Daily Health Policy Report

Thursday, July 24, 2014

Last updated: Thu, Jul 24

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Capitol Hill Watch

Administration News

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

New Health Law Court Decisions Could Have Limited Political Impact

Kaiser Health News staff writers Mary Agnes Carey and Julie Rovner report: “Political analysts say this week’s court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall’s midterm elections. The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplace” (Carey and Rovner, 7/24). Read the story.

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Groups Sue Tennessee Over Medicaid Enrollment Delays

Kaiser Health News staff writer Phil Galewitz reports: “The suit was filed several weeks after the Obama administration ordered Tennessee and several other states to resolve problems that have led to a backlog nationwide of more than 1 million applications for Medicaid, the state-federal health insurance program for the poor” (Galewitz, 7/23). Read the story

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Capsules: Advocacy Groups Say Medicare Should Negotiate With Drugmakers; Study Estimates 10 Million Americans Gained Health Coverage

Now on Kaiser Health News' blog, Julie Appleby reports on the latest regarding Medicare and coverage of new blockbuster drugs: "Medicare could save billions if Congress overcame its reluctance to anger the drug industry and allowed the program to demand rebates or negotiate prices, Rep. Henry Waxman, D-Calif., said Wednesday. He added that’s something polls show many Americans support" (Appleby, 7/23).

Also on Capsules, Phil Galewitz reports on a new study that offers an updated estimate of the number of newly insured people: "About 10.3 million Americans gained health coverage this year, primarily as a result of the Affordable Care Act, according to a study by the federal government and Harvard University, published Wednesday in the New England Journal of Medicine. The estimate of newly insured adults — the largest to date — is the first published in a major medical journal and authored by some federal health researchers" (Galewitz, 7/24). Check out what else is on the blog.

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Political Cartoon: 'Path Of Greatest Resistance?'

Kaiser Health News provides a fresh take on health policy developments with "Path Of Greatest Resistance?" By Nate Beeler.

Meanwhile, here's today's haiku:

GETTING BETTER ALL THE TIME?

The best physicians
seek recertification
to improve their care.
-James P. Richardson, MD 

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

10 Million Newly Insured Because Of Health Law, Study Says

The study, done by Harvard researchers and published by the New England Journal of Medicine, was based on Gallup polling and data from the Department of Health and Human Services. It also estimated that the uninsured rate declined by 5.2 percentage points in the second quarter of 2014. 

The Associated Press: Study: 10M Have Gained Coverage Through Health Law
A new study estimates that more than 10 million adults gained health insurance by midyear as the coverage expansion under President Barack Obama’s law took hold in much of the country. The study published Wednesday in the New England Journal of Medicine found that the share of Americans ages 18 to 64 without insurance dropped by a little more than 5 percentage points (7/23).

Politico: New England Journal Of Medicine Report: 10 Million Newly Insured
The Obama administration is touting yet another study showing that the Affordable Care Act has expanded health insurance to millions of Americans — this one published in the New England Journal of Medicine and estimating that 10 million have gained coverage under the law. Using Gallup polling and HHS data, Harvard researchers estimate that the uninsured rate declined by 5.2 percentage points in the second quarter of this year, corresponding to 10.3 million adults gaining coverage — although that could range from 7.3 to 17.2 million depending on how the data are interpreted. At least one researcher also has an HHS affiliation (Winfield Cunningham, 7/23).

Modern Healthcare: 10.3 Million Gained Insurance Under Obamacare
About 10.3 million Americans have gained insurance coverage since the full implementation of Obamacare last year, according to an analysis published Wednesday in the New England Journal of Medicine. The uninsured rated dropped to 16.3% at the end of April from 21% before the initial open enrollment period for plans on the new insurance exchanges. The decreases were most pronounced among low-to-middle income households in states that expanded Medicaid eligibility to residents with incomes up to 138% of the federal poverty level (Demko, 7/23).

The Hill: Study Finds 10.3M Gained Insurance Through Health Law
The study conducted by researchers from the Department of Health and Human Services and Harvard University found the the number of uninsured has fallen from 21 percent in September 2013 to 16.3 percent in April 2014. In particular, it found jumps in the insurance rates for Hispanics, blacks and young adults. (Al-Faruque, 7/23).

