health Information Exchange, Inc. -- has been officially dissolved. Officials at the Kansas Department of Health and Environment said the state on Thursday began processing so-called "opt outs" -- requests by patients to exclude their information from the statewide health information exchange (Cauthon, 7/19).

California Healthline: More Healthy Families Feedback Sought
The state has had difficulty getting input from families involved in this year's transition of 860,000 Healthy Families beneficiaries into Medi-Cal managed care plans. Only 11 percent of those contacted in the most recent survey responded to the state's questions, officials reported Wednesday. Results of a beneficiary survey were released at the monthly meeting of the Managed Risk Medical Insurance Board, which oversees Healthy Families. State officials called 5,000 Healthy Families households to ask about the transition. Only 568 of them -- about 11 percent -- responded (Hart, 7/19).

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Editorials and Opinions

Viewpoints: Anthem Stuns Health Law Supporters In Calif.; Administration May Realize Portions Of Overhaul Are 'Unworkable;' Judd Gregg Finds Fault With Employer Mandate Delay

Los Angeles Times: It's Anthem Blue Cross' Turn To Turn On Obamacare
Let's get this out of the way right up front: I feel like a guy who's continually making excuses for a friend who repeatedly messes up. For supporters (such as myself) of the 2010 Patient Protection and Affordable Care Act, better known as Obamacare, Friday presented another occasion to make excuses. This time it was the stunning news that Anthem Blue Cross will not offer group plans to small employers through a new, subsidized marketplace being set up by Covered California -- at least not in the exchange's first year (Jon Healey, 7/19). 

The Wall Street Journal: A CEO's-Eye View Of ObamaCare
Why did the Obama administration earlier this month delay enforcement of the Affordable Care Act's employer mandate until 2015? The administration claims that it needed more time to get the mandate right. Some have suggested that politics—the concern that negative effects of the mandate might kick in before midterm elections in 2014—may have influenced the decision. My own hope is that the administration acted because it is beginning to understand that portions of the ACA are unworkable despite its drafters' good intentions (Andrew Puzder, 7/21).

The Hill: Opinion: Method In Mandate Madness
Independent of the question of the legal defensibility of this action, the essential effect of splitting the healthcare initiative [by delaying the employer mandate] will, far from improving the system, actually lead that system to sputter toward implosion. Its parts will simply fail to mesh and fail to function. Of course, the truly cynical might say that this was the game plan all along. First, get a large number of people hooked on a new entitlement — the subsidized, exchange-sponsored insurance. ... The result will be exchanges that are not sustainable but full of people getting a new government benefit. This will require the federal government to step in and save the rights of these folks to their new entitlement. ... The goal has always been a government-run system (Judd Gregg, 7/22).

Forbes: As Detroit Goes Bankrupt, Michigan's Senate Considers Adding Billions of Unfunded Liabilities to Its Medicaid Program
Last week, the City of Detroit filed for bankruptcy, making it the largest municipal bankruptcy in American history. It’s a remarkable story, especially for natives of the state, like me, who have watched Detroit slowly decline for decades. But it’s even more remarkable when you consider the fact that the Michigan state legislature is on the verge of adding billions in unfunded liabilities to the state’s Medicaid program, precisely at the time when Michigan’s politicians should be most acutely aware of the dangers of fiscal irresponsibility (Avik Roy, 7/22).

Missoulian: Delay On Health Care Mandate Buys Businesses Time
The Patient Protection and Affordable Care Act is new, it's complicated and it's confusing. That means those who will be affected by it -- and that's nearly everyone -- need time to prepare for the impending changes. That's why "Obamacare," as it's now almost universally called, was designed to launch its most significant provisions in stages, ending with full implementation by 2020. However, by now it's become clear that more time and educational outreach are needed before the law can move forward smoothly. Fortunately, Montana got a little of both this month (7/21).

USA Today: Our Disabled Deserve Access Abroad
Too many countries haven't done what the United States did 23 years ago this week when we passed the Americans with Disabilities Act. In too many countries, what we take for granted hasn't been granted at all. We need to change that — and we can. But it requires American leadership in the world so that our wounded warriors and Americans with disabilities can travel, serve, study and work anywhere in the world with the same dignity and respect they enjoy here at home (Secretary of State John Kerry, 7/21). 

USA Today: Can Medicare Reach Its 65th Birthday
Every day, 10,000 people in the U.S. celebrate their 65th birthday, making each one of these seniors eligible for Medicare. The very program that gives America's seniors access to affordable health care will turn a youngish 48 on July 30, but in a biting irony, it could go bankrupt before reaching its 65th birthday (Doug Holtz-Eakin and Ken Thorpe, 7/20). 

The Boston Globe: Medicare 'Cost-Savings' Rules Pushing Costs Onto Patients
How could a 99-year-old badly injured woman on an inpatient unit be an "outpatient?" And why would Mass. General, one of our most distinguished community resources, do such a thing? While the big players spend a small fortune to game the system, patients remain in the dark. The culprit, it turns out, is Medicare cost containment. In order to cut costs — actually shift them, partly to hospitals and partly to patients — Medicare applies extreme financial pressure on hospitals to book admissions as outpatients whenever possible. This shifts them from Medicare Part A (the hospital program) to Medicare Part B, which is designed to cover only doctor bills. The hospital gets paid a lot less and the patient gets stuck for a lot more (Robert Kuttner, 7/18).

Sacramento Bee: Cuts To Public Health Come Back To Hurt County
Anyone who wants to understand the alarming rise in sexually transmitted disease in Sacramento County need only look at the numbers. Five years ago, Sacramento County had half a dozen public health clinics to serve the poor. Today, only one still operates. Five years ago, Sacramento had 10 communicable disease investigators who tracked STD cases and contacted sex partners of infected patients to make sure they got treatment. As The Bee's Cynthia Craft reported Friday, the county today has only one full-time investigator and another who works half time. By necessity, the shrunken staff limits its investigations to pregnant women with untreated chlamydia (7/20).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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