Daily Health Policy Report

Monday, July 23, 2012

Last updated: Mon, Jul 23

KHN Original Reporting & Guest Opinion

Health Reform

Campaign 2012

International AIDS Conference

Capitol Hill Watch

Administration News

Quality

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Greg Millett: New HIV Infections Are Down, But 'Much More' To Be Done (Video)

In this Kaiser Health News video, Greg Millett, a senior policy advisor in the Office of National AIDS Policy, tells Joanne Silberner that the president's National HIV/AIDS Strategy has improved coordination among federal agencies and that the 2010 health law will improve access to care for those living with HIV/AIDS (7/23). Watch the video or read the transcript.

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'Child Life Specialists' Help Sick Kids Be Kids

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Yoselyn Gaitan, an eight-year-old with a shy smile, sits quietly in an exam room at Children's National Medical Center in Washington D.C., wearing a tiny hospital gown. She looks a little uneasy as she waits to be brought back to the operating room for the final surgery on her cleft palate. Kelly Schraf spots her through the curtain, and tiptoes into her room" (Gold, 7/23). Read the story.

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Meet A New Breed Of Medical Professional: The Health Coach

APRN's Annie Feidt, working in partnership with Kaiser Health News and NPR, reports: "Health coaches are a new kind of health professional, and it's their job to help people make those easy-to-say, hard-to-do behavioral changes that promote good health—getting enough exercise, eating a balanced diet, managing stress" (Feidt, 7/23). Read the story.

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Capsules: Medicare IDs Few Hospitals As Outliers In Readmissions

Now on Kaiser Health News' blog, Jordan Rau reports: "Despite several years of concerted efforts, hospital readmission rates aren’t dropping, the latest Medicare data show. Readmissions cost Medicare $17.5 billion in inpatient spending, with nearly 10 million Mediciare beneficiaries readmitted within 30 days for any cause, a rate of nearly one in five Medicare patients who enter a hospital" (Rau, 7/23). Check out what else is on the blog.

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Texas Advocates Push Insurance Rate Review

KUHF's Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: "In an effort to make insurance affordable, the federal law requires every state to conduct a special review whenever a health insurer wants to raise premiums more than 10 percent. This rate review would help protect small businesses and individuals who buy their own policies. The provision went into effect last September, and since then, insurers made nine such requests in Texas" (Feibel, 7/20). Read the story.

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States Efforts To Outsource Prison Health Care Under Scrutiny

Reporting for Kaiser Health News and working in collaboration with The Washington Post, Kimberly Leonard writes: "States, in an attempt to cut costs, are increasingly outsourcing health care for inmates to for-profit companies, but the trend is raising concerns among unions and prisoners' rights groups" (Leonard, 7/22). Read the story.

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Political Cartoon: 'Tax or Penalty?'

 

Kaiser Health News provides a fresh take on health policy developments with "Tax or Penalty?" by Bruce Tinsley.

And here's today's health policy haiku:

EYES ON THE INTERNATIONAL AIDS CONFERENCE

More than two decades
have passed and the conference
is back in D.C.

The epidemic
has changed... but stats here make clear
much work still remains.
-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

CBO's Updated Health Law Cost Estimates Could Be Released This Week

Meanwhile, news outlets report on varying aspects of the implementation of state-based health exchanges -- including the assistance provided to state officials by Michael O. Leavitt, an adviser to GOP presidential hopeful Mitt Romney and head of a health care consulting company.

National Journal:  CBO Health Estimate Expected This Week
For the independent economists who score legislation for members of Congress, the hard work on President Obama's landmark 2010 health care law began soon after the Supreme Court handed down its ruling on the law's constitutionality. They've spent the past month rejiggering their estimates to arrive at a best guess for how much the law will cost now—a figure that Democrats and Republicans are eager to get (McCarthy, 7/23).

The New York Times: Romney Aide Helps States Comply With Health Care Law
If Republicans in Congress agree on anything, it is their desire to eradicate President Obama's health care law. But one of the top advisers to Mitt Romney, the party's likely presidential nominee, has spent the last two years advising states and private insurers on how to comply with the law. The adviser, Michael O. Leavitt, gets high marks from state officials and policy experts, who describe him as a pragmatist with a voracious appetite for information. But his work has caused consternation among some conservatives, who want states to resist the health care law (Pear, 7/21). 

CQ Healthbeat:  On Exchanges, Republicans Torn Over Moving Ahead
States must notify the Department of Health and Human Services by Nov. 16 of whether they plan to create their own exchanges, but even so some Republican governors are waiting until the Nov. 6 election to make a decision — a risky strategy if they want to keep the federal government from running the show (Reichard, 7/20).

The Washington Post: Va. Attorney General Argues For Do-Nothing Policy Against Federal Health-Care Law
Ken Cuccinelli II, the first state attorney general in the nation to sue over the federal health-care law, has hit upon a new anti-"Obamacare" strategy that is much easier than going to court: Do nothing. Virginia and other states can shield businesses from hefty fines for failing to provide adequate health insurance for employees, he contends, simply by refusing to set up their own state-based insurance exchanges (Vozzella, 7/21).