Reuters: Over 10 Million U.S. Adults Gain Coverage Under Obamacare
The study, which appeared in the New England Journal of Medicine, also found evidence that more Americans had a personal doctor and fewer difficulties paying for medical care within the first six months of gaining insurance (Morgan, 7/23).

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Health Insurers To Refund Consumers $330 Million

The refunds are required under the health law when insurers spend less than 80 to 85 percent of health care premiums for medical care. Florida consumers will receive the biggest rebates, with $41.7 million returned, according to government data.

Reuters: U.S. Health Insurers To Pay $330 Million In Premium Rebates
U.S. health insurers will send out about $330 million in rebates to employers and individuals this summer under President Barack Obama's healthcare law, the U.S. Department of Health and Human Services said on Thursday. The law, often called Obamacare, requires insurance companies to refund customers when they spend less than 80 percent or 85 percent of healthcare premiums they collect for medical care. The rebates will go to about 6.8 million people and have a value of about $80 per family. They are to be sent by Aug. 1 either directly to consumers or to the employer providing the health coverage, who is required to pass the savings onto employees, the agency said in a report (Humer, 7/23).

The Hill: Insurers Returned $9B To Consumers Under O-Care
Insurance companies returned about $9 billion from premiums since 2011 because of an ObamaCare provision to cap how much profit they can make, according to a new Department of Health and Human Services (HHS) report released Thursday. Under the Affordable Care Act, insurance companies are required to spend at least 80 to 85 percent of the premiums they collect on patient care or to make improvements to healthcare quality (Al-Faruque, 7/24).

The Associated Press: Insurers Owe More Than $8M in Refunds in Illinois
The federal government says more than 108,000 Illinois health insurance customers will benefit from more than $8 million in refunds because of a provision of the nation's health care law. The U.S. Department of Health and Human Services released the figures Thursday (7/24).

Health News Florida: Florida #1 In Rebates; Blue Owes $10M
Insurers must pay $41.7 million in rebates to Florida individuals and employers this summer, an amount that far exceeds refunds in any other state, according to a federal report released Thursday. That brings Florida's three-year total from the ObamaCare rebate program to almost $220 million. This year's rebate will average $65 per family in Florida, according to the report from the U.S. Department of Health and Human Services (Gentry, 7/24).

Detroit Free Press: Michiganders Getting $13.1 Million in Health Insurance Refunds
Thousands of Michiganders will receive unexpected checks or savings in their health coverage this summer — $13.1 million in all — after 17 Michigan companies overspent funds that were to cover health care rather than overhead, according to a report released today by the Obama administration. Under federal health reform, insurers that cover small groups and individuals must spend at least 80% of what consumers pay in premiums to cover patient care or to improve quality rather than to cover red tape or set aside as profit (Erb, 7/24).

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Parsing The Health Law Court Decisions: What Does It All Mean?

News outlets analyze this week's conflicting appeals courts' decisions regarding a key part of the health law, including the impact the ultimate outcome of the cases could have on coverage, politics and the marketplace.   

The New York Times: Court Ruling On Health Care Subsidies Risks Loss Of Coverage
The conflicting court rulings left much unresolved — both cases will be appealed further, and additional cases challenging the subsidies in federal exchange states are still making their way through trial courts in Indiana and Oklahoma. But the ruling in Halbig v. Burwell, in which a panel of the United States Court of Appeals for the District of Columbia found that subsidies could be awarded only in states that set up their own insurance exchanges, raised the possibility that many of the 4.5 million people who were found eligible for subsidized insurance through the federal exchange would drop their new coverage (Goodnough, 7/23).

Kaiser Health News: New Health Law Court Decisions Could Have Limited Political Impact
Political analysts say this week’s court decisions on the legality of tax subsidies for those obtaining coverage under the Affordable Care Act may not have a broad impact on this fall’s midterm elections. The decisions sent a mixed legal message, complicating the political message as well. One appellate court panel ruled the subsidies cannot be provided in the 36 states relying on the federal insurance exchange; the other ruled in favor of the Obama administration, saying Congress intended that the subsidies be available regardless of whether states operated their own insurance marketplace (Carey and Rovner, 7/24). 

