Daily Health Policy Report

Wednesday, July 24, 2013

Last updated: Wed, Jul 24

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Women's Health

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Deciphering The Health Law's Subsidies For Premiums

Kaiser Health News staff writer Julie Appleby talks with Cathy Livingston, a partner with Jones Day in Washington, D.C., who specializes in tax issues involving the federal health law, about how to find out if you’re eligible for a premium subsidy and how the process will work (Appleby, 7/24). Read the interview.

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Florida Providers Jump On ACO Bandwagon

The Miami Herald's Daniel Chang, reporting as part of a partnership between Kaiser Health News and the Herald, writes: "In concept, the coordinated medical care that Rivera receives is nothing new, containing some of the familiar components of traditional health maintenance organizations, such as reducing unneeded medical procedures and careful selection of providers who will work for pre-negotiated rates. But Rivera’s doctor belongs to a group that has applied to become an accountable care organization or ACO — a creation of the Affordable Care Act that policy makers say will improve the quality of medical care and lower costs by financially rewarding providers who can demonstrate that they keep their patients healthy at less expense" (Chang, 7/24). Read the story.

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Capsules: Study: Doctors Look To Others To Curb Health Costs; State Budget Officials In Alaska For Annual Gathering

Now on Kaiser Health News' blog, Alvin Tran reports on a new study about how physicians view efforts to curb health costs: "When it comes to controlling the country’s health care costs, doctors point their fingers at lawyers, insurance companies, drug makers and hospitals. But well over half acknowledge they have at least some responsibility as stewards of health care resources" (Tran, 7/23).

Also on Capsules, Phil Galewitz reports on the state budget officials' Alaska meeting: "The National Association of State Budget Officers (NASBO) – representing the state officials who count the pennies and balance the accounts — is having its annual meeting this week in Anchorage. The implementation of federal health law known as Obamacare is a big item on the agenda, including a discussion about states’ costs to expand Medicaid and to shift the program to managed care. Budget chiefs from Maryland and Florida, two states moving in opposite directions on the law, will talk about Medicaid expansion" (Galewitz, 7/23). Check out what else is on the blog.

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Political Cartoon: 'Pachyderm Pedestal?'

Kaiser Health News provides a fresh take on health policy developments with "Pachyderm Pedestal?" by Pat Bagley.

Meanwhile, here is today's health policy haiku:


Increasing health costs?
Not my fault, say some doctors.
Who then? The lawyers!

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

Fierce Battle Shaping Up Over Health Law's Rollout

The White House believes a successful rollout of the health law will help determine President Barack Obama's legacy, while Republicans appear equally intent on reaping political benefits by gutting this and other administration priorities.

The New York Times: Legacy On Line In Fierce Drive On Health Law
The message is clear. Few things are more important to the White House this year than a successful health care rollout on Oct. 1, when millions of uninsured Americans will be required to obtain private health coverage in government-run marketplaces. Getting it right — or wrong — will help determine Mr. Obama's place in history (Shear, 7/23).

The New York Times: House G.O.P. Sets New Offensive On Obama Goals
Congressional Republicans are moving to gut many of President Obama's top priorities with the sharpest spending cuts in a generation and a new push to hold government financing hostage unless the president's signature health care law is stripped of money this fall (Weisman, 7/23).

Politico: GOP Gauges Obamacare Views In Swing Districts
Republicans are eyeing congressional swing districts President Barack Obama narrowly won last year for signs that the unpopularity of Obamacare could help them unseat House Democrats in 2014. Polls conducted by the National Republican Congressional Committee and released to POLITICO show that nearly half of voters in two swing districts Obama carried in 2012 — Minnesota's 8th and New Hampshire's 1st — expect the Affordable Care Act to diminish the quality of their health care (Cunningham, 7/24).

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Michelle Obama Seeks Latino Activists' Assistance With Insurance Enrollment

Speaking Tuesday to the National Council of La Raza, the first lady urged the organization's members to encourage their friends and families to enroll in new coverage options.