The Associated Press/CBS News: Official: Progress Made On Neb. Health Exchange
State insurance officials assured lawmakers Thursday that Nebraska has made headway in its efforts to comply with the federal health care law, but one senator questioned whether Gov. Dave Heineman can fulfill the law's requirements without calling a special session. Bruce Ramge, director of the Department of Insurance, told a legislative panel that Nebraska is "on par" with other states in its plans to create a state-based marketplace where users can comparison shop for health insurance (7/20).

Politico Pro: Authors: Exchanges Can Provide Subsidies
The "Obamacare" critics who are proposing a legal challenge to the exchange subsidies say it wasn't just a drafting error in the law, but a deliberate decision by Congress that appears to allow subsidies in state exchanges but not federal ones. But people involved in drafting the Affordable Care Act don't remember it that way — especially Senate Finance Committee Chairman Max Baucus, one of the main authors of the law (Millman and Dobias, 7/20).

In other news related to the health law's implementation -

The Hill: Challenges To Obama Administration's Birth-Control Mandate Piling Up In Court
Challenges to President Obama’s birth-control mandate are piling up in court. Twenty-four lawsuits have been filed against the federal birth-control mandate so far, mostly from religious groups that view the policy as a dangerous erosion of religious freedom. Foes of the mandate got a boost after Illinois-based Wheaton College — a prominent Protestant school — filed its own suit on Wednesday, joining mostly Catholic-affiliated institutions in arguing the mandate tramples on religious liberty (Viebeck, 7/22).

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Working Poor At Heart Of Medicaid Debate As Govs Draw Line In The Sand

Even as state executives such as Texas Gov. Rick Perry and Florida Gov. Rick Scott remain firm in their opposition to the health law's Medicaid expansion, health providers such as Cleveland Clinic CEO and President Tony Cosgrove express their support for it.   

The Associated Press: Working Poor Stand At Center Of Medicaid Debate
Families like the Gallegos stand at the center of a debate over President Barack Obama's health care overhaul, which could have expanded Medicaid coverage to 1.3 million uninsured Texans. But Republican Gov. Rick Perry has said he will not widen the program because it would cost too much (Sherman and Llorca, 7/22).

Miami Herald: Medicaid Expansion Spurs Debate In Florida
Medicaid is about to take a starring role in the national health care debate. Today, only certain people qualify for the health insurance program for the very poor: the elderly, the disabled, pregnant women and children. Under its proposed expansion, any poor American could qualify — a key part of health care reform. But thanks to the recent U.S. Supreme Court ruling, decisions about expanding Medicaid have been left to the states. And Gov. Rick Scott was the first governor in the land to declare he wouldn't do it (Martin and Holan, 7/21).

CQ Healthbeat:  Cleveland Clinic Leader Supports Medicaid Expansion
Cleveland Clinic president and CEO Toby Cosgrove warned Friday that in states that do not expand Medicaid in 2014, medical providers will suffer from lower reimbursements and insurance premiums will be higher than in states where the health program for the poor is broadened.  Governors in many states are facing pressure from medical providers such as hospitals, clinics and physicians to go ahead with the expansion of Medicaid as called for in the 2010 health care law (Adams, 7/20).

Modern Healthcare: Cosgrove Sees Premiums Going Up If Medicaid Isn't Expanded
The head of the largest Medicaid provider in Ohio said private insurance premiums will increase if that state opts not to expand the program. Dr. Delos Cosgrove, president and CEO of the Cleveland Clinic, said if his state opts not to expand its Medicaid program to cover all patients with incomes of up to 133% of the federal poverty level with a 5% leeway up to 138%, then he expects the number of indigent patients will increase (Daly, 7/21).

The Associated Press: US Poverty On Track To Rise To Highest Since 1960s
Stacey Mazer of the National Association of State Budget Officers said states will be watching for poverty increases when figures are released in September as they make decisions about the Medicaid expansion. Most states generally assume poverty levels will hold mostly steady and they will hesitate if the findings show otherwise. "It's a constant tension in the budget," she said (Yen, 7/23).

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Campaign 2012

Third-Party Groups To Target Health Law With New Wave Of Attack Ads

Also in the news, the Supreme Court -- especially after the recent health law decision -- is an effective tool to rally fundraising among both Democrats and Republicans. Meanwhile, a defense policy expert suggests presidential candidates focus on long-term military mental health issues. Finally, The Wall Street Journal examines how health care is playing in the Montana Senate race, where candidates are sparring over who is soft on cancer.

The Washington Post: Third-Party Groups Ready Multiple Ads Attacking Health Care Law
Conservative groups are gearing up to spend millions of dollars over the next three months on ads attacking President Obama's health care law and Democrats who support it, but in many cases voters will have no way of knowing who paid for the barrage. The ads amount to the next wave of opposition to Obama's health care plan, which was upheld by the Supreme Court last month as constitutional under the federal government's taxing authority. Some of the groups most active on the issue have received funding from health-care firms opposed to parts of the legislation (Eggen, 7/20).