Bloomberg: No Panic As Obamacare Subsidies Seem Safe For Future
Americans are unlikely to lose Obamacare subsidies any time soon, at least, and not in most states. A three-judge panel of a federal appeals court in Washington ruled July 22 that subsidies to help people pay insurance premiums are illegal in 36 states that use the federal healthcare.gov system. The ruling, in a case brought by political opponents of the health law, rattled advocates who painted doomsday scenarios of broken insurance markets across the country. That probably won’t happen, health-care industry executives and analysts said in interviews. The ruling is likely to be reversed, and even if it isn’t, a way to work around the court decision might be as simple as a bit of legislation in statehouses (Wayne, 7/24).

The Wall Street Journal: Key Question On Health-Law Subsidies: Were Plaintiffs Harmed?
That argument is simmering beneath court battles about the legality of insurance subsidies tied to the Affordable Care Act. Mr. Klemencic is a key plaintiff in a case in which a Washington, D.C., court Tuesday invalidated subsidies for consumers in up to 36 states, the ones relying on a federal insurance exchange. Whether challengers like Mr. Klemencic had legal standing to sue the Obama administration in the first place turns on whether he was harmed by the subsidies. The ruling struck down an Internal Revenue Service rule that said qualifying consumers could receive subsidies whether they bought coverage on a state-run insurance exchange or a federal one. A second court, in Virginia, upheld the legality of the subsidies in another ruling Tuesday (Kendall, 7/23).

Modern Healthcare: Working Around Exchange Subsidy Ruling Should Be Easy
Tuesday's split decision in two federal appellate court cases over whether consumers shopping on the federal insurance exchange can receive premium subsidies could have major effects on the healthcare market. But some experts say officials in states that have not established their own state-run exchanges could solve the problem fairly easily if they want to, and that they will face significant political pressure to do so (Tahir and Demko, 7/23).

The New York Times: Bolstered By Ruling, Republicans Attack Health Law
Republicans in Congress resumed their campaign against the Affordable Care Act on Wednesday with new zeal, fired up by a ruling of a federal appeals court panel that said premium subsidies paid to millions of Americans in 36 states were illegal. Republicans pointed to the ruling as evidence of problems in the law that could not easily be solved (Pear, 7/23).

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Healthcare.gov Active With Special Enrollments

ProPublica reports that the once problem-plagued federal exchange handled an estimated 960,000 transcations between April 19 and July 15. 

ProPublica/NPR: Federal Health Exchange Stays Busy After Open Enrollment Ends
For months, journalists and politicians fixated on the number of people signing up for health insurance through the federal exchange created as part of the Affordable Care Act. It turned out that more than 5 million people signed up using healthcare.gov by April 19. But perhaps more surprising is that, according to federal data released Wednesday to ProPublica, there have been nearly 1 million transactions on the exchange since then. People are allowed to sign up and switch plans after certain life events, such as job changes, moves, the birth of a baby, marriages and divorces (Ornstein, 7/23).

The Hill: Healthcare.Gov Still Seeing Market Activity
Healthcare.gov has processed nearly 1 million transactions since mid-April, a sign that the site is still adding special enrollments to the federal exchanges because of changes in life circumstances. The once-troubled website handled roughly 960,000 "834" forms between April 19 and July 15, according to data obtained by ProPublica via public records request (Viebeck, 7/23).

Meanwhile, in the news from Hawaii --

McClatchy: Website Proposed to Boost Health Insurance Enrollment in Hawaii
The state is stepping in to create a single website to boost Obama¬≠care enrollment after a bungled first attempt left thousands of applicants without health insurance. The state Office of Information Management and Technology told lawmakers at a Monday, July 21, briefing that it plans to create a single portal at Hawaii.gov that will help direct consumers to either Medicaid, the government insurance program for low-income residents, or the Hawaii Health Connector, the troubled online exchange created by President Barack Obama’s Affordable Care Act (Consillio, 7/23).

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Medicaid Residents Sue Tennessee On Enrollment Delays

The suit claims that the state's decision to require residents to apply through the health law marketplace slowed down enrollment. In other Medicaid news, The Associated Press examines problems in Oregon caused by the rush of enrollment.

Modern Healthcare: Suit Alleges Tennessee Put Medicaid Applicants in Limbo by Steering Them to HealthCare.Gov
Tennessee residents who faced lengthy delays when they applied for Medicaid are now suing the state for failing to process their applications in a timely manner. The lawsuit, filed Wednesday in U.S. District Court in Nashville, claims that the backlog developed when the state began requiring residents to apply for the TennCare program through the federal health insurance marketplace HealthCare.gov, which was not designed to process Medicaid applications (Kutscher, 7/23).

Kaiser Health News: Groups Sue Tennessee Over Medicaid Enrollment Delays
The suit was filed several weeks after the Obama administration ordered Tennessee and several other states to resolve problems that have led to a backlog nationwide of more than 1 million applications for Medicaid, the state-federal health insurance program for the poor (Galewitz, 7/23).

The Associated Press: Medicaid Enrollees Strain Oregon
Low-income Oregon residents were supposed to be big winners after the state expanded Medicaid under the federal health care overhaul and created a new system to improve the care they received. But an Associated Press review shows that an unexpected rush of enrollees has strained the capacity of the revamped network that was endorsed as a potential national model, locking out some patients, forcing others to wait months for medical appointments and prompting a spike in emergency room visits, which state officials had been actively seeking to avoid (7/23).

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GAO Official: Report Intended To Identify Trouble Spots In Health Law Fraud Controls

But Republicans saw it as evidence of more problems with the health overhaul.

Politico: GAO: Too Early To Draw Obamacare Fraud Conclusions
It’s too early to draw conclusions about fraud in the Obamacare marketplaces, a congressional investigator said at a hearing focused on a report finding 11 out of 12 fake applicants were able to obtain subsidized health insurance. Republicans jumped on the report as proof that the health care law invites fraud, but the Government Accountability Office official said the sample is too small and investigators “can’t draw any conclusions” until their work is complete. The investigation is ongoing, GAO’s Seto Bagdoyan said, and the “intent of this sample was not to project in any way” based on this initial stage of work, but instead to identify areas of potential focus for future work (Weinger, 7/23).

The Fiscal Times: Obamacare Fraud Controls Found Severely Lacking
At the moment there’s no way of knowing whether any significant portion of the millions of people who signed up for health insurance coverage through the Affordable Care Act’s Health Care Exchanges did so fraudulently. But a preliminary report issued by the Government Accountability Office on Wednesday it suggests that, for any who did, it would have been pretty easy. The GAO, at the request of members of Congress conducted what amounted to a sting operation against various healthcare exchanges, using fraudulent identities to apply for, and receive, health insurance coverage and federal subsidies through the exchanges (Garver, 7/24).

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Health Care Marketplace

$1,000-A-Pill Hepatitis C Drug Boosts Gilead's Fortunes

Sales of the new hepatitis C drug Sovaldi reached $3.5 billion in the second quarter, putting it on track to become one of the world's best-selling medicines and intensifying concerns about its costs. Two advocacy groups and a Democratic lawmaker demanded that Medicare be able to negotiate with Gilead and other drugmakers to bring down such costs.

The New York Times: Gilead Reports Strong Sales of Sovaldi, Putting It On Pace to Become A Blockbuster 
Sales of the new hepatitis C drug Sovaldi reached $3.5 billion in the second quarter, a huge figure that puts it on track to become one of the world’s best-selling medicines but could intensify concerns about society’s ability to pay for it. The sales, announced on Wednesday by Gilead Sciences, were an increase from the $2.3 billion in the first three months of the year, the first full quarter of sales since the drug’s approval in December (Pollack, 7/23).

The Wall Street Journal: Hepatitis C Pill Rockets Gilead Into Big Leagues
For decades, a liver disease that would slowly kill the infected person didn't even have a name, let alone an effective medicine. Now, a new pill promising to cure most cases of the disease, eventually called hepatitis C, is believed to be the biggest new drug launch ever, catapulting maker Gilead Sciences Inc. 13% into the ranks of the top-selling pharmaceutical companies (Rockoff, 7/23).

Bloomberg: Patient Cures Spur Demand For $1,000 Hepatitis C Pill
The powerful new hepatitis C drug that sent Gilead Sciences Inc. (GILD)’s sales soaring last quarter is doing the same for the hopes of millions of patients. Sandra Cabrera and Ted Tabor both suffered devastating damage from hepatitis C. After just weeks of taking Gilead’s Sovaldi, they feel much better and tests suggest the lethal virus is disappearing from their blood (Bennett and Langreth, 7/24).

Kaiser Health News: Capsules: Advocacy Groups Say Medicare Should Negotiate With Drugmakers
Expensive new blockbuster drugs, such as a $1,000-a-pill hepatitis C treatment called Sovaldi, highlight the need to do something soon, the California Democrat said, backing recommendations made in a report released Wednesday by two advocacy groups, the Medicare Rights Center and Social Security Works (Appleby, 7/24).

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Health Care Occupations Offer Pathway For Lesser-Educated Workers

According to a Brookings Institution report, the number of people with less than a bachelor's degree working in 10 specific health care occupations increased from 46 percent to 39 percent between 2000 to 2011. 

USA Today: Health Care Jobs Lift Less-Educated Workers
The boom in health care jobs is skewed toward positions requiring less education, providing lower-paid workers a potential pathway to better careers, a new Brookings Institution report says. From 2000 to 2011, the number of workers in 10 large health care occupations who had less than a bachelor's degree surged 46 percent, vs. 39 percent growth for all health care jobs, the study says (Davidson, 7/24).

St. Louis Public Radio: The Number Of Health Care Workers With Low Education Levels Is Rising – But Their Wages Aren’t
About half of the health care workers in the St. Louis area have less than a bachelor's degree. The number of health care workers with lower levels of education is on the rise here but for the most part, their salaries are not. That puts the St. Louis region in line with the national trend, according to a new report released on Thursday by the Brookings Metropolitan Policy Program. The analysis relied on U.S. census data from the 100 largest metro areas, including St. Louis. The researchers found that most health care workers with an associate degree or less are employed in one of ten occupations, so the report focused on those (LaCapra, 7/23).

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Capitol Hill Watch

Rep. Paul Ryan To Propose Consolidation Of Anti-Poverty Programs

The proposal calls for melding a range of safety net programs -- from food stamps to housing vouchers -- into a single grant offered to states, which would come with strict accountability standards. The proposal, which does not include Medicaid, is part of a GOP effort to rethink how conservatives approach antipoverty programs.

The Washington Post: Paul Ryan To Unveil Anti-Poverty Plan
The new proposal, called an "Opportunity Grant," would begin on a pilot basis. It would consolidate a range of safety-net programs — from food stamps to housing vouchers — into a single grant offered to states. State governments, working with local officials and nonprofit and faith groups, would then distribute the money, with strict accountability standards. Medicaid, the health program for the poor, would not be included (Goldfarb, 7/22).

The Wall Street Journal: Paul Ryan To Propose Sweeping Consolidation In Antipoverty Pitch
Mr. Ryan previously has proposed deep cuts in federal spending on programs such as Medicaid and food stamps, and he has said that federal assistance creates a culture of "dependency" among the poor that makes it harder for people to climb the economic ladder. Mr. Ryan does not offer new proposals for Medicaid in his plan (Paletta, 7/23).

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Administration News

Senate Could Vote On VA Nominee's Confirmation Before The August Break

Meanwhile, Health and Human Services Secretary Sylvia Burwell named Leslie Dach, a former Wal-Mart vice president, to be a senior adviser as part of Burwell's effort to head off difficulties in the upcoming health law enrollment period.  

Politico: Robert McDonald Could Soon Be Confirmed To VA
The Senate is expected to vote on the White House’s nominee to lead the embattled Department of Veterans Affairs before senators leave for a five-week August recess, Sen. Bernie Sanders (I-Vt.) said on Wednesday. Robert McDonald was cleared by the Senate Committee on Veterans’ Affairs on Wednesday by a 14 - 0 vote (French, 7/23).

The Hill: Burwell Appoints New Counselor From Wal-Mart
Health and Human Services (HHS) Secretary Sylvia Burwell continued her management shake-up Wednesday by naming a former vice president at Wal-Mart as senior adviser. The move to bring Leslie Dach to HHS reveals Burwell's interest in heading off problems during ObamaCare's second enrollment period, due to start in November. The new HHS secretary also wants to add professionals with significant private sector experience to her inner circle (Viebeck, 7/23).

In addition, the head of the Centers for Disease Control and Prevention's lab resigns -

Politico: CDC Lab Head Quits After Anthrax Scare
The head of a laboratory at the Centers for Disease Control and Prevention in the spotlight after dozens of employees were potentially exposed to live anthrax bacteria has resigned. Michael Farrell resigned on Tuesday, CDC spokesman Tom Skinner said. Farrell had led the Bioterror Rapid Response and Advanced Technology laboratory on the agency’s Atlanta campus since 2009 (Norman, 7/23).

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State Watch

Highlights: Texas Abortion Rates Falls Dramatically; Start-Up Problems For Virginia's Psychiatric Reforms

A selection of health policy stories from Virginia, New York, Texas, Louisiana, Wisconsin, Connecticut, Maryland and North Carolina.

The Washington Post: Virginia Psychiatric-Bed Registry Does Not Work As Intended, Lawmakers Told
A four-month-old psychiatric-bed registry that is supposed to provide up-to-the-minute information for Virginians who need emergency mental health treatment is being updated as seldom as once a day, state officials told a panel of lawmakers this week (Shin, 7/22).

NPR: States Help New Mothers Get Birth Control Through Medicaid
Here's the catch: Her Medicaid plan won't pay for contraception if she tries to get it while she's still at the hospital. New York has just joined five other states in making it easier for our fictional mom to have access to the kind of family planning options she was seeking without worrying about the price tag. At first glance this is a technical issue about Medicaid reimbursements. But it is also about postpartum contraception and which women have access to it (Farrington, 7/23).

Texas Tribune: New Law Led to Statewide Drop in Abortions
The number of abortions in Texas decreased by about 13 percent statewide and 21 percent in the Lower Rio Grande Valley following the passage of strict abortion regulations that went into effect last November, according to a report that academic researchers released Wednesday. The study, by the Texas Policy Evaluation Project at the University of Texas, which is analyzing the effects of reproductive health-related laws passed during the last two legislative sessions, found that as the number of clinics that provide abortions declined, so did the number of abortions performed statewide (Edelman, 7/23).

The Associated Press: Healthy Virginians Aim Of State Panel
First lady Dorothy McAuliffe is joining a panel of public health experts intent on promoting policies to ensure a healthier Virginia. The Virginia Department of Health is convening the meeting Wednesday at the University of Virginia in Charlottesville. Called the “Excellence in State Public Health Law Conference,” the meeting is intended to assess policy proposals for improving the health of all Virginians (7/23).

The Wall Street Journal: Invoking Anti-Fraud Law, Louisiana Doctor Gets Rich
Over two decades, the 65-year-old internist has filed 12 lawsuits accusing health-care companies of defrauding taxpayer-funded programs such as Medicare. Five of his suits have together led the government to recover hundreds of millions of dollars. Those successful suits have also enriched Dr. LaCorte, who has received a $38 million cut under a federal law that encourages fraud reporting. Much was from a $250 million U.S. settlement with Merck & Co. in 2008 over allegations it overcharged Medicaid for Pepcid, a heartburn drug. He used part of his portion to buy a boat he named Pepsid (Loftus, 7/23).

The Milwaukee Journal Sentinel: Hospital Costs Rise More Slowly In Southeastern Wisconsin
Hospitals in southeastern Wisconsin have gotten serious about controlling costs, with payments from commercial health plans increasing at roughly half the national rate from 2003 through 2012, according to a study released Wednesday. Payments to hospitals from private health insurers and employers increased an estimated 37 percent in southeastern Wisconsin in that time period compared with a 75 percent increase in the national hospital component of the Consumer Price Index, according to the study done for the Greater Milwaukee Business Foundation on Health Inc (Boulton, 7/23).

The CT Mirror: Moms Of Children With Mental Illness Share Their Pain, Tell Their Stories, Push For Change
It expands by word of mouth and whispers, the informal network of mothers who have found in each other a place to talk about having children with illnesses that are often kept secret. One mother whose son is struggling found them because she was crying every day at work. A coworker who knew someone in the group got her in touch with the other moms. Other people approach Mary Jo Andrews after she speaks at events about mental illness. “Are you taking new people in your group?” they ask. She tries to make sure they’d fit, that they’re not dealing with “normal teenage stuff.” This group is for moms whose children have serious mental illness (Becker, 7/24).

Baltimore Sun: Sinai Hospital to Address ‘Frequent Fliers’ to the Emergency Department
When people routinely visit the emergency room for nonemergencies, it's not only costly to the health care system but a stress on hospitals, especially one such as Sinai Hospital, which is among several in the state that care for the worst traumas. So the hospital announced Wednesday that it is partnering with a nonprofit health care advocacy group to target so-called "frequent fliers" or "super utilizers," about 200 patients who visit the emergency department four or more times in a four-month period, some as many as 20 times (Cohn, 7/23).

North Carolina Health News: Complicated Hospital Accounting Adds To Medicaid Uncertainty
Lawmakers in North Carolina were having trouble reconciling this year’s Medicaid numbers because of difficulty getting data out of the NCTracks Medicaid billing and claims processing system, which launched a year ago and has struggled since. So lawmakers turned to hospitals themselves, asking hospital finance officers what they thought they were owed. And the answer they got back was a collective, “We’re not sure.” That’s because hospital accounting is different from keeping the books for other kinds of businesses – very, very different. And very difficult. And the difficulty in calculating hospital costs has only added to the uncertainty at the General Assembly over how much lawmakers should set aside to resolve Medicaid’s debts (Hoban, 7/24).

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Weekend Reading

Longer Looks: The Economics Of Infertility; Placebos As Treatment Raises Ethical Dilemmas

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

Vox: States That Deny Anti-Psychotics To The Poor Have Lots Of Mentally Ill People Behind Bars
About a decade ago, Medicaid programs were struggling to keep up with skyrocketing prescription drug costs. Between 1997 and 2002, drug spending in the program for low-income Americans grew by about 20 percent annually. ... Medicaid directors began looking for ways to tamp down on those costs. One of the most popular policies was something called "prior authorization" for a new wave of more expensive, anti-psychotic drugs ,... These policies, in a sense, worked: they helped rein in how much Medicaid spent filling prescriptions. But in another sense, they may not have worked at all: a growing body of research has begun questioning whether restricting drug spending may have just shifted costs elsewhere — particularly, into the prison system (Sarah Kliff, 7/22). 

The Washington Post: They Want A Baby. The Economy Won't Play Along.
The languishing economy has caused people to doubt if they can afford to be parents. The barriers are even higher for Melissa and Rick [Myrick], among the 6 percent of U.S. married couples facing infertility. Living in Missouri, one of 35 states that doesn’t mandate insurance coverage for infertility, they are on the hook for related doctor’s visits or drugs. They face a huge upfront price tag — a cost that can't be pushed down the road, when their economic outlook might be brighter. That's frustrating to them. "Why should the economy play into my family planning?" Melissa asks (Todd C. Frankel, 7/21). 

The Pacific Standard: People Are Clueless About Placebos
Most people have a basic understanding of placebos and why they're necessary in scientific experiments. However, placebos are also viable options for treating patients in clinical settings. ... Despite their healing effects, the premise of prescribing placebos is ethically ambiguous. In some cases (but not all), patients can't know that they're taking a dummy drug, otherwise the placebo will have no effect. This deception means that both doctors and patients can feel uncomfortable with the idea of placebos as medical treatment (Bettina Chang, 7/21). 

The New York Times: Is Truvada, The Pill To Prevent H.I.V., 99 Percent Effective? Don't Be So Sure
Truvada, the once-a-day pill to help keep people from contracting H.I.V., is on the cover of this week's New York magazine, and Tim Murphy's cover story focuses on how the pill is changing sex by drastically reducing gay men’s fear of infection. It’s not hard to see why: Mr. Murphy writes, "When taken every day, it's been shown in a major study to be up to 99 percent effective." This is a claim I hear thrown around a lot among gay men in New York. And it's wrong. The 99 percent figure isn’t a study finding; it’s a statistical estimate, based on a number of assumptions that are reasonable, but debatable (Josh Barro, 7/16).

New York Magazine: Sex Without Fear
This summer—on social media, on Fire Island, at the Christopher Street pier, and in certain cohorts around the ¬country—what many gay men are talking about among themselves is Truvada. And what’s surprising them is how fraught the conversation can be. For some, like Jacobs, the advent of this drug is nothing short of miraculous, freeing bodies and minds. For doctors, public-health officials, and politicians, it is a highly promising tool for stopping the spread of HIV. But for others, a drug that can alleviate so much anxiety around sex is itself a source of concern. They worry that Truvada will invite men to have as much condom¬less sex as they want, which could lead to a rise in diseases like syphilis. Or they fret that not everyone will take it as religiously as they ought to, reducing its effectiveness and maybe even creating resistance to the drug if those users later become HIV-positive and need it for treatment (Tim Murphy, 7/13). 

The Boston Globe: Honoring A Once-Scorned Voice For Medical Openness
Dr. Ernest Amory Codman was in his mid-40s when his golden career as a sought-after Harvard surgeon began to unravel. He had quit in exasperation from Massachusetts General Hospital, and when he took his dispute with hospital leaders public, colleagues turned against him. Many stopped sending him patients. It was the early 1900s, and Codman was impatiently pushing hospitals and doctors to adopt a practice many considered heretical at the time: Record the "end results’" for every patient — including harm caused by physicians’ errors — and make them public. A century later, many of Codman’s ideas are the bedrock of modern medicine (Liz Kowalczyk, 7/21).

NPR: A YouTube Video Is Doctor's Secret Weapon Against Back Pain
In my patient's case, I was confident that her back pain wasn't serious. A minor injury was the clear cause. And nearly all back pain like hers from a simple mechanical strain gets better on its own. I wanted to reassure her. I told her to go about her daily life. Keep exercising, but try to take it just a little bit easy until she felt better. At a minimum, I said, she should be walking 30 minutes a day. Also, try some ibuprofen, which helps with inflammation and doesn't require a prescription. But she wasn't buying it (Dr. John Henning Schumann, 7/20).

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Editorials and Opinions

Viewpoints: Looking To The Supremes For Answer On Subsidies; 'Personhood' Laws

The Wall Street Journal: Fast-Tracking ObamaCare To The Supreme Court
Liberals are telling themselves that the latest ObamaCare legal challenge won't amount to much, although more nervously after the D.C. Circuit Court of Appeals ruled Tuesday that the White House is defying the law's plain text by allotting insurance subsidies through the federal exchanges. Allow us to increase their anxiety by speeding things along to the Supreme Court (7/23).

The Washington Post: Without Obamacare, What Would The Country Really Give Up?
After months of mostly encouraging news, many analysts have been upbeat about the law. Enrollment in private insurance and in Medicaid is up significantly. Nearly all of those buying private coverage are receiving tax credits, dropping their premiums by 76 percent, on average. Despite predictions to the contrary, a huge chunk — maybe something like half — of the newly insured lacked coverage before signing up, so the law isn’t just forcing people to move from one plan onto another whether they want to or not. The law is instead pushing the proportion of Americans without insurance down significantly. Given these things have happened despite a troubled rollout, it’s fair to be optimistic about year two (Stephen Stromberg, 7/23). 

The Washington Post: A Conservative Judiciary Run Amok
Retired Supreme Court Justice John Paul Stevens captured our ideal when he wrote of the judge as "an impartial guardian of the rule of law." By effectively gutting the Affordable Care Act on Tuesday, two members of a three-judge panel on the D.C. Circuit Court of Appeals showed how far right-leaning jurists have strayed from such impartiality. We are confronted with a conservative judiciary that will use any argument it can muster to win ideological victories that elude their side in the elected branches of our government (E.J. Dionne Jr., 7/23).

The New York Times' The Upshot: Two Americas On Health Care, And Danger Of Further Division
For decades, the United States has had a fragmented health policy. States called the shots on major elements of how health care and health insurance were financed and regulated. The result: a hodgepodge of coverage and a wide variance in health. The Affordable Care Act was intended to help standardize important parts of that system, by imposing some common rules across the entire country and by providing federal financing to help residents in all states afford insurance coverage. But a series of court rulings on the law could make the differences among the states bigger than ever (Margo Sanger-Katz, 7/23).

Bloomberg: Obamacare Takes A Body Blow
When you read through the ruling, it’s easy to see the many ways in which the law’s architects brought this on themselves. The law was highly complex, badly drafted and highly controversial. ... the Democrats had to push it through on a straight party-line vote with some adroit parliamentary maneuvering -- which gave them a health-care law, but one that was badly put together and couldn’t be substantially amended (Megan McArdle, 7/22).

Bloomberg: Obