Daily Health Policy Report

Tuesday, July 24, 2012

Last updated: Tue, Jul 24

KHN Original Reporting & Guest Opinion

International AIDS Conference

Health Reform

Campaign 2012

Capitol Hill Watch

Health Care Marketplace

Coverage & Access

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Lisa Fitzpatrick: Routine Testing For HIV Needed (Video)

In this Kaiser Health News video, Lisa Fitzpatrick, the medical director of infectious diseases at United Medical Center, tells Joanne Silberner that in addition to more frequent testing, more attention needs to be paid to keeping people with HIV under the care of a doctor (7/23). Read the transcript or watch the video.

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Insuring Your Health: Forget The Company Plan – The Boss Wants You On Your Dad's Insurance

In this Kaiser Health News consumer column, Michelle Andrews writes: "Young adults who need health insurance have more options than before under the health-care overhaul, which generally allows them to stay on their parents' plans until they reach age 26. But the provision gives employers new options, too: They can encourage their young employees to join Mom and Dad's plan rather than sign up for the company policy" (Andrews, 7/23). Read the column.

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Political Cartoon: 'Personal Responsibility?'

Kaiser Health News provides a fresh take on health policy developments with "Personal Responsibility?" By Chuck Legge.


Red state or blue state... 
More affordable health plans,
Adopt exchanges!
-Austin Bordelon

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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International AIDS Conference

Conference Marked By Talk Of 'Cure,' Commitment To Greater Investment In Research

The U.S. pledged an additional $150 million for the global AIDS fight, in what Secretary of State Hillary Clinton said was a step designed to move closer to "an AIDS-free generation." 

The Washington Post: Politicians Praise AIDS Investment, But Urge More Spending And Support
Some of Washington's most powerful people delivered to the 19th International AIDS Conference pretty much the same message: Fighting AIDS is a good investment that is getting better every year, but current spending isn't enough to end the epidemic. Whether the world's richer countries, and especially the United States, will decide to increase spending or alternatively wring more from current investment is a matter of much discussion among the 25,000 researchers, clinicians and activists here through Friday (Brown and Botelho, 7/23).

Los Angeles Times: Scientists Make Curing HIV A Priority
An influential group of scientists gathered this week at the International AIDS Conference in Washington, D.C., is committing to a goal that just five years ago would have seemed ludicrous: to cure HIV. After studying the virus for more than 30 years and developing potent drugs that transformed the disease from a death sentence into a manageable chronic condition, a growing number of researchers now say the search for a cure should be a major research priority (Loury, 7/23).

CNN: Talk Of 'Cure' At Historic AIDS Conference
This week, the world's largest gathering of AIDS doctors and experts is converging on Washington for the 19th International AIDS Conference. ... There's a lot going on: research on how to prevent HIV infection, treatment as prevention and, for the first time in a long time, talk about a "cure." In fact, one of the main themes is the launch of "Towards an HIV Cure": a global scientific strategy by an international working group of 300 researchers who are developing a road map of sorts, outlining priorities for finding a cure for the disease that has claimed approximately 30 million lives worldwide (Young, 7/23).

ABC News: Big Names Call For More AIDS Funds
Researchers may be turning the corner on the AIDS epidemic -- but eliminating the disease completely will take more research and more money. Such was the message of a series of high-profile talks at the International AIDS Conference in Washington, D.C. ... But what all of these solutions have in common is that they will cost money -- and in the current fiscal climate, garnering the additional funds necessary to scale up these innovations is a challenge (Duwell, 7/24).

NPR: AIDS Returns To The U.S. Spotlight
More than 20,000 people are attending the 19th International AIDS Conference in Washington this week. The meeting features speeches from U.S. Presidents Barack Obama and Bill Clinton, Secretary of State Hillary Clinton, former first lady Laura Bush, health ministers from many countries around the world, Bill Gates, NIH scientists Anthony Fauci and Francis Collins and hundreds more (Neel, 7/23).

