Daily Health Policy Report

Tuesday, July 22, 2014

Last updated: Tue, Jul 22

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch



Public Health & Education

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Medicare Testing Payment Options That Could End Observation Care Penalties

Reporting for Kaiser Health News, Susan Jaffe writes: “Medicare officials have allowed patients at dozens of hospitals participating in pilot projects across the country to be exempted from the controversial requirement that limits nursing home coverage to seniors admitted to a hospital for at least three days. The idea behind these experiments is to find out whether new payment arrangements with the hospitals and other health care providers that drop the three-day rule can reduce costs or keep them the same while improving the quality of care. They are conducted under a provision of the Affordable Care Act that created the Center for Medicare and Medicaid Innovations to develop ways of improving Medicare” (Jaffe, 7/22). Read the story, which also appeared in the Washington Post.

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Insuring Your Health: Arkansas Weighs Plan To Make Some Medicaid Enrollees Fund Savings Accounts

Kaiser Health News’ consumer columnist Michelle Andrews writes: “If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts. Those that don't may have to pay more of the cost of their medical services, and in some cases may be refused services” (Andrews, 7/22). Read the story.

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Political Cartoon: 'Brace Yourself?'

Kaiser Health News provides a fresh take on health policy developments with "Brace Yourself?" by Clay Bennett.

Meanwhile, here's today's haiku:


Johnson suit ruling -
Does this leave the House speaker
sitting or standing?

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

Narrow Networks Backlash Being Felt Across The Insurance Marketplace And Campaign Trail

News outlets report that consumer frustration with health law plans' limited choice of doctors and hospitals is emerging in a number of areas.  

Politico: Obamacare: Anger Over Narrow Networks
Anger over limited choice of doctors and hospitals in Obamacare plans is prompting some states to require broader networks — and boiling up as yet another election year headache for the health law. Americans for Prosperity is hitting on these “narrow networks” against Democrats such as Sen. Jeanne Shaheen of New Hampshire, whose GOP opponent Scott Brown has made the health law a centerpiece of his campaign to unseat her. And Republicans have highlighted access challenges as another broken promise from a president who assured Americans they could keep their doctor (Norman, 7/ 22).

Modern Healthcare: Providers, Insurers Grapple With Narrow-Network Backlash
Narrow networks are a reality of the new health insurance landscape. Nearly half of all insurance plans sold on the public exchanges in 2014 were narrow network plans, defined as those with less than 70% of area hospitals included, according to an analysis by the research firm McKinsey & Company. But given that reality, insurers and providers need to do a better job of providing consumers with accessible, easily understandable information about networks when they shop for coverage. That was the message conveyed by participants in a panel discussion about network adequacy on Monday in Washington sponsored by the Alliance for Health Reform (Demko, 7/21).

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Judge Dismisses Sen. Johnson's Lawsuit Against Health Law Provision

Sen. Ron Johnson, R-Wis., is challenging the requirement that members of Congress and their staffs get government-subsidized health care through the law's online marketplaces, but U.S. District Judge William Griesbach in Wisconsin says Johnson and his aide had not been harmed by the law.

The Associated Press: Judge Tosses Wisconsin Senator’s Health Care Suit
A federal judge on Monday dismissed a U.S. senator’s lawsuit challenging a requirement that congressional members and their staffs to obtain government-subsidized health insurance through small business exchanges, saying the senator had no grounds to sue (Johnson, 7/21).

Politico: Judge Tosses Sen. Ron Johnson’s Obamacare Lawsuit
A federal judge said Monday that Sen. Ron Johnson (R-Wis.) cannot challenge the Obamacare policy that lawmakers and their staff obtain health insurance through the exchanges. The ruling could prove ominous for House Republicans as they prepare to file suit against the Obama administration, also against Obamacare. That suit would focus on a different issue, the president’s delay of the employer mandate (Haberkorn, 7/21).

The Milwaukee Journal Sentinel: Federal Judge Throws Out Ron Johnson's Obamacare Lawsuit
Johnson, a Republican from Oshkosh, argued that members of Congress and their staffs were required to get insurance on their own under the Affordable Care Act, also widely known as Obamacare. But U.S. District Judge William Griesbach in Green Bay ruled Monday that Johnson and his aide, Brooke Ericson, didn't have legal standing to bring their case because they hadn't been injured. "Given that the plaintiffs receive, at worst, a benefit, they cannot claim to be injured under an equal protection theory," Griesbach wrote in his 20-page decision. In a statement, Johnson said he would review the decision before deciding whether to appeal (Marley, 7/22).

Reuters: U.S. Judge Dismisses Republican Lawsuit Over Obamacare Subsidy For Congress
U.S. Senator Ron Johnson of Wisconsin had challenged the right of the federal government to continue making employer contributions to Congressional health insurance plans even when lawmakers and their staff purchase coverage through new Obamacare online exchanges. U.S. District Judge William Griesbach, in Green Bay, dismissed the lawsuit on Monday, saying Johnson had failed to show he had been harmed by the regulation (O’Brian, 7/22).

Bloomberg: Wisconsin Senator's ACA Subsidy Suit Thrown Out
U.S. District Judge William Griesbach in Green Bay, Wisconsin, threw out the senator's case, ruling yesterday that without a "concrete injury" that can be remedied by the court, the dispute ought to be resolved politically. Johnson, a first-term Republican from Wisconsin, sued President Barack Obama's administration this year. He argued the subsidy treats legislators and their employees better than most Americans working for private employers, violating the U.S. Constitution's guarantee of equal protection (Harris, 7/22).

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Despite Controversies And Doubts, Cover Oregon Board Meeting To Plan For The Future

The board directing the troubled Oregon health exchange is meeting this week to begin making recommendations about next steps and the future. In addition, Washington's health benefit exchange faces challenges of its own.   

The Oregonian: Cover Oregon Board Starts Mulling Its Future Makeup And Direction
Battered by controversy, its vision in doubt, the board of Cover Oregon will meet today and tomorrow to start planning its future. The board will report to the Legislature in September on whether the bureaucracy set up to operate Oregon's health insurance exchange should remain a stand-alone public corporation or other agency, and if so how board members should govern it. Originally board members had contemplated a two-day retreat to tackle these questions. But now the event is structured as a series of meetings. The planning sessions that start tonight can't be live-streamed as typical board meetings are, though the public can dial in on a conference call (Budnick, 7/21).

The Oregonian: Former Top Cover Oregon Official Won $67,000 Settlement After Threatening Lawsuit
Gov. John Kitzhaber has defended his handling of the Cover Oregon debacle by noting that he engaged in "cleaning our own house," including holding three officials "accountable" after the health insurance exchange website did not work. But newly released records reveal that one of those three, Triz delaRosa of Cover Oregon, didn't go quietly. After Kitzhaber called for delaRosa, the exchange's chief operating officer, to be fired on March 20, she warned the state she'd sue if she was fired, according to documents obtained under Oregon's public records law. She laid blame for the exchange fiasco on Oregon Health Authority mismanagement, as well as Kitzhaber's staff, for failing to confront problems Cover Oregon reported after taking over the project in May 2013 (Budnick, 7/21).

Seattle Times: Washington Health Exchange Sounds The Alarm, Questions Deloitte
One message came through loud and clear at today’s meeting of the Washington Health Benefit Exchange’s Operations Committee: It may not be time to panic about the health exchange’s problem-riddled invoicing and payments system, but it is time to sound the alarm and get all hands on deck. “We are really out of rope on this one,” Chief of Staff Pam MacEwan told the committee. “We need this to be fixed a while ago. We don’t have the patience of the public or the carriers on this anymore” (Marshall, 7/21).

Meanwhile, on the Medicaid expansion front -

Kaiser Health News: Insuring Your Health: Arkansas Weighs Plan To Make Some Medicaid Enrollees Fund Savings Accounts
If all goes according to plan, next year many Arkansas Medicaid beneficiaries will be required to make monthly contributions to so-called Health Independence Accounts. Those that don't may have to pay more of the cost of their medical services, and in some cases may be refused services (Andrews, 7/22).

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Capitol Hill Watch

Health Policy And The Campaign Trail: Reports From Minnesota And Virginia

News reports highlight how health policy issues -- and the health law in particular -- are playing in these races.  

The Associated Press: GOP Seeks Jolt To Senate Race Against Dem Franken
Mike McFadden leaned his sturdy frame over the front counter of the Shady Drive Inn as the owner aired the same frustrations with political gridlock that some of her regular customers grumble about. Then she asked the Senate candidate point-blank: "What party are you affiliated with?" McFadden tiptoed into the answer: "Well, I’m an American first," he said. "But I'm a Republican." … McFadden is embracing a lot of ideas that many fellow Republicans are fighting fervently to kill. He supports an immigration overhaul with a path to citizenship. He says President Barack Obama's health care law must go, but he wants a replacement that replicates some of its goals (Bakst, 7/21).

The Washington Post: In Virginia’s 10th Congressional District, GOP Struggles To Woo Minority Voters
With the GOP's most conservative voices opposing immigration reform and the federal health-care law — issues of great importance to Latinos and Asians — Republicans acknowledge the challenges they face in appealing to those groups. Their goal, at least initially, is to chip away at Democratic dominance (Schwartzman, 7/20).

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Senate, House Conference Panel Makes Small Advances On VA Bill

Sen. Bernie Sanders, I-Vt., said the Senate will accept some offset on the cost of the package, a demand from the House. But the negotiations still have other issues to resolve. Meanwhile, the nominee to lead the agency prepares to testify before the Senate, and a new report examines problems at the VA.

Politico: Progress On VA Reform Deal
Members of a committee tasked with reforming the Department of Veterans Affairs have moved slightly closer toward closing a deal, even as Senate Majority Leader Harry Reid predicted the committee's failure. Sen. Bernie Sanders (I-Vt.), a co-chairman of the House and Senate VA conference committee, said Monday the panel’s 14 Senate-members have agreed to offset portions of the reform legislation. The Congressional Budget Office has estimated overhauling the agency could cost around $30 million (French, 7/21).

The Associated Press: VA Nominee McDonald Goes Before Congress
President Barack Obama's choice to lead the beleaguered Veterans Affairs Department is going before the Senate Veterans Affairs Committee for a confirmation hearing as Congress considers a bill to help the next VA leader do his job. Based on comments by lawmakers from both parties, VA nominee Robert McDonald appears headed to easy confirmation. The path for the veterans' bill is decidedly rockier (7/22).

The Associated Press: Report: Retaliation By Supervisors Common At VA
A pharmacy supervisor at the VA was placed on leave after complaining about errors and delays in delivering medications to patients at a hospital in Palo Alto, Calif. In Pennsylvania, a doctor was removed from clinical work after complaining that on-call doctors were refusing to go to a VA hospital in Wilkes-Barre. Medical professionals from coast to coast have pointed out problems at the VA, only to suffer retaliation from supervisors and other high-ranking officials, according to a report Monday by a private government watchdog (Daly, 7/22).

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Out-Of-Pocket Costs Rising Significantly For Medicare Beneficiaries: Report

The analysis by the Kaiser Family Foundation examines seniors' costs from 2000 to 2010. Also, another story focuses on a new Medicare effort to find ways to exempt beneficiaries from the requirement that they be in the hospital for three days before they qualify for nursing home coverage.

Politico Pro: Kaiser Study Finds Rising Out-Of-Pocket Medicare Costs
People on Medicare have seen their out-of-pocket costs rise significantly since 2000, and the increase is especially acute for those who are older, female, have chronic conditions or frequently stay in the hospital. A new analysis from the Kaiser Family Foundation uses Medicare survey information from 2000 to 2010 to provide a detailed look at how much beneficiaries spend for their health care, who pays the most and which types of services account for the most out-of-pocket spending. The analysis looks at the three main ways seniors and others on Medicare pay for their health care: monthly premiums, cost sharing for Medicare-covered benefits and costs for services not covered by the program. The typical person paid an average of $4,734 each year for their care, 44 percent more than in 2000 (Cunningham, 7/21).

Kaiser Health News: Medicare Testing Payment Options That Could End Observation Care Penalties
Medicare officials have allowed patients at dozens of hospitals participating in pilot projects across the country to be exempted from the controversial requirement that limits nursing home coverage to seniors admitted to a hospital for at least three days. The idea behind these experiments is to find out whether new payment arrangements with the hospitals and other health care providers that drop the three-day rule can reduce costs or keep them the same while improving the quality of care. They are conducted under a provision of the Affordable Care Act that created the Center for Medicare and Medicaid Innovations to develop ways of improving Medicare (Jaffe, 7/22).

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Debate Heats Up Over Physicians' Skill Reviews

In other news regarding medical practice, the federal database detailing payments to doctors from the drug and device industries is plagued by error messages.   

The Wall Street Journal: Doctors Upset Over Skill Reviews
The medical community is embroiled in a bitter debate about what board-certified physicians should be required to do to prove that their knowledge and skills are up-to-date. Besides holding a state medical license, about 75% of U.S. doctors are certified by 24 privately run boards, signifying that they have mastered their area of specialty, in fields ranging from internal medicine to orthopedics. The specialty boards require their physicians to pass rigorous exams, generally every 10 years, to stay certified. In recent years, those boards also have begun requiring doctors to enroll in official Maintenance of Certification programs in between exams to show they are committed to lifelong learning and quality improvement (Beck, 7/21).

Related KHN coverage: Docs Slam Recertification Rules They Call A Waste Of Time (Rabin, 7/21).  

The Hill: Error Messages Rife On Site Showing Doc, Industry Ties
A long-awaited federal database designed to reveal doctor payments from the drug and medical device industries is plagued with confusing error messages, according to a report. Physicians told ProPublica that they are seeing long waits and error messages when trying to look up their entries on a preliminary version of the Open Payments website (Viebeck, 7/21).

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Public Health & Education

Newborns' Health Indicators Improve Despite Economic, Health Disparities

The Washington Post: The Wealth Gap Is Growing, But Poor Women See One Improvement: Healthier Newborns
Something extraordinary is happening to poor pregnant women such as Verret: They’re giving birth to healthier babies. While other economic and health disparities have widened, giving way to huge national debates about inequality, pregnant women at the lowest rung of the nation’s economic ladder are bucking that trend. They have narrowed the gap with wealthier women in the health of their babies (Goldfarb, 7/20).

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Health Care Marketplace

Drug Industry News: FDA Offers Warning About Compounding Pharmacy; More On Sovaldi

This latest warning is the Food and Drug Administration's third in 15 months.  

The Wall Street Journal’s Pharmalot: FDA Spars With Recalcitrant Compounding Pharmacy, Again
For the third time in 15 months, the FDA is warning health care providers and consumers not to use drugs that were made by a Dallas compounder because the medicines may be contaminated. And the ongoing struggle between the agency and NuVision Pharmacy underscores the difficulties that beset the pharmaceutical supply chain despite a recently passed law designed to bolster safety (Silverman, 7/21).

Meanwhile, praise and criticism continues regarding the new and costly hepatitis C drug Sovaldi.

The San Francisco Chronicle: Costly Hepatitis C Drugs Could Add $300 To Every American’s Yearly Premium, CVS Says
Gilead Sciences’ new hepatitis C drug receives as much praise for its healing powers as it receives criticism of its price, $84,000 for 12 weeks. Those parallel storylines played out even further in a prominent scientific journal’s latest edition, published online over the weekend. In one study in the Journal of the American Medical Association, Sovaldi and the medication with which it must be taken, ribavirin, were found to cure high rates of patients with both hepatitis C and HIV. In a commentary in the same publication, one of the nation’s largest pharmacy benefit managers complained that the cost of covering new hepatitis C drugs, including Sovaldi, could add as much as $300 annually to every American’s health insurance premium over the next five years (Lee, 7/21).

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State Watch

State Highlights: Fla. Cracks Down On Direct Medicaid Marketing

A selection of health policy stories from Hawaii, California, Virginia, Kansas and Maryland. 