The Associated Press: First Lady Asks For Latinos' Help On Health Care
Michelle Obama urged Latino activists on Tuesday to help sign people up for her husband's health care overhaul, especially the millions of younger, healthier people the system will need to offset the cost of caring for older, sicker consumers. The first lady said that, starting July 31, consumers can create an account at www.healthcare.gov, or www.cuidadodesalud.gov, its Spanish-language equivalent, so they can get ready to sign up for health insurance in the fall, starting on Oct. 1 (Plaisance, 7/23).

The Hill: First Lady Presses For ObamaCare Enrollment In Address To La Raza
First lady Michelle Obama touted the Affordable Care Act in a speech Tuesday to the National Council of La Raza, urging members to encourage their friends and family to enroll in the health law's new coverage options. ... Outreach to Latinos is a key part of the White House's enrollment drive for ObamaCare. A large proportion of uninsured young men — the population the administration most wants to reach — are Hispanic (Baker, 7/23).

CQ HealthBeat: Administration And Its Allies Turn To Spanish Media To Market Health Law
Perhaps the most overlooked beneficiary of President Barack Obama's health care law is the Spanish language channel Univision. Univision Communications Inc. and other Spanish-speaking media outlets are at the center of a multi-million-dollar effort to explain the overhaul to Latinos, who are critical to the law's success because one of every three uninsured people in the United States is Hispanic (Adams, 7/23).

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Detailing How Health Law Premium Subsidies Will Work

Kaiser Health News asked a tax expert to explain who will be eligible for this assistance and how the process will work. Meanwhile, The Washington Post examines how the overhaul is linked to work-hour caps for part-timers.

Kaiser Health News: Deciphering The Health Law's Subsidies For Premiums
Kaiser Health News staff writer Julie Appleby talks with Cathy Livingston, a partner with Jones Day in Washington, D.C., who specializes in tax issues involving the federal health law, about how to find out if you’re eligible for a premium subsidy and how the process will work (Appleby, 7/24). 

The Washington Post: Health-Care Law Is Tied To New Caps On Work Hours For Part-Timers
This month, the Obama administration delayed the employer insurance requirement until January 2015. But Virginia, like some other employers around the country that capped part-timers’ hours in anticipation of the initial deadline, has no plans to abandon its new 29-hour-a-week limit (Somashekhar, 7/23).

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Some States Plan Aggressive Marketing Of Health Exchanges

News outlets report on state implementation activities, including efforts by California and Oregon to promote new health insurance marketplaces, presentations made to New Hampshire's special commission weighing whether to expand Medicaid and a closed door meeting by Idaho exchange officials.

Sacramento Bee: California, Other States Prepare To Promote Health Insurance
Barns, crab-fishing boats and beach bonfires create the backdrop for Portland-based musician Matt Sheehy's performance of the Oregon health care exchange anthem, "Long Live Oregonians," in a recent ad. "We're free to be healthy / gonna breathe our fresh air / want to get the best care / that a state can get," Sheehy croons in the Cover Oregon spot that debuted in early July. With just a few months until state health care exchanges open to enrollment Oct. 1, Oregon and other states have begun elaborate marketing campaigns to promote their insurance marketplaces to consumers (Mantz, 7/24).

The Associated Press/Washington Post: Virginia Near Bottom In Per Capita Spending To Promote Awareness Of Health Care Law
Only one state will spend less per capita than Virginia to promote public awareness of the new health care reform law. According to data compiled by The Associated Press from federal and state sources, the $3.9 million in outreach spending in Virginia amounts to 49 cents per resident. Only Wisconsin, at 46 cents, is spending less per capita (7/24).

The Associated Press: NH Officials: Expanding Medicaid Could Save $46M
New Hampshire health officials outlined Tuesday how the state could expand Medicaid to cover 49,000 more poor adults and still save $46 million over the next seven years. Department of Health and Human Services officials presented the details to a special commission weighing whether to recommend that lawmakers expand the Medicaid program under the federal health care overhaul law (Love, 7/23).