NPR: U.S. AIDS Cases Come Into View
The HIV epidemic in the U.S. started in 1981, mainly in major cities along the East and West Coasts. The first reports were from Los Angeles, New York and San Francisco among gay and bisexual men. Within months, it was clear that injecting drug users were also getting the virus. Even now, you can see the lingering geographic contours of how the epidemic unfolded (Neel, 7/23).

The Associated Press: US Adds $150 Million To Fight AIDS, Targets Stigma
The U.S. is adding an extra $150 million to the global AIDS fight, taking a first step toward reaching some stigmatized populations. Despite tough fiscal times, "I am here today to make it absolutely clear the U.S. is committed and will remain committed to achieving an AIDS-free generation," Secretary of State Hillary Rodham Clinton told the International AIDS Conference on Monday (Neergaard, 7/24).

The Wall Street Journal: U.S. Pledges More Funding To Fight AIDS World-Wide
Secretary of State Hillary Clinton on Monday pledged new funding from the U.S. to curb the global HIV/AIDS pandemic and said the administration has significantly accelerated the pace at which it is getting lifesaving AIDS drugs to developing countries. The initiatives are part of a priority the administration set late last year for what Mrs. Clinton calls an "AIDS-free generation"—in which HIV infections are virtually eliminated in newborns, risk of infection in adults is far lower than it is today, and treatment is readily available (McKay, 7/23).

Politico: Hillary Clinton Vows 'AIDS-Free Generation' At Conference
Clinton spoke of leveraging public-private partnerships, in addition to coordinating with The Global Fund, which receives major support from The Gates Foundation to fund its efforts against AIDS, tuberculosis and malaria. She noted that the U.S. President's Emergency Plan for AIDs Relief, known as PEPFAR, is now providing anti-retroviral treatment to almost 4.5 million people worldwide and is on pace to reach its goal of 6 million by the end of next year (Norman, 7/23).

Medpage Today: Hillary Clinton: AIDS Fight 'One We Can Win'
"We have already come so far -- too far to stop now," Clinton said during the conference's opening plenary session. Clinton defined what she means by an "AIDS-free generation" -- a phrase she pioneered late last year in a speech at the NIH -- and she underscored the Obama administration's commitment to defeating the HIV/AIDS pandemic. She also announced -- to repeated applause -- several new financial initiatives and HIV prevention goals (Smith, 7/23).

JAMA: HHS Secretary Announces New HIV/AIDS Initiatives For Patients And Clinicians
In remarks during the opening ceremony at the XIX International AIDS Conference last night, US Secretary of Health and Human Services (HHS) Kathleen Sebelius announced 4 new public-private collaborations to help people living with HIV get care for their illness and to help train clinicians to treat patients with the infection (Stephenson, 7/23).

Medpage Today: IAC: End Of AIDS Epidemic On Horizon
A single message pervaded the opening ceremony for the 19th International AIDS Conference (IAC): The end of the HIV/AIDS epidemic is in sight. "We've reached a point where the goal of an AIDS-free world -- once a far-off dream -- is now within sight," said Kathleen Sebelius, Secretary of Health and Human Services, the last in a string of speakers Sunday evening who made much the same point. But the job is not yet finished, she added (Petrochko, 7/23).

Medpage Today: Fauci: AIDS Pandemic Still With Us
The end of the AIDS pandemic? A cure for HIV? The first is possible, researchers, politicians, and activists said here at the 19th International AIDS Conference. But the second is still a distant prospect, despite renewed enthusiasm for research in that direction. How can the two ideas both be true? To unpack the issue, MedPage Today North American Correspondent Michael Smith sat down with Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, in this exclusive MedPage Today InFocus report (Smith, 7/23).