Politico: Election Of Supreme Importance To Court's Future
President Barack Obama lost a potential campaign attack line when the Supreme Court upheld his health care law. But the nation's highest court still serves as one of Obama's best tools for raising money and waking up his base. And as Mitt Romney is discovering, invoking the Supreme Court can fire up conservatives, too (Samuelsohn and Gerstein, 7/22).

CBS News: In Nevada, Obama Makes Play For Veteran Support
The Brookings Institute's Michael O'Hanlon, who specializes in national security and defense policy, argues that both Romney and Mr. Obama can earn support from former service members by presenting bold ideas at the VFW conference and demonstrating a real understanding of issues relevant to the community. … O'Hanlon suggested that both candidates would do well to present a plan for addressing long-term mental health issues among military veterans (Madison, 7/23).

The Wall Street Journal: The Cancer Card And A Fighter In Florida
The tough battle for a U.S. Senate seat for Montana has reached the point where the candidates are battling over who is soft on cancer -- and featuring dueling cancer survivors in their television ads. Incumbent Democrat Jon Tester aired an ad on July 10 criticizing Rep. Dennis Rehberg, his Republican challenger, for voting to defund Title X of the Public Health Service Act, which funds family-planning services for low-income women. ... The Rehberg campaign, which launched a rebuttal ad this week, says the congressman didn't vote to eliminate breast-cancer screening. It shows an elderly woman who has had breast and thyroid cancer saying, "Denny has a good heart and understands what cancer does to everyone it touches." At the end of the ad, viewers find out the woman is Mr. Rehberg's mother  (Bendavid, 7/21).

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International AIDS Conference

AIDS Conference Opens In D.C. With Snapshot Of The Disease In America

News outlets examine where HIV/AIDS stands in America, what's being done to combat it, and where the future will lead.

The Associated Press: AIDS Conference Opens At Key Turning Point
Researchers, doctors and patients attending the world's largest AIDS conference are urging the world's governments not to cut back on the fight against the epidemic when it is at a turning point. There is no cure or vaccine yet, but scientists say they have the tools to finally stem the spread of this intractable virus -- largely by using treatment not just to save patients but to make them less infectious, too (Neergaard, 7/23).

Politico: After 22 Years, AIDS Conference Comes To D.C.
The massive International AIDS Conference convenes here this week, and hopes are running high that a long-sought goal of "a generation without HIV" may be within reach. Thousands of HIV and AIDS researchers, activists and policymakers from around the world are in Washington, and it's the first time the conference has been held in the United States in 22 years, ending a boycott of a policy forbidding U.S. visas to people who had HIV that the late Sen. Jesse Helms (R-N.C.) originally pushed into law (Norman, 7/22).

The Washington Post: Global AIDS Conference Rally Calls For Cheaper Medicines, More Funding
The first International AIDS Conference to be held in the United States in more than two decades opened Sunday with repeated assertions that the 31-year-old epidemic can be realistically brought to an end with more money and attention, strategically applied. The money is needed to put millions more of the world's 34 million HIV-infected people on medication, with special attention to those most at risk of getting and transmitting the virus -- male homosexuals, drug users and the poor (Brown, Shaver and Botelho, 7/22).

NBC News: AIDS Conference Opens With Eye To A Cure
Could it really be possible to cure AIDS? … It has exploded across the world -- killing 25 million people, infecting a million more every year, and moving from gay and bisexual men into wives and mothers, to their children, and among drug users. But experts think it might be possible to stop the spread and even to speak of curing the infection in those with human immunodeficiency virus (HIV), which causes AIDS. And they see a hopeful symbolism, as well, in the return of the giant international conference, held every two years, to the United States, where it hasn't been in 22 years (Fox, 7/22).

McClatchy Newspapers: International AIDS Conference Begins In Washington
More than 23,000 delegates – researchers, activists, advocates and policy makers – from nearly 200 countries came to the Washington Convention Center on Sunday for the kickoff of the International AIDS Conference, saying they want to work together to assess what the future of HIV and AIDS might hold. Secretary of Health and Human Services Kathleen Sebelius used the event to announce that the government has more than 150 antiretroviral drugs available through the President's Emergency Plan for AIDS Relief, or Pepfar, a globally funded plan begun under President George W. Bush (Mohamed, 7/22).

News stories look at what has changed since the last AIDS conference in the United States --

The Washington Post: Everything's Different (Almost) Since Last International AIDS Conference In U.S.
AIDS has killed 35 million people. It's caused physical pain and mental anguish for many who live with it. It's created a generation of African orphans. It's drained untold trillions of dollars from national economies and people's pockets. There's also one other way to describe the AIDS saga. It's a success story (Brown, 7/21).

The Washington Post: For Americans With HIV, There Are Many Obstacles To Successful Treatment
"The issue of how to treat patients is a done deal. We know what to do," said John G. Bartlett, 76, who watched the AIDS epidemic unfold as head of the division of infectious diseases at Johns Hopkins Hospital from 1980 to 2006. Today, the big issues are how to find the patients, test them, get them into medical care and keep them there, provide them medicines, educate them and follow their progress. This cascade of challenges reflects both the peculiarities of this disease and medical care in the United States (Brown, 7/21).