The Associated Press: Insurance Exchange Plans Extended Closed Meeting
The board overseeing Idaho's health insurance exchange plans a 3-hour, 40-minute meeting behind a downtown Boise law office's closed doors where citizens will be barred Thursday — nearly twice as long as a public meeting scheduled later that day (Miller, 7/23).

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ACOs Trigger Activity By Consumers, Providers

As Reuters reports, consumers will actively have to seek out providers who are participating in this new delivery system model, and the Miami Herald checks in on how the idea is working in Florida.

Reuters: Better Healthcare For Less Money, If You Can Find It
Consumers intrigued by the new model of accountable healthcare - which promises better-coordinated care that could save lots of money - are going to have to actively seek out participating providers. A tenet of accountable care is better quality: doctors are paid to keep patients healthy, rather than for treating them when they are sick (Pinsker, 7/23).

Miami Herald: Florida Providers Jump On ACO Bandwagon
In concept, the coordinated medical care that Rivera receives is nothing new, containing some of the familiar components of traditional health maintenance organizations, such as reducing unneeded medical procedures and careful selection of providers who will work for pre-negotiated rates. But Rivera’s doctor belongs to a group that has applied to become an accountable care organization or ACO — a creation of the Affordable Care Act that policy makers say will improve the quality of medical care and lower costs by financially rewarding providers who can demonstrate that they keep their patients healthy at less expense (Chang, 7/24). 

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Capitol Hill Watch

Bipartisan Proposal Would Change The Way U.S. Values Medical Procedures

Some members of Congress believe it is time to "redo the RUC" and strengthen oversight of the American Medical Association committee that helps to set payment levels.  

The Washington Post: Bill Aims To Reshape Medical Pricing
A bipartisan group of legislators has drafted a bill that would reshape the way the nation pays doctors, responding to criticism that the nation's current method of valuing medical procedures misprices payments. The pricing system, which is used by Medicare and most private insurers, depends upon assessments made by the American Medical Association, the chief lobbying group for physicians. In confidential meetings held every year, the AMA assigns values to thousands of services doctors provide (Whoriskey, 7/23).

CQ HealthBeat: Redo The RUC? McDermott Says Yes, But Will Other Lawmakers?
The top Democrat on the House Ways and Means Health Subcommittee is hoping to parlay fresh attention to the issue of big Medicare payments for such procedures as colonoscopies into support for legislation that would strengthen oversight of an American Medical Association panel that helps set payment levels (Reichard, 7/23).

Medicare physician payment legislation also draws attention -

Medpage Today: SGR Repeal Bill Gains Broad Support
Physician groups voiced general support for a bill approved Tuesday by a Congressional subcommittee to replace Medicare's sustainable growth rate (SGR) formula. Medical societies agreed that the bill approved by the House Energy and Commerce Health Subcommittee strikes a good balance among the physician community's many interests and is a fair transition away from today's fee-for-service Medicare reimbursement system. However, nearly all also agree the bill is not perfect and more work is needed before a final product is signed into law. They point to the proposal's quality-reporting measures as an example (Pittman, 7/23).

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Health Care Marketplace

Study: Docs Place 'Major Responsibility' For Health Care Costs On Others

In a survey of doctors by Mayo Clinic researchers, most respondents pointed to lawyers, health insurers, hospitals, drug companies and patients as having a large stake in cutting costs.

Los Angeles Times: Are Doctors Passing The Buck On Health Care Costs?
Mayo Clinic researcher Dr. Jon C. Tilburt and colleagues polled 2,556 doctors on health care costs in 2012, asking them to gauge their level of responsibility for controlling costs -- as well as others' responsibility. More than half of respondents said that trial lawyers, health insurance companies, hospitals and health systems, pharmaceutical and device manufacturers and patients had a major responsibility for cutting costs. But only 36 percent said that physicians themselves had major responsibility (Brown, 7/23).

Kaiser Health News: Capsules: Study: Doctors Look To Others To Curb Health Costs
When it comes to controlling the country's health care costs, doctors point their fingers at lawyers, insurance companies, drug makers and hospitals. But well over half acknowledge they have at least some responsibility as stewards of health care resources (Tran, 7/23).