At the same time, media outlets report on news related to the science as well as the treatment and prevention of HIV/AIDS -

Kaiser Health News: Lisa Fitzpatrick: Routine Testing For HIV Needed (Video)
In this Kaiser Health News video, Lisa Fitzpatrick, the medical director of infectious diseases at United Medical Center, tells Joanne Silberner that in addition to more frequent testing, more attention needs to be paid to keeping people with HIV under the care of a doctor (7/23).

Modern Healthcare: Doc Training Part Of HHS Anti-HIV Efforts
HHS unveiled a health-professionals online training program geared toward improving the care of HIV patients as part of a broader announcement of prevention and care initiatives targeting HIV/AIDS. Through the program, physicians, nurses and other providers can earn continuing medical education credit for completing online modules that address topics such as the basics of caring for HIV-infected patients, the benefits of starting HIV treatment early, barriers to HIV care and understanding how to bridge financial barriers to care (Barr, 7/23).

The Associated Press: US Study Finds High HIV Infection In Black Gay Men
New research shows black gay men are becoming infected with the AIDS virus at higher rates than their white counterparts, sparking urgent calls to address this growing part of the epidemic. A study funded by the U.S. National Institutes of Health tracked black gay and bisexual men in six cities, and found the rate of new infections is 2.8 percent a year. That's 50 percent higher than is seen in white men who have sex with men (Neergaard, 7/24).

ABC News: HIV Infections Rising Young Gay Men In Urban Areas
Despite decades of prevention efforts, HIV continues to increase among young gay men in urban areas, and most of these men are unaware they are infected, according to new data from the Centers for Disease Control and Prevention (CDC). Researchers looked at survey data spanning 1994 to 2008 on gay, bisexual and other men who have sex with men ages 18 to 29 year old living in Baltimore, Los Angeles, Miami, New York City and San Francisco, recruited from bars and nightclubs.  The study focused on HIV prevalence as well as HIV testing (Duwell, 7/24).

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Health Reform

McDonnell Wants Better Answers To Medicaid Exchange Questions

Also in the news, the Boston Globe examines the possible impact of the Supreme Court's health law decision on state-federal relations.

CQ Healthbeat:  McDonnell Miffed At Tavenner Reply To GOP Governors "Thirty Questions" Letter
Republican Governors Association Chairman Bob McDonnell went over the head of Centers for Medicare and Medicaid Acting Administrator Marilyn Tavenner Monday to complain about her reply to his July 10 letter, which posed 30 questions about building exchanges and expanding Medicaid under the health law. … In her letter, dated July 13, Tavenner said states face no deadline for deciding whether to expand Medicaid. She added that states can get extra money for Medicaid IT costs and to build exchanges — even if they ultimately decide not to build an exchange.  She also said guidance would be issued, but did not answer such questions as when states would learn the operational details of a federal exchange, what charges they would incur for federal data provided to state exchanges, when rules will be released on multistate plans offered in exchanges, and a number of other questions (Reichard, 7/23).

Modern Healthcare: Coverage Push Could Miss Some Kids: GAO
The 2010 federal healthcare overhaul could extend health insurance coverage to about 5.3 million uncovered children but leave 1.7 million uncovered, according to the Government Accountability Office. The projections, which were released Monday by the nonpartisan investigative arm of Congress, were based on 2009 data and requested by senior Senate Democrats (Daly, 7/23).

Boston Globe: What Does The Supreme Court's Health Care Decision Mean For Federal-State Relations?
In the weeks since the Supreme Court issued a decision on the Affordable Care Act, some local health law experts have taken a longer look at the implications. And they're concerned about just how far-reaching the decision could be. … The Medicaid decision may have big ramifications, Wendy Parmet, associate dean for academic affairs at Northeastern University School of Law, said during a panel discussion last week. "It raises enormous questions about the future of state and federal relations," said Parmet, who filed briefs in support of the law on behalf of several Massachusetts organizations (Conaboy, 7/23).

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Campaign 2012

Where Does Ryan Stand On Romney's List?