The Associated Press: Health Officials Crack Down On Medicaid Marketing
[Florida] health officials are taking a cue from past problems and are banning health insurance companies from marketing their plans directly to Medicaid consumers as the state is rolling out a massive overhaul by transitioning millions into managed care. Insurance companies are allowed to market to consumers under the contracts, but only if the state gives prior approval (Kennedy, 7/22).

Stateline: King County’s Wellness Plan Beats The Odds
When King County, Washington, launched its employee wellness program seven years ago, its motive was clear. “We were being eaten alive by runaway medical costs,” says the county’s top executive Dow Constantine. By all accounts, the previous administration was desperate to bring down double-digit health care cost growth that threatened to destroy the entire budget. That partially explains why King County, which spends nearly $200 million per year to insure 14,000 workers and their families, who mostly live and work here in the county seat, was willing to risk millions more on a wellness program that would prove to break the traditional mold. It may also explain why labor unions took the unusual step of joining management in a plan that would ultimately shift more health care costs to workers (Vestal, 7/22). 

The Associated Press: 75K in Hawaii Have No Health Care
The rate of people without health insurance in Hawaii has dropped below 6 percent since the implementation of the federal health care law, state officials said Monday. Officials said at a joint House committee briefing that roughly 75,000 people in Hawaii don't have health insurance, down from well over 100,000 last year. The rate is down from about 8 percent before the push to enroll people last year, Insurance Commissioner Gordon Ito said (Garcia, 7/21).

Los Angeles Times: Amid Whooping Cough Epidemic, LAUSD Offers Free Vaccines
Starting middle school comes with a whole host of worries -- going to a new school, picking electives, making friends -- but coming down with whooping cough doesn’t need to be one of them. For incoming 7th grade students in the Los Angeles Unified School District, proof of a TDaP booster shot is mandatory before school starts Aug. 12. L.A. Unified will host a number clinics, listed below, to help make sure students receive a booster shot free of charge (Hayden, 7/21).

The Associated Press: Va. Panel Promises Changes in Mental Health System
Lawmakers on a newly formed panel on Monday promised a top-to-bottom review of Virginia's mental health system with the goal of making it a model for the rest of the country. … The panel has four years to review the state's mental health programs and suggest possible changes (Suderman, 7/21).

The Associated Press: Widow: Jury Sent Tobacco Company A $23B Message
A Florida widow awarded $23.6 billion in the death of her chain-smoking husband on Monday called the massive verdict a message to Big Tobacco, even though she likely won't see much if any of the money. The punitive damages — $23,623,718,906.62, to be precise — almost certainly will be significantly reduced on appeal, if not thrown out entirely, legal experts and industry analysts said. In another major tobacco trial, a $28 billion verdict in a 2002 case in Los Angeles turned into $28 million after appeals (7/21).

Kansas Health Institute News Service: Kansas Chiropractor Pleads Guilty To Health Care Fraud
A Wichita chiropractor pleaded guilty today to defrauding health care insurers of more than $1.3 million. U.S. Attorney for Kansas Barry Grissom announced the plea by Jeffrey D. Fenn, 33, of Wichita. Fenn also pleaded guilty to two counts of aggravated identity theft and a count of tax evasion, admitting that between March 2011 and October 2013 he executed the fraud scheme through his businesses, including Wichita Health and Wellness, Fenn Chiropractic, P.A., and Wichita Pain Associates, P.A. Fenn submitted false billing claims to Medicare, Blue Cross/Blue Shield of Kansas, Coventry Health Care of Kansas, Inc., and the Federal Employees Health Benefits Program (7/21).

The New York Times: Hospital Agrees To Pay $190 Million Over Recording Of Pelvic Exams
The doctor wore an unusual pen around his neck. It was really a concealed camera, and for years he secretly recorded women at some of their most private moments, during pelvic exams. On Monday, Johns Hopkins Hospital agreed to pay $190 million to more than 7,000 women for the gross violation of doctor-patient trust in what experts said was one of the largest medical malpractice cases of its kind. Dr. Nikita A. Levy, a gynecologist and obstetrician for Johns Hopkins Community Medicine in Baltimore, was fired in February 2013 after a female colleague reported her suspicions of his penlike device. Ten days later, he committed suicide (Gabriel, 7/21).

The Wall Street Journal: Johns Hopkins Agrees To $190 Million Exam-Photos Settlement
The investigation found no evidence that Dr. Levy had shared the images. No criminal charges were filed against the 54-year-old doctor, who committed suicide during the investigation by wrapping a plastic bag around his head and pumping it with helium, the Associated Press said (Levitz, 7/21). 

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Editorials and Opinions

Viewpoints: 'Entitlement Meltdown;' Improving Medicare Advantage; 'Sloppy Work Habits' At CDC

The Wall Street Journal: Heading Off The Entitlement Meltdown
Each day, 10,000 baby boomers retire and begin receiving Medicare and Social Security benefits. And while five workers supported the benefits of each retiree in 1960, there will be only two workers funding each retiree by 2030. Those who dismiss long-term budget projections should re-read the last paragraph. The retirement of 77 million baby boomers into Social Security and Medicare is not a theoretical projection. Demography is destiny (Sen. Rob Portman, R-Ohio, 7/21). 

The New York Times' The Upshot: Medicare Advantage Is Not Efficient, But Here's How It Can Be
Medicare Advantage plans — private plans that serve as alternatives to the traditional, public program — have been growing in popularity. One reason is that they offer additional benefits beyond those available in the traditional program but often at no additional cost to beneficiaries. This is a great deal for beneficiaries, but a bad one for taxpayers, who have to cover the extra cost. If the program were reorganized to more closely resemble the Affordable Care Act’s exchanges, it could still provide good value to consumers at a lower cost to taxpayers (Austin Frakt, 7/21). 

The New York Times Magazine: What The Hobby Lobby Ruling Means For America
Last month, as you've probably heard, a closely divided Supreme Court ruled that corporations with religious owners cannot be required to pay for insurance coverage of contraception. The so-called Hobby Lobby decision, named for the chain of craft stores that brought the case, has been both praised and condemned for expanding religious rights and constraining Obamacare. But beneath the political implications, the ruling has significant economic undertones. It expands the right of corporations to be treated like people, part of a trend that may be contributing to the rise of economic inequality (Binyamin Appelbaum, 7/22). 

Los Angeles Times: A CDC Safety Net Full Of Holes
The recent safety lapses at the Centers for Disease Control and Prevention might have been chalked up to the sloppy work habits of a few employees, easily resolved, if it weren't for the revelation last week that there has in fact been a systemic problem with laboratory safety for a number of years. These problems, involving dangerous pathogens, have been uncovered both at CDC laboratories and at other laboratories around the country that are overseen by the CDC. The problems could easily have endangered human lives (7/21). 

Bloomberg: How Civil-Rights Law Could Overturn Hobby Lobby
Employers who single out contraceptives as undeserving of coverage don’t only violate ethical expectations of gender equality. They also violate federal anti-discrimination law. Title VII of the Civil Rights Act of 1964 prohibits employers from discriminating on the basis of sex, including enacting policies that, while gender-neutral on their face, disproportionately hurt either men or women. ... The Hobby Lobby decision did not address Title VII simply because the court wasn't asked to. ... Nonetheless, the justices should have considered the anti-discrimination law on the books. By ignoring the discriminatory aspects of the denials, the Hobby Lobby majority was able to argue that the government’s interest in protecting contraceptive access could not sustain the Religious Freedom Restoration Act challenge mounted by the objecting corporations (Alexandra Brodsky and Elizabeth Deutsch, 7/21).

Charlotte Observer: Tackling Medicaid In North Carolina
We don't know if Gov. Pat McCrory was sincere or not when he said last week that he’s open to expanding Medicaid once a plan is in place to fix its unpredictable cost problems. But it was good to hear. ... A recent (Raleigh) News & Observer series showed that parts of the N.C. Medicaid program work. Costs per person have decreased as spending nationally has gone up. More providers in the state, compared with the national rate, are willing to participate. And services are better, especially preventive care, than in many other states. An overhaul that throws out all that good to fix the bad is wrongheaded. We hope lawmakers can reach agreement on a plan that doesn’t do that. We also hope they, like McCrory, will keep the door open – or rather open it again – on expansion (7/20).

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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.