Medpage Today: Docs Point To Others To Cut Health Costs
Respondents said trial lawyers (60 percent), health insurance companies (59 percent), hospitals and health systems (56 percent), pharmaceutical and device manufacturers (56 percent), and patients (52 percent) have a "major responsibility" for reducing health care costs. ... Only employers (19 percent) and physician professional societies (27 percent) bear less responsibility than individual physicians, the survey found (Pittman, 7/23).

Also in the news --

The Fiscal Times: Why Medical Spending May Finally Flatten Out
As you may have heard, health care spending has taken a somewhat encouraging turn over the last few years. A combination of a recession "hangover," implementation of the Affordable Care Act Medicare payment reforms and patients spending less out of pocket have kept prices in check. Both Medicaid and Medicare, for example, spent 5 percent less last year than their 2010 projections. The question perplexing health care economists at the moment is whether medical spending will continue to moderate or once again start to outpace inflation. Although lower spending for the public programs is a good short-term trend, it's uncertain if the 3 percent annual health-spending growth rate from 2009 through 2011 will continue (Wasik, 7/24).

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Women's Health

State Abortion Clinic Restrictions Could Impact Women's Health Care Access

Stateline reports that abortion opponents are advancing new clinic standards that may be impossible to meet. Abortion rights supporters fear these rules could force many clinics to close, making it more difficult for some women to get a broad array of health care services.

Stateline: New Laws Turn Focus To Women's Health Care Access
New state restrictions on clinics that provide abortions could leave millions of women—many of them poor and uninsured—without easy access to cancer screenings and other basic health care services. In recent years, abortion opponents have tried to limit abortions by barring them after a certain number of weeks and by requiring women who want to end their pregnancies to have ultrasounds. Those strategies target abortion directly. Now abortion opponents in some states are pushing for new standards for clinics, such as requiring doctors to have admitting privileges at a nearby hospital, that may be difficult or impossible for them to meet. Abortion rights supporters fear the new rules could force many clinics to close—a result that would make it more difficult for women to get a broad array of health care services, not just abortions (Grovum, 7/24).

And in the news about Plan B -

Boston Globe: Plan B One-Step Gets Exclusive Rights
The US Food and Drug Administration decided late Monday night to grant exclusive rights to Teva Pharmaceuticals to put its brand name form of emergency contraception on drugstore shelves without any age restrictions for the next three years. Plan B One-Step, Teva’s product, has started to appear in some drugstores this week on shelves next to spermicides and pregnancy tests. It has new packaging saying it can safely be taken by women and girls of all ages to prevent pregnancy within three days of unprotected sex. The FDA will allow generic manufacturers of the one-pill form of emergency contraception -- which contains high doses of the female hormone progestin -- to place their products directly on drugstore shelves (Kotz, 7/23).

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State Watch

State Highlights: Medicaid Pilot Project Costs $32B More Than Expected

A selection of health policy stories from the District of Columbia, New York, Georgia, Minnesota, Illinois, North Carolina, Colorado and California.

Modern Healthcare: Reform Update: Medicaid Pilot Projects Cost $32 Billion More Than Expected, GAO Says
HHS has allowed states to spend billions more on Medicaid pilot projects in recent years than the agency's own rules allow, and the problem may grow in the future, according to a new federal audit. States regularly apply for approval of so-called demonstration projects that provide Medicaid coverage or services to populations beyond those required by federal rules (Daly, 7/23).

The Washington Post: D.C. Officials Agree To Plan To Settle D.C. Chartered Finances
District officials have agreed to pay $48 million to settle the accounts of D.C. Chartered Health Plan, the once-prominent Medicaid contractor that unraveled over the past year amid financial stress and allegations of its owner's involvement in political corruption (DeBonis, 7/23).

The New York Times: Ending Long Battle, Cuomo Agrees To Plan To House Mentally Ill
The administration of Gov. Andrew M. Cuomo agreed on Tuesday to give 4,000 mentally ill people who have been kept in institutional homes in New York City the opportunity to move into their own subsidized apartments, settling a contentious legal battle over the care for such patients that dragged on for a decade (Secret, 7/23).

Modern Healthcare: New Ga. Alliance Joins Wave Of Providers Seeking Common Benefits And Independence
The goals of population health management may be encouraging rampant consolidation across the health care industry, but some systems are pushing back and seeing whether they can achieve the same results with looser arrangements. Over the past two weeks, in markets 900 miles apart, two new non-equity alliances have been formed to pool resources, coordinate information and gain population health management expertise (Kutscher, 7/23).

Georgia Health News: Hospital Alliance Emerges In Middle, South Georgia
More than 20 hospitals in Middle and South Georgia, including nonprofit systems in Macon, Columbus, Valdosta and Tifton, have formed an alliance that aims to reduce costs, coordinate clinical information and improve the health of area residents. The alliance, called Stratus Healthcare, also includes about 1,500 physicians, along with 23 hospitals. It bills itself as the largest hospital alliance in the Southeast (Miller, 7/23).

MPR News: Psychiatric Emergency Room A 'Bottleneck' For Mental Health Care
One of the busiest entry points into Minnesota's mental health system is the psychiatric emergency room. Sometimes they walk in off the street or are brought in by police or EMS. Nearly always they are in need of treatment for mental illness. On a relatively serene Monday morning, MPR's Tom Crann spoke with Hennepin County Medical Center psychiatrist Dr. Kathleen Heaney, who described what it's like in a psychiatric emergency room that is an important place for mental health services, one that is often over burdened (Crann, 7/23).

MPR News: Bone Marrow Donor Campaign Targets College Students
Every year, thousand people with blood cancers fail to receive the bone marrow transplants they desperately need to survive. The shortage of bone marrow donors is so acute that last year only about half of the 12,000 patients requesting a donor received one. A key problem is that doctors find it hard to convince younger people -- whose blood cells are better able to fight cancer -- to join the registry of donors. With that in mind, nearly two dozen college students from across the nation came to Minneapolis this week to learn new strategies that could help persuade people their age to become bone marrow donors (Benson, 7/24).

Chicago Sun-Times: Condell Medical Plays Its Part In Charitable Care
Advocate Condell Medical Center played an integral role in Advocate Health Care's $614 million contribution in charitable care and services during 2012. The total is an increase of $43 million over the previous year (7/23).

North Carolina Health News: Hospitals Lose Clout, And With It, Dollars
In many areas of North Carolina, the local hospital is one of the biggest employers in town. And for years, hospitals have leveraged that local power into statewide political clout. But not this year. Lawmakers have made a series of moves during this legislative session that will force a trimming of hospital budgets across the state, as the once powerful hospital lobby has found itself increasingly in the crosshairs of budget writers (Hoban, 7/24).

The Denver Post: Colorado's Rural Health Services Bleeding Money In New, Old Ways
The hospital in Rangely is threatening to cut off ambulance service to the western half of a remote neighboring county. … A new round of crises and challenges in rural Colorado medicine has health experts and public officials on alert, scrambling to shore up services in far-flung areas (Booth, 7/24).

Health Policy Solutions (a Colo. news service): In Abrupt Reversal, Anthem Covers Transgender Care
One of Colorado's largest health insurance companies has reversed itself and is now covering care for transgender patients. Kelly Costello, 32, of Denver, received stunning news last week. One day after getting a formal notice that Anthem Blue Cross and Blue Shield of Colorado would not cover chest reconstruction surgery, the company abruptly overturned its decision. … In March, Colorado's Division of Insurance issued a bulletin barring health insurance companies from discriminating against people who are gay, lesbian, bisexual or transgender (Kerwin McCrimmon, 7/24).

California Healthline: Medi-Cal Children Having Trouble Getting Dental Care Services, Survey Says
California children aren't getting the dental care they need through Medi-Cal, according to a survey released yesterday by The Children's Partnership. By the end of this year, the survey pointed out, about five million children -- more than half of the state's kids -- will be Medi-Cal children. And those youngsters are having difficulty accessing dental care in California, the survey said. It also found one particularly troubling trend in access, according to Jenny Kattlove, director of strategic health initiatives for The Children's Partnership. The state posts a registry of those dentists in California who are accepting new Medi-Cal patients -- but 10% of those providers aren't actually taking on Medi-Cal children, Kattlove said (Gorn, 7/23).