Reporters also look at what experts at the conference are saying about the fight against AIDS --

Kaiser Health News: Greg Millett: New HIV Infections Are Down, But 'Much More' To Be Done (Video)
In this Kaiser Health News video, Greg Millett, a senior policy advisor in the Office of National AIDS Policy, tells Joanne Silberner that the president's National HIV/AIDS Strategy has improved coordination among federal agencies and that the 2010 health law will improve access to care for those living with HIV/AIDS (7/23).

NPR: Testing, Treatment Key Weapons IN AIDS Fight
Thirty years ago, we first began hearing about AIDS -- then a mysterious, unnamed disease that was initially thought to be a rare form of cancer that affected gay men. Scientists soon learned that it was neither of those things, and, in fact, it was a virus that everyone was vulnerable to. … The battle, however, is far from over. Each year in the U.S., 50,000 new cases of HIV are diagnosed. One of the hardest-hit places is Washington, D.C., which plays host this week to the International AIDS Conference (7/22).

Bloomberg: New Strategies Needed to End AIDS Epidemic, Speakers Say
New strategies are needed to take advantage of scientific breakthroughs that promise to break the back of an AIDS epidemic that last year killed more than 4,000 people a day worldwide, U.S. and global officials said. In opening remarks yesterday at the International AIDS Conference in Washington, U.S. Health Secretary Kathleen Sebelius led a parade of speakers with similar messages: The world needs to be more focused and efficient in getting therapies and preventatives to those in need…. None of the speakers, though, offered specific programs to increase global access to needed treatments (Pettypiece and Wayne, 7/23).

The Washington Post: Shift In Strategy To Treatment As Prevention For HIV/AIDS
Jerome Smith said he never got tested for HIV until it was almost too late. By the time he was checked five years ago, his immune system was so weakened that he had developed AIDS. The doctor told Smith, a D.C. government worker, that he had probably been infected for at least a decade. Smith, now 39, says he doesn't understand how his disease had been missed. In the two years before the diagnosis, he had been treated in local hospital emergency rooms for pneumonia, for unexplained fever and for a deadly bacterial infection. Each time, he underwent countless tests as doctors tried to figure out why he was sick. Not once, he said, did anyone test for HIV (Sun, 7/21).

And they also look at what is being done to test and keep specific populations from contracting the virus or spreading it themselves -- to varying degrees of success --

The New York Times: In Washington, H.I.V. Testing Moves Beyond the Clinic
Angela Byrde, 27, is getting only the second H.I.V. test of her life -- at the Department of Motor Vehicles. Her situation exemplifies what is wrong with Washington's AIDS epidemic, and America's -- and what the nation's capital is finally doing to fix that. As a diabetic with Medicaid coverage, Ms. Byrde has seen doctors several times a year since she was 12, but they never suggested that she be tested, even though she lives in a city with one of the country's highest H.I.V. infection rates. Now the city, trying to find the estimated 5,000 Washingtonians who are infected but do not know it, is offering tests in grocery stores and high schools, on corners where addicts gather and even in motor vehicle offices. And it is paying people to take them (McNeil, 7/20).

Medpage Today: HIV Diversity In Immigrants Poses Challenge
People with HIV who were born outside the U.S. are more likely to be of Hispanic or Asian origin than native-born patients, researchers reported. They are also more likely to have acquired the virus through heterosexual contact, according to Irene Hall, PhD, of the CDC, and colleagues. Combined with other differences, the findings suggest that the HIV epidemic among immigrants has different epidemiological characteristics than among (U.S.-born) HIV-positive people, Hall and colleagues reported online in the Journal of the American Medical Association and at a media conference [in Washington, D.C.] before the opening of the International AIDS Conference (Smith, 7/22).

Bloomberg: Drive To End AIDS In U.S. Stalls As Epidemic Grips Minorities
Monique Moree is the new face of the AIDS epidemic in the U.S. The 31-year-old stay-at-home mom, who is black, was pregnant with her third child in 2005 when she found out she had HIV, the virus that causes AIDS…. While black men and women are 14 percent of the population, they accounted for 44 percent of 48,000 new HIV cases in 2009, the latest year for which definitive data is available, according to the Atlanta-based Centers for Disease Control and Prevention. The infection rate in black men was more than six times that in white males, and black women were 15 times more likely to become infected than their white counterparts, the CDC data shows (Armour and Langreth, 7/23).

Minneapolis Star Tribune: AIDS Fight Turns To Virtual Outreach
Four years ago, researchers at the University of Minnesota developed a sexually explicit, interactive gaming and information website called Sexpulse to educate gay men about safer sex and HIV. The provocative experiment came under fire from social conservatives, who called it government-supported gay porn and tried to kill its funding. But the project survived, and this week the team will present its research on HIV and social media at the International AIDS Conference in Washington, D.C., which featured remarks Sunday by former President George W. Bush and U.S. Health Secretary Kathleen Sebelius…. As AIDS research enters its fourth decade, advocates are still seeking new tools to stop the disease and help its victims (Hernandez, 7/23).