NPR reports on the effect Rep. Paul Ryan, R-Wis., could have if Mitt Romney chose him as a running mate. Ryan's budget plan, which includes sweeping changes to Medicare, is one of the reasons why he may not be "the safest choice."

NPR: Budget Hawk Ryan Offers Romney Risk, Reward
Among those on Mitt Romney's list of potential running mates, Wisconsin Rep. Paul Ryan has youth and experience, he's a conservative from a swing state, and he has big ideas and the policy chops to back them up. But the chairman of the House Budget Committee would not be the safest of choices. … The budget plan he introduced in 2010, or the "road map," as he called it, ignited a major debate within Congress. … Ryan's budget was instantly controversial. It called for sweeping cuts to social programs, and, most troubling for seniors, would have changed Medicare from a guaranteed benefit to a voucher program (Seabrook, 7/24).

Meanwhile, in Minnesota, state Republicans are pushing to make federal issues such as the health law and taxes key at the state level, too.  

The Associated Press/Minneapolis Star Tribune: Minn. Republicans Criticize New Health Care Taxes
Republican lawmakers facing a critical legislative election season focused on taxes in the federal health care overhaul Monday as they attempt to bring a nationally charged issue — and the T-word — into state races. The GOP-led House Taxes Committee hearing featured U.S. Rep. Erik Paulsen as a star witness, with questions from Republican U.S. Senate candidate Kurt Bills, a state representative who serves on the panel. Bills is the underdog challenging Democratic Sen. Amy Klobuchar in a race widely considered to favor the incumbent. Paulsen recapped his effort to repeal a 2.3 percent excise tax on the medical device industry last month, saying the pending tax is already leading to layoffs as companies anticipate its Jan. 1 effective date (Lohn, 7/23).

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Capitol Hill Watch

Burgess To Offer Legislation To Fund High-Risk Pools, Reinsurance Programs

Rep. Michael Burgess, R-Texas, plans to offer the bill before the August recess. Meanwhile, after fighting back a tea-party primary challenge, Sen. Orrin Hatch, R-Utah, hopes to emerge as a dealmaker on tax and budget issues.

CQ Healthbeat:  Burgess To Offer Replacement Bill Before August Recess That Would Fund Risk Pools
Rep. Michael C. Burgess said Monday he'll introduce legislation before the August recess that would provide about $25 billion for existing state high-risk pools and reinsurance programs.  The risk pools and re-insurance programs are intended to provide coverage to people denied health insurance because of pre-existing medical conditions.  Burgess detailed his plans for the legislation in a short interview following a forum sponsored by the Congressional Health Care Caucus, an organization he leads to showcase GOP positions on health policy (Reichard, 7/23). 

The Associated Press: His Tea Party Threat Defused, One-Time Kennedy Partner Hatch Wants To Be Dealmaker On Taxes
The type of real, red-faced debate that delighted Hatch and Kennedy also produced landmark laws like the American Disabilities Act and children's health insurance. With former Democratic Sen. Chris Dodd, the bellowing begat federally subsidized child care. Tense talks with no less a partisan than Rep. Henry Waxman, D-Calif., produced a patent exemption that cleared the way for the generic drug industry (Kellman, 7/23).

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Health Care Marketplace

Study: One In 10 Employers Will Drop Health Coverage In The Next Few Years

The report by the consulting company Deloitte, which is to be released Tuesday, predicts the decline in work-based plans as much of the health law kicks in. Meanwhile, two Massachusetts insurers see opportunities to expand their out-of-state business. 

The Wall Street Journal: Deloitte: One In 10 U.S. Employers To Drop Health Coverage 
Around one in 10 employers in the U.S. plans to drop health coverage for workers in the next few years as the bulk of the federal health-care law begins, and more indicated they may do so over time, according to a study to be released Tuesday by consulting company Deloitte (Radnofsky, 7/24).

Boston Globe: Two Insurers See New Markets Beyond Mass.
While the political squabble over the federal health care law continues, two Massachusetts health insurers see an opportunity to expand their out-of-state businesses and pick up thousands of new customers who must have coverage or face penalties. Tufts Health Plan and Harvard Pilgrim Health Care, which already operate in some nearby states, are strategizing on how they can boost their market share outside Massachusetts as about 30 million Americans who do not have insurance buy subsidized private coverage or become eligible for Medicaid under the law upheld by the Supreme Court last month (Weisman, 7/24).

In related news -

The Associated Press/Washington Post: Health Insurer WellPoint Reports On 2nd Quarter Performance Thursday
WellPoint Inc., the nation's second-largest health insurer, will report second-quarter results on Wednesday, nearly a week after competitor UnitedHealth Group Inc. saw its stock price slip despite posting a 5 percent increase in quarterly profit (7/23).

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Moody's: Nonprofit Hospitals Continue To Face Economic, Budget Challenges

According to Moody's Investors Service, there were more downgrades than upgrades among nonprofit hospitals, an indicator driven by the slow economic recovery, growing stress on state budgets and the mounting federal deficit.

Reuters: Economy, Budget Woes Threaten Non-Profit Hospitals: Moody's
The number of rating downgrades for non-profit hospitals outpaced upgrades in the first quarter of 2012, Moody's Investors Service said on Monday, adding it remains cautious about the effects of a slow economic recovery, federal deficit cutting measures and state budget pressures on the sector (Lambert and Trokie, 7/23).

Modern Healthcare: Credit Downgrades Outnumber Upgrades: Moody's
As the operating environment continued to challenge not-for-profit providers, Moody's Investors Service last quarter downgraded 32% more hospital debt than it upgraded. … "The increased proportion of downgrades were driven by the continued slow economic recovery, increasing pressure on state budgets, and a large and growing federal deficit," said Carrie Sheffield, author of the Moody's report, in the release. "The deficit problem may lead to reductions in Medicare and Medicaid, which translate into weak volumes and revenue declines for hospitals" (Kutscher, 7/23).

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Coverage & Access

VA Disability Claims Continue To Pour In

Despite efforts by the Obama administration to direct additional resources to help meet the disability benefits and treatment needs of veterans, the problems continue to grow.  

The Associated Press: Fact Check: Disability Claims Still Growing At VA
President Barack Obama paints an encouraging picture of the additional resources his administration has poured into helping veterans get disability benefits and mental health treatment. But he glosses over just how much those problems have grown during his time in office (Freking, 7/24).

In related news --

St. Louis Beacon:  Mental-Health Workers Answer Call To Provide Free Services To Vets And Families
St. Louis therapist Charli Prather believes she has found a meaningful way to serve her country: She's signed up with the national nonprofit Give An Hour, a network of mental-health professionals who offer confidential services, free of charge, to veterans, current members of the U.S. military and their loved ones (Leonard, 7/23).

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State Watch

States Wonder Just How Big An Impact Health Law Dollars Will Have

An analysis in Minnesota expects the state to receive only about $42 million in increased state revenue between fiscal years 2010 and 2015 from the health law. Meanwhile, budget cuts -- even with the increase in coverage from the health law -- have some Pennsylvanians worried that the mental health coverage gap could persist.

MinnPost: Early Analysis Shows Limited Minnesota Revenue Impact From Health Care Law
On Monday, the state House Taxes Committee reviewed how the Affordable Care Act could alter the state's revenue projections. … It turns out the law won't do much at the state level. According to staff analysis, the tax hikes in the ACA will amount to about $42 million in increased state revenue between fiscal year 2010 and fiscal year 2015 (Nord, 7/23).