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Editorials and Opinions

Viewpoints: Indian Health Service Takes Big Cuts; Labor 'Mutiny' Over Health Law; Gov. Jindal Says Medicaid Expansion Would Have Moved Privately Insured To Medicaid

The New York Times: Abandoned In Indian Country
It's an old American story: malign policies hatched in Washington leading to pain and death in Indian country. It was true in the 19th century. It is true now, at a time when Congress, heedless of its solemn treaty obligations to Indian tribes, is allowing the across-the-board budget cuts known as the sequester to threaten the health, safety and education of Indians across the nation. ... One of the most important is the Indian Health Service, which serves about two million people on reservations and is grossly underfinanced even in good times. It routinely runs out of money halfway through the year. Though Medicare, Medicaid and veterans' health were exempted from sequestration cuts, the Indian Health Service was not (7/23).

The New York Times' Economix: The New Economics Of Part-Time Employment, Continued
A revised definition of part-time employment may have some popular appeal, but it will not repair the Affordable Care Act's disincentives for full-time employment or its extra costs for taxpayers (Casey Mulligan, 7/24). 

The Wall Street Journal: Obama's New York Model
President Obama has found a new example for the pending wonders of his health-care reform—New York. In his latest sales pitch last week, he declared that insurance rates in New York's ObamaCare exchange "will be at least 50% lower next year than they are today. Think about that: 50% lower." ... The real news is that New York ruined its individual insurance market two decades ago by imposing the same regulations that ObamaCare is about to impose on every other state (7/23).

The Wall Street Journal's Political Diary: Labor Vs. ObamaCare
The labor union mutiny against the Affordable Care Act expanded Thursday with a letter to President Obama from the head of the Laborers' International Union of North America, which represents more than 500,000 workers in construction and other industries. Echoing a similar appeal by three top union chiefs the previous week, union president Terry O'Sullivan wrote that ObamaCare will have "destructive consequences" for health plans that cover millions of workers and their families (Alexander Kazam, 7/23).

New Orleans Times-Picayune: Gov. Bobby Jindal: Why I Opposed Medicaid Expansion
First, as a general principle, we should not move people from private insurance onto government-run programs. It seems a matter of common sense that we should want to encourage self-sufficiency and target taxpayer spending only for those most in need. But Medicaid expansion would have moved up to 171,000 Louisianians off private insurance and stopped another 77,000 people from obtaining private insurance. To cover 214,000 low-income uninsured people in Louisiana, Obamacare would add more than twice that number -- more than 450,000 people -- to the Medicaid rolls. This makes no sense (Louisiana Gov. Bobby Jindal, 7/23).  

Health Policy Solutions (a Colo. news service): Not So Invincible – Young People Confused About Obamacare
Contrary to what many in the media may believe, young people do care about the implementation of Obamacare, the Affordable Care Act (ACA). But just like many other people in America, many of us may be confused about its provisions and which may apply to us and how. Though I am a senior at Boston University, and have studied health policy, I acknowledge that I do not understand everything I may need to know about the new law (Danielle Robbio, 7/24).

CNN: Will Obamacare Help Primary Care?
You're wiped out, eating too much, your chest feels funny when you climb stairs, sex isn't working well, you can't wait for a drink and your spouse is looking at you warily. But you just bought health insurance online from a health exchange. Now, before you head for an ER, if only you could find a doctor. ... Primary care doctors -- the pediatricians, family doctors and internists who constitute the foundation of our medical system -- are also in trouble (Dr. Tom Delbanco, 7/23).

Tampa Bay Times: Fed Must Save Children From State Apathy
The federal government took the only recourse available by finally asking the courts to end Florida's shameful practice of warehousing disabled children in nursing homes. For two years, Gov. Rick Scott's administration has made clear that it had no intention of changing course on a policy that punishes children with complex medical needs and keeps them from their homes, families and communities. If Florida won't comply with the antidiscrimination laws, then it falls to the federal government and the courts (7/23).

Bloomberg: How Republicans Can Help Us Grow Old Gracefully
If you thought the fight over Obamacare was bruising, brace yourself for the coming battle over long-term-care insurance. Demographic pressure and ill-fitting public programs make the current approach unsustainable, whether we like it or not. ... A better option is for the U.S. to follow the lead of almost every other developed country and create a social insurance plan for long-term care, in which the government collects premiums from the working-age population and uses the money to fund care for those who qualify (7/23).

The Seattle Times: Feds Make A Hash Of State's Mental-Health System
The U.S. Centers for Medicaid and Medicare Services informed the state of Washington that the state's outpatient mental-health system violated federal procurement laws, as articulated in OMB Circular A-87. Hope that didn't lose you. That accountant-speak is bone-dry. ... "Now wait a minute," longtime readers will say, "haven't you spent a lot of time arguing that health insurance doesn't necessarily make us any healthier? (7/22).

The Lund Report: Optimism Abounds In Cover Oregon Land – Is It Real?
Oregonians have been led to expect that they will receive large subsidies to help pay the cost of their personal health insurance now that health insurance is required. We also know they have been told that if they like their current insurance policy, they can keep it. Sounds good on the surface, but if we dig a little deeper we find that both statements don't hold much weight (John Gridley, 7/23).

Georgia Health News: Palliative And Hospice Care Help Make Life Livable
A hundred years ago, the average life expectancy in the United States was just under 50 years. Today it's nearly 80 years – a true testament to the benefits of modern medical advances. The development of highly effective treatments and technologies significantly extended Americans lives. However, these technological treatments can also affect quality of life, and not always for the better (Dr. Victor Alvarez, 7/23).

Minneapolis Star Tribune: Want Better Health Care? Be Pushy
I've been a physician for 35 years. During the most recent 25, I've devoted time to practice improvement and population health initiatives. In part, this involved helping individuals to be healthier. It also involved helping the care delivery system explore how to make care more effective, more efficient and more satisfying to patients (the combination labeled "the triple aim") (Dr. Charles J. Fazio, 7/23).

Bloomberg: What My Dog Taught Me About Health Insurance
Last February, on Valentine’s Day, the Official Blog Spouse and I took custody of an eight-week-old bullmastiff puppy named Fitzgerald. The first thing we did was to drive him home from Indiana and install him in the Stately McSuderman McMansion. The second thing we did was to buy him pet health insurance. "Now wait a minute," longtime readers will say, "haven’t you spent a lot of time arguing that health insurance doesn’t necessarily make us any healthier?" (Megan McArdle, 7/23).

JAMA: The Critical Role of Caregivers in Achieving Patient-Centered Care
Achieving high-quality, cost-effective medical care remains an elusive goal of the US health care system, but there is widespread agreement that patient-centered care will be a key ingredient.1 Yet for frail elders and patients with advanced illness, many of whom have multiple chronic diseases, patient-centered care is impossible without caregiver involvement. Although advocacy groups such as the National Alliance for Caregivers have long endorsed attention to family members and prominent research organizations such as the newly created Patient-Centered Outcomes Research Institute mention families in their research agendas, the critical role of caregivers deserves considerably more attention from clinicians (Dr. Muriel R. Gillick, 7/22).

JAMA: Who Owns Human Genes?
The [Supreme Court's] compromise ruling acknowledged difficult issues in a simmering controversy. Granting commercial rights over naturally occurring biological products seemed unethical because industry should not be able to control access to unaltered materials found in nature. However, failure to afford intellectual property protection could stifle innovation, robbing entrepreneurs of financial incentives for discovery. Myriad lost the exclusive right to isolate the BRCA1 and BRCA2 genes of individuals, but maintained the right to its unique method of synthetically creating BRCA cDNA to produce and market its tests (Lawrence O. Gostin, 7/22). 

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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.