Baltimore Sun: Fewer Americans Suppressing HIV Virus, Study Finds
Fewer Americans than previously thought are controlling their HIV infections and potentially putting the public at higher risk, according to a new study from Johns Hopkins University and University of Pennsylvania. The researchers found that there are tens of thousands of people -- particularly young adults, blacks, injection drug users and the uninsured -- that are not consistently suppressing their viral loads. Mostly, they are not adhering to their drug regimens. And when patients go on and off their medications, they can become resistant to therapy and put other people in greater danger of contracting the virus that causes AIDS (Cohn, 7/22).

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Capitol Hill Watch

Rep. Burgess Offers Bill To Extend Current Medicare Doc Pay Rates Another Year

The measure on Medicare reimbursements to physicians would put off a dramatic rate cut scheduled to take effect next year.

Modern Healthcare: Legislation Offers One-Year Extension Of Medicare Doc Payment Rates
Rep. Michael Burgess (R-Texas) has introduced legislation that would provide a one-year extension for Medicare physician payment rates. Called the Assuring Medicare Stability and Access for Seniors Act of 2012, the bill is intended to provide payment certainty throughout 2013 as lawmakers develop a long-term Medicare physician payment program that is different from the current sustainable growth-rate formula (Zigmond, 7/22).

Politico Pro: Pediatric Residency Training Gets A Boost
House appropriators this week allotted $275 million to help fund medical education for pediatric resident physicians. The amount is $9.8 million above current levels, and more than the $185 million proposed by the White House. Call it a win for the children's hospitals across the U.S., which use the  funds to offset the cost for training pediatricians and pediatric specialists (DoBias, 7/20).

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Administration News

Health Law's Under-26 Provision Applies To Same Sex Partners' Children

On Friday, adminstration officials published a proposed rule to this effect. Meanwhile, Sen. Tom Coburn, R-Okla., is questioning the Obama administration's decision to allow temporary firefighters to gain access to health insurance through the Federal Employee Health Benefits Program.  

Politico: 'Obamacare' Extends Health Care Benefits To Same-Sex Partners' Children
The Obama administration is giving a new health benefit to same-sex partners -- and it's built on one of the most popular provisions of "Obamacare." On Friday, the administration published a proposed rule that would extend one of the health care law's best-known provisions -- allowing children to stay on their parents' health plans until age 26 -- to same-sex partners of federal workers (Millman, 7/20).

Politico Pro: Coburn Questions Firefighter Health Coverage
Sen. Tom Coburn may have started a firestorm about firefighters. The Oklahoma Republican is questioning a federal agency over its decision to allow temporary firefighters to immediately access the same health insurance choices offered to government workers under the Federal Employee Health Benefits Program (Dobias, 7/20).

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Quality

Why It's Hard For Medicine To Fix Its Mistakes

ProPublica offers an examination of the challenges hospitals face in adopting procedures to address medical errors.

ProPublica:  Why Can't Medicine Seem To Fix Simple Mistakes?
NYU's Langone Medical Center announced this week that it was adopting new procedures after the death of a 12-year old boy from septic shock. The hospital's emergency room sent Rory Staunton home in March and then failed to notify his doctor or family of lab results showing he was suffering from a raging infection.  In response to the case, which was closely covered by The New York Times, the hospital promised a bunch of basic fixes: ER doctors should be immediately notified of certain abnormal lab results and, if such results come in after a patient is sent home, the hospital should call the patient and his doctor (Weber, Ornstein and Allen, 7/20).

In other news related to health care quality --

Kaiser Health News: Capsules: Medicare IDs Few Hospitals As Outliers In Readmissions
Despite several years of concerted efforts, hospital readmission rates aren't dropping, the latest Medicare data show. Readmissions cost Medicare $17.5 billion in inpatient spending, with nearly 10 million Mediciare beneficiaries readmitted within 30 days for any cause, a rate of nearly one in five Medicare patients who enter a hospital (Rau, 7/23).

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Health Care Marketplace

New Health Professionals Emerge Within The Marketplace

This pair of stories from Kaiser Health News reports on new kinds of health professionals and the roles they have within the health care continuum.

Kaiser Health News: 'Child Life Specialists' Help Sick Kids Be Kids
Yoselyn Gaitan, an eight-year-old with a shy smile, sits quietly in an exam room at Children's National Medical Center in Washington D.C., wearing a tiny hospital gown. She looks a little uneasy as she waits to be brought back to the operating room for the final surgery on her cleft palate. Kelly Schraf spots her through the curtain, and tiptoes into her room (Gold, 7/23). 

Kaiser Health News: Meet A New Breed Of Medical Professional: The Health Coach
Health coaches are a new kind of health professional, and it's their job to help people make those easy-to-say, hard-to-do behavioral changes that promote good health -- getting enough exercise, eating a balanced diet, managing stress (Feidt, 7/23).

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State Watch

Medicaid Highlights: Calif. Medi-Cal Payments Could Be Hurting Patient Access

Shortcomings are examined in programs in California, where low reimbursements are discouraging doctors, and Kansas, where there's a large waiting list for developmentally disabled care.