Philadelphia Inquirer: Affordable Care Act Will Expand Mental Health Coverage, But Budget Cuts A Worry
Mentally ill people will have a much easier time accessing care two years from now, thanks to the new federal health care law. But advocates worry that current budget cuts may create a shortage of the very mental health services the newly insured will want to use. In 2008, 67,560 uninsured people in Pennsylvania did not get mental health care because they could not afford the services, according to the Pennsylvania Insurance Department. That number should drop dramatically by 2014, when the Affordable Care Act (ACA) requires all American citizens to have health coverage that will include mental health services (Gaestel, 7/23).

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Ariz., Mo. Officials Grapple With How To Tackle Abortion Restrictions, Coverage

In Arizona, local officials are split on whether to enforce a new law restricting abortion, while Missouri lawmakers prepare for a veto override vote on allowing employers there to exclude abortion and contraception from health insurance they offer.

The Wall Street Journal's Law Blog: Challenge To Arizona Abortion Law Finds Prosecutors Taking Opposite Sides
A recent set of Arizona laws restricting abortion has gotten the kinds of responses you'd expect from various groups -- Planned Parenthood filed a lawsuit last Monday -- but also has state prosecutors taking opposite positions on whether enforcement should be delayed (Favate, 7/23).

St. Louis Beacon: Campaign Trail: Electoral Pressures Could Prompt Override Veto Of Contraception Bill
On Sept. 12, lawmakers will convene for their veto session. The annual event is typically ceremonial in nature, with plenty of farewells to departing legislators. But this year, lawmakers will try to overturn Gov. Jay Nixon's veto of a bill allowing employers to exclude abortion, contraception or sterilization from insurance coverage. At first glance, the prospects may seem dim because the bill fell four votes short of obtaining a veto-proof majority in the House. But a quick look at the roll call for the bill shows the votes could be there if it's put up for an override (Rosenbaum, 7/23).

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State Roundup: Minn. Seeks Its Own Indepedent Medicaid Audit

A selection of health policy stories from Minnesota, Wisconsin, Missouri and California.

(St. Paul) Pioneer Press: Minnesota Medicaid Program: Independent Audit Sought; Federal Probes Under Way
The Minnesota Department of Human Services is commissioning an independent audit to respond to lingering questions about the state Medicaid program's past practices in paying private HMOs. The Medicaid rate-setting process also is the subject of several federal investigations. Questions have swirled at the state Capitol this year about whether Minnesota officials have been manipulating the rate certification process in Medicaid to wrongly gain excess federal funds (Snowbeck, 7/23).

Milwaukee Journal Sentinel: Federal Government Renews State's Family Care Program
The federal government has renewed a joint program with Wisconsin providing long-term care for the elderly and disabled, but also found that Wisconsin violated the terms of the Family Care program last year.The decision by President Barack Obama's administration means that the Family Care program can continue to provide services to needy residents in the state that allow them to live outside a nursing home. But Gov. Scott Walker's administration will also have to reimburse anyone who was harmed by an enrollment cap placed on the program by the Republican governor and lawmakers last year and lifted by them this spring (Stein, 7/23).

St. Louis Beacon: Missouri's Newest Managed-Care Contractor Develops Partnership With Health Centers
Shannon Bagley has a passion for crunching numbers and for seeking good care for the medically needy. … She is combining her knowledge of health-care economics and medical services in her job as president and CEO of Home State Health Plan. A subsidiary of Centene Corp., Home State was one of three companies that won contracts to handle managed care for Mo HealthNet, the state's Medicaid program. The managed-care component serves about 410,000 people. … She says Home State's approach stands out partly because of its ground-breaking partnership with the Missouri Primary Care Association and a dozen MPCA member community health centers across Missouri (Joiner, 7/24).

The Associated Press: Calif. County To Vote On Medication Disposal Bill
A proposed ordinance that would put the pharmaceutical industry on the hook for not only making drugs, but also getting rid of them, is scheduled to be taken up by California's Alameda County on Tuesday. The Alameda County Board of Supervisors plans to vote on an ordinance that would require drug makers to pay for programs to dispose of expired and unused drugs. Government and industry officials said the ordinance would be the first of its kind nationwide (Nirappil, 7/24).