San Jose Mercury News: Medi-Cal Compensation Inadequate, Doctors Say, As Enrollment Boom Looms
When Dr. Jerold Kaplan made a home visit last year to a man with a foot wound, he billed Medi-Cal -- the state's health care program for the poor and disabled -- what he thought was a modest $90. His payment: $8.96. … As California gears up for a major expansion of Medi-Cal under national health reform, such compensation is leading to a critical concern: Will enough physicians be willing to see the influx of new patients? ... "Medi-Cal has gotten so ridiculous in its reimbursement there are a lot of doctors that aren't interested in working for it," Kaplan said (Kleffman, 7/22).

Kansas Health Institute News: Group Aims To Reduce Medicaid Waiting Lists For Developmentally Disabled Services
A Kansas group campaigning to reduce the waiting list for services for the developmentally disabled is holding meetings and trying to build grassroots support for its effort statewide. … Launched in January, the campaign aims to persuade Kansas officials to eliminate a backlog for Medicaid-funded services that currently has about 4,915 developmentally disabled people on a waiting list. About 3,225 people are waiting for any services and about 1,690 are on the list to receive additional services (Sherry, 7/20).

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State Roundup: Plan For New Md. Hospital Advances

A selection of health policy stories from Maryland, Texas, California, North Carolina, Oregon, Arizona and Massachusetts.

The Washington Post: Filling In The Details Of How Prince George's Should Revamp Its Publicly Funded Medical System
Maryland officials are preparing to unveil this week a detailed plan for a $600 million regional hospital to replace the ailing Prince George's Hospital Center and establish a new health-care network throughout Prince George's County. The plans are part of a broad effort to improve health care in a county where an estimated 150,000 residents lack health insurance or have insufficient coverage and often rely on hospital emergency rooms for primary care (Spivak, 7/21).

Kaiser Health News: States Efforts To Outsource Prison Health Care Under Scrutiny
States, in an attempt to cut costs, are increasingly outsourcing health care for inmates to for-profit companies, but the trend is raising concerns among unions and prisoners' rights groups. About 20 states, including Arizona, Illinois and Maryland, have shifted all or portions of their prison health care operations to private firms (Leonard, 7/22).

Kaiser Health News: Texas Advocates Push Insurance Rate Review
In an effort to make insurance affordable, the federal law requires every state to conduct a special review whenever a health insurer wants to raise premiums more than 10 percent. This rate review would help protect small businesses and individuals who buy their own policies. The provision went into effect last September, and since then, insurers made nine such requests in Texas. But so far the Texas Department of Insurance has not completed any reviews (Feibel, 7/20).

HealthyCal: Navigating Patients To Better Health And Lower Costs
Dale was homeless and uninsured when he moved to Santa Cruz last year to live with his sister. Shortly after that, he ended up in the hospital and underwent emergency surgery. On top of his surgical recovery, he suffers from mental health problems and diabetes. Dale (not his real name) is the type of patient the Health Improvement Partnership of Santa Cruz County is aiming to assist with its second health navigator pilot project. Due to launch in July, the project will help people who have limited access to medical care travel the often complicated road from hospital bed to recovery, because those patients are often the most likely to land back in the hospital (Graebner, 7/23).

North Carolina Health News: Winston-Salem Center Will Provide Support For Mentally Ill
Mental health advocates in Winston-Salem are opening a drop-in center dedicated to people with mental illness helping one another. They're driven by an emerging movement in the mental health world that focuses not just on symptom management, but recovery from serious illness.

Oregonian: Alaska Native Medical Center A Model For Curbing Costs, Improving Health
James has stumbled into the primary care center of one of the most effective and innovative health systems in the nation. Southcentral Foundation, run by and for Alaska Natives, assumes it improves health only by developing relationships with patients. It has dramatically reduced health disparities that persist among Native Americans and across the country, including the Portland area. The nonprofit has attracted health leaders from all over the world, including Oregon, which drew on Southcentral's design in making coordinated care teams the centerpiece of state health reform (Graves, 7/21).

San Francisco Chronicle: Alameda County To Vote On Drug Disposal
With a law believed to be nationally unprecedented, Alameda County is about to tell the pharmaceutical industry it must pay to get rid of the unused pills in people's medicine cabinets. On Tuesday, the county's Board of Supervisors will cast its final vote on the Safe Drug Disposal Ordinance. It would require makers of drugs sold or distributed in Alameda County to pay for a countywide program to safely collect and destroy unused medications (Lee, 7/22).

Arizona Republic: Maricopa County Nixes Hospital-Tax Vote
County health officials scuttled a plan to ask voters in November for a new tax to upgrade county health facilities, but the matter could go on the ballot within the next two years. The board of directors of the Maricopa Integrated Health System on Friday rejected the proposal by Betsey Bayless, MIHS president and chief executive, to put the measure on this year's general-election ballot. It would have asked voters to raise taxes for a $950 million bond issue to pay for a new county hospital and improvements to existing facilities (Lee, 7/20).

Boston Globe: Laptop Theft May Affect 3,900 Beth Israel Patients
About 3,900 Beth Israel Deaconess Medical Center patients will be getting letters alerting them that some of their personal health information may have been breached after a physician's personal laptop computer was stolen from a hospital office. The theft occurred May 22, hospital officials said Friday, and the stolen laptop, which contained a tracking device, has not been recovered (Lazar, 7/21).

Boston Globe: Cancer Drug Bill Moves Through The State Senate
Legislation that would require health insurers to cover chemotherapy equally, regardless of whether it was given intravenously or in pill form, passed the state Senate late Thursday evening and is being sent to the House. The bill was drafted to address an inequality in cancer care: Many patients who receive chemotherapy through an infusion have their care covered by insurance or pay a copayment for their office visit, whereas pills often have higher out-of-pocket costs. The disparity has grown in importance as the trend in cancer drug development has meant a surge in treatments administered as pills (Johnson, 7/21).

The Associated Press/Arizona Republic: Arizona County Attorneys At Odds Over Abortion Law
Two prominent Arizona prosecutors who would have to enforce a new abortion restriction are taking opposite positions on whether it should be allowed to take effect as scheduled. A lawsuit recently filed by abortion-rights groups challenges the new law's ban on abortions starting at 20 weeks of pregnancy. Maricopa County Attorney Bill Montgomery and Pima County Attorney Barbara LaWall were named as defendants in the suit because of their law-enforcement positions (Davenport, 7/20).

California Healthline: DHCS Rejects Judge's Opinion On Adult Services Eligibility
An administrative law judge from the Department of Social Services issued an opinion that the Department of Health Care Services does not have the legal authority in two cases to deny eligibility for the Community Based Adult Services program. That opinion was rejected in an alternate decision issued Wednesday by DHCS director Toby Douglas. The appeals process, contained at this point within the state Health and Human Services Agency, is overseen by DSS, which submits its findings to Douglas, who has final word on appeals decisions (Gorn, 7/23).

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Editorials and Opinions

Views On AIDS: Despite Advances, Still No Cure, No Vaccine, And Indifference Grows

The Washington Post: Turning The Tide With AIDS
The story of the AIDS pandemic has been grim for so long that optimism seems hardly possible. But as the 19th International AIDS conference opens in Washington on Sunday, there is hope for control of a disease that has killed nearly 35 million people over three decades and 1.7 million in the past year. Unfortunately, there is still no cure, nor a vaccine proven safe and effective. But a headline in the New England Journal of Medicine asks, "The Beginning of the End of AIDS?" This is not wishful thinking (7/21).

The Washington Post: AIDS Remains A Problem. But Is It Still A Priority For The Gay Community?
HIV no longer seems to be a priority for some in the gay community. Foundations focused on lesbian, gay, bisexual and transgender people, which have historically provided millions of dollars in crucial funding for HIV service organizations, are shifting their resources elsewhere. The fight is different now. There is a lack of urgency among some well-off, white gay men, a segment of the LGBT community that was crucial in battling HIV and turning the tide in the 1980s and '90s (Daniel Tietz, 7/20).

Boston Globe: A Quiet Breakthrough On HIV
Thirty years into the battle against HIV, medical researchers still haven't discovered a cure or a vaccine. But the Food and Drug Administration’s recent approval of a new use for the antiretroviral drug Truvada marked a quiet breakthrough that could bring them closer to that goal (7/21).

Philadelphia Inquirer: With Return To The U.S., AIDS Group Focuses On Girls
United Nations statistics show that young women are most likely to be infected with HIV due to several factors, including a lack of education. Yet only 2 cents of every international-aid dollar directed toward fighting AIDS focuses on young women. Women ages 15-24 have twice the infection rate of young men. This affects society at large. Without HIV, the mortality rate among women with children would be 20 percent lower. More orphans would still have a mother (7/22).

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Viewpoints: Cutting Health Costs Is Next Battle; Texas Medicaid Chief On Why Expansion Won't Work; Grief, Anger Over End-of-Life Decision

The New York Times: A Formula For Cutting Health Costs
No matter what happens to President Obama's health care reforms after the November elections, the disjointed, costly American health care system must find ways to slow the rate of spending while delivering quality care. There is widespread pessimism that anything much can be achieved quickly, but innovative solutions are emerging in unexpected places. A health care system owned and managed by Alaska's native people has achieved astonishing results in improving the health of its enrollees while cutting the costs of treating them (7/21).

The New York Times: Only The First Step In Containing Health Costs
Here's a frightening thought: Despite the recent Supreme Court decision upholding the Affordable Care Act, serious work on more health care legislation is still needed. ... Even with the law, health care spending is still projected to rise rapidly over coming decades, so more steps to contain costs will have to be taken (Christina D. Romer, 7/21).

Milwaukee Journal Sentinal: Want Free Health Care? Show Up At 5 A.M.
It's 5:25 a.m. on a recent Saturday and a sizable line is already forming outside Columbia St. Mary's Family Health Center for its free clinic for the uninsured. The first-come, first-serve facility doesn't open its doors until after 7 a.m., but for those waiting to be seen, it's their only option (James E. Causey, 7/21).

The Dallas Morning News: Health Exchange Would Benefit Texas
This newspaper didn't think the Affordable Care Act was the best health care overhaul for America, but for the life of us we can't figure out why Gov. Rick Perry is so rock-solid against implementing sensible parts of the legislation. ... The governor and other opponents contend the Affordable Care Act comes with too many rules governing exchanges. Here's the problem: If Texas doesn’t create its own marketplace, the feds will do it for us. Since when is that a good idea? (7/20).

Austin American Statesman: Human Services Chief: Why Medicaid Expansion Won't Work For Texas
The Texas Medicaid program paid $467 million for almost 2.5 million emergency visits in 2009, and half of those visits weren't even for emergencies. Yet federal law makes it virtually impossible for states to charge even small co-pays to discourage unnecessary emergency room use by Medicaid clients. This is just one small reason why Medicaid is broken. If we want true reform of our health care system, we should start by reducing the convoluted maze of federal regulations that often prevents states from ensuring that Medicaid makes the most of limited tax dollars (Tom Suehs, 7/21).

Miami Herald: Not So Fast, Gov. Scott
Gov. Rick Scott's oh-so-quick dismissal of the opportunity to provide healthcare to more Floridians under Medicaid, which came just one day after the Supreme Court decision upholding most of the Affordable Care Act, should not be the last word on the subject. His decision was politically inspired, and his facts have been called into question. For Floridians desperate to get basic health care the consequences could be dire. Train wreck, perfect storm, falling off the cliff — all of these phrases have been used to describe the impact of Mr. Scott's decision unless the Legislature takes a more thoughtful approach (7/22).

Arizona Republic: Brewer Attacks On Health Care Bad For All Of Us
Nearly 1.3 million Arizonans lack access to quality, affordable health care -- and Gov. Jan Brewer is quietly moving to add to that number by taking away health-care coverage from families who currently have it. Immediately before the July Fourth holiday, the Governor's Office filed a petition asking the U.S. Supreme Court to overturn an appeals-court decision allowing state employees to put domestic partners on their health benefits (Chad Griffin, 7/21).

Sacramento Bee: Is There An Rx For Coaxing Young To Buy Health Plans?
Just as Hollywood movies are judged by opening weekend box office, California's health exchange will be judged by Day One enrollment. So the state is planning aggressive pre-enrollment rollout for October 2013. More than 2.5 million uninsured adult students attend community colleges. The state should go there and focus on social networks like Facebook, Twitter, LinkedIn, Google+ and YouTube. It should connect with young people who are waiting restaurant tables, or employed at firms with part-time workers. The aim of the Affordable Care Act is to make sure that people are not priced out of coverage by life transitions. Young adults tend to be most affected by that and, thus, stand to be the biggest beneficiaries of the Affordable Care Act, if they enroll in insurance. That should reduce cost shifting and drive costs down for the rest of us, too (7/23).

iWatchNews:  A Nice Little Gift From ObamaCare Directly To You
One of the reform law’s most important provisions — the one that insurance firms and Wall Street despise most — is the one that sets the minimum allowable MLR, effective last year, at 80 percent for policies sold to individuals and small businesses. For large groups it's 85 percent. If insurers' MLRs drop below those percentages, they have to send rebate checks to their policyholders. Really.  That reckoning came last week for insurance companies that violated the law in 2011. Checks from insurance companies to individuals are now pouring into mailboxes all across the country (Wendell Potter, 7/23).

Los Angeles Times: For Palm Springs Man, Grief And Anger Over An End-Of-Life Decision
On the evening of July 2, Bill Bentinck, 87, was led from his Palm Springs home in handcuffs, in mourning and in shock. The body of his wife of 25 years, Lynda, was still in the house, but there was no time to grieve. After telling police that his terminally ill wife had chosen to disconnect her oxygen supply and put an end to her suffering from emphysema, he was arrested on suspicion of murder. Bentinck, a straight-talking man in the Jimmy Stewart mold, felt that he had made a difficult but compassionate choice in honoring his wife's last wish and not reconnecting the oxygen. But police saw it differently (Steve Lopez, 7/22).

Philadelphia Inquirer: The Family Factor In Health Care
Yet, even if they pull off a political coup by reversing the central legacy of the Obama presidency, Republicans are painting themselves into a corner if they think that "block-granting" Medicaid to the states, introducing a premium-support option for Medicare, ending tax disincentives for non-group insurance, and allowing consumers to purchase interstate health plans will, by themselves, solve the health-care "crisis." That's because the explosive growth of the health-care sector has more to do with social and demographic realities than a lack of free-market principles in health-care delivery and financing. Indeed, family breakdown all across America is the unacknowledged force fast tracking health-care expenditures (Robert W. Patterson, 7/22).

Milwaukee Journal Sentinel: Nation Must Re-Examine Mental Health System
The shooting, like others before it, will raise two issues, one of easy access to guns and another involving the nation's mental health systems. We need to be clear that the vast majority of people with mental health issues are non-violent. But, while it is too early to know Holmes' mental status, his actions symbolize the need to re-examine how we look at mental health in this country (7/20).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.