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Editorials and Opinions

Views On AIDS: The Benefits Of Male Circumcision; A More Optimistic Battle; The Need To Focus On High-Impact Prevention Strategies

A selection of editorials and op-eds from around the country that focus on the campaign to eradicate HIV.

Los Angeles Times: HIV Prevention Done Right
This week, tens of thousands of delegates are meeting in Washington for the biennial International AIDS Conference, striving to advance an agenda for an AIDS-free generation. Achieving such an ambitious goal will require multiple strategies, but virtually all agree that male circumcision — which provides powerful protection against HIV infection as well as other health benefits for men and women — must be a core element. Yet although some prevention efforts in Africa have been successful, others have floundered (Daniel Halperin, 7/24).

San Francisco Chronicle: Put Women's Health In Women's Hands
At this week's International AIDS Conference, activists and leaders will debate "what's next" in the battle against HIV/AIDS. They should consider Alicia, a young woman in Alameda County, where AIDS is now the leading cause of death among African American females age 20 to 40. Alicia's boyfriend doesn't like wearing condoms, so they don't always use them. She doesn't want to get pregnant, but even if she goes on the pill, she'll remain at risk for HIV and other sexually transmitted infections. Her health, even her life, will be jeopardy. The need for HIV prevention and contraception go hand in hand for many women (Bethany Young Holt and Mary A. Pittman, 7/23).

The Hill: Is HIV/AIDS Funding Insufficient?
That is a billion dollar question when we face other competing priorities like heart diseases, diabetes, maternal health, and cancer. The political leaders are talking about an AIDS-free generation. Whether this is possible or not is another debate, but it is a laudable goal. It is possible to have 15 million AIDS patients on treatment by 2015, thus ensuring close to universal access to treatment we dream of. There is also huge cry for more funds. The International AIDS Conference in July 2012 will debate this and other issues. However, serious rethinking must be done and each donor must ask, Is funding for HIV/AIDS sufficient? I think it is. Here is why (Taifiqur Rahman, 7/23).

Journal of the American Medical Association: Toward An AIDS-Free Generation
Since the first cases of what is now known as AIDS were reported in 1981, an entire generation has grown up under the constant cloud of this modern-day plague. Across the globe, more than 34 million people are living with the human immunodeficiency virus (HIV), the virus that causes AIDS, including approximately 1.2 million individuals in the United States. HIV/AIDS has been responsible for the deaths of an estimated 30 million individuals. Although the rate of new HIV infections has declined or stabilized in many countries, the disease continues to exact an enormous toll. ... Despite these daunting statistics, the fight against HIV/AIDS is currently viewed with considerably more optimism than in years past because powerful interventions have been developed, scientifically proven effective, and refined (Dr. Anthony S. Fauci and Gregory K. Folkers, 7/22).

Journal of the American Medical Association: The Future Of HIV Prevention In The United States
In the United States, 1.1 million people live with human immunodeficiency virus (HIV), a 60% increase from 15 years ago. The increasing number of people who can potentially transmit HIV makes prevention more difficult. Yet federal domestic HIV prevention funding, after adjustment for inflation, has not increased since 1991, necessitating a different approach to HIV prevention (Dr. Jonathan Mermin and Dr. Kevin A. Fenton, 7/22).

Journal of the American Medical Association: Forever Young
Terri understood that taking her medications would improve her immune system and keep her healthy. But like many of them, she still apparently would not take the medicines daily. Perhaps this one action provided a sense of control over her life, a life that was filled with many things that happened beyond her control. For many people in both the United States and abroad, HIV has become a well-controlled chronic disease, but for Terri and other perinatally infected young people, HIV is still capable of claiming lives (Dr. Alia Chisty, 7/22).  

Journal of the American Medical Association: HIV Infection Among Persons Born Outside The United States
Even though HIV poses no risk of casual transmission, the United States has had a very restrictive policy toward entry of persons with HIV. In 1987, the United States prohibited entry of HIV-infected travelers or legal residents. In 1991, the ban was lifted for travelers but remained in place until 2010 for those wishing to reside in the United States. During this time, the United States did not ban persons with latent tuberculosis infection or evidence of hepatitis B infection from traveling or immigrating to the United States, and reentry testing was not required for US travelers who returned home after having visited high-prevalence HIV areas. The ban on entry of HIV-infected persons to the United States was not consistent with public health principles and may have had negative public health consequences (Dr. Mitchell H. Katz, 7/22).

Journal of the American Medical Association: Aging And HIV-Related Cognitive Loss
Although antiretroviral therapy has had a major effect on improving the survival of individuals with human immunodeficiency virus (HIV), cognitive disorders related to HIV remain an important burden of disease and disability worldwide (Dr. Farrah J. Mateen and Edward J. Mills, 7/22).

Journal of the American Medical Association: HIV/AIDS In 1990 And 2012: From San Francisco To Washington, DC
During the last 2 decades, scientists, public health officials, and AIDS activists have not always agreed, but they have often listened to one another and worked toward common goals (Dr. Robert Steinbrook, 7/22). 

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Viewpoints: Aurora Shootings Show Need For More Aggressive Psych Treatment; Venture Capitalist Says Health Exchanges Can Curb Costs

A selection of editorials and opinions on health care from around the country.

The New York Times: More Treatment Programs
Looking at guns, looking at video games — that's starting from the wrong perspective. People who commit spree killings are usually suffering from severe mental disorders. The response, and the way to prevent future episodes, has to start with psychiatry, too. The best way to prevent killing sprees is with relationships — when one person notices that a relative or neighbor is going off the rails and gets that person treatment before the barbarism takes control. But there also has to be a more aggressive system of treatment options, especially for men in their 20s. The truly disturbed have always been with us, but their outbursts are now taking more malevolent forms (David Brooks, 7/23).

Politico: Exchanges Can Slow Growth Of Health Care Costs
Texas Gov. Rick Perry has pledged he won't create a state health insurance exchange or implement the optional Medicaid expansion — both components of the recently upheld Affordable Care Act. So far, only 16 states have begun creating insurance exchanges. Eighteen are considering it, four have pledged not to and 13 have yet to announce their intentions. This is a shame, because health insurance exchanges are a great idea. As a venture capitalist focused on health care information technology, I'm always looking for ways to create efficiencies and cut costs in our health system — and exchanges are a promising way to do this (David Jones, 7/23).

Richmond Times-Dispatch: Medicaid: High Stakes In Health Coverage Question
Expanding Medicaid eligibility should be an easy decision, given the generous federal funding promised in the ACA — 100 percent federally funded until 2019 and 90 percent thereafter. States are legitimately concerned about the cost of increased enrollment from people currently eligible but not enrolled in Medicaid, for which the federal match of 50 to 70 percent is significantly less generous. But an increase in enrollment of the currently eligible population has more to do with the coverage mandate — the requirement for streamlined access to health insurance Exchanges and the creation of state-based counselors to assist the uninsured — than the expansion of eligibility (G. Lawrence Atkins and Renee M. Landers, 7/24).

Archives of Internal Medicine: Addressing the Growth in Intensive Care  
(W)e should stop adding ICU beds to the current system. Although the burden of critical illness is on the rise, adding more ICU beds will increase costs and is unlikely to improve the overall health of the nation. Given the large variation in ICU bed use in US hospitals, it is possible that if all hospitals learn to operate like the ones that admit a smaller proportion of patients, we can reduce wasteful use without negatively affecting health (Dr. Christopher W. Seymour and Dr. Jeremy M. Kahn, 7/24).


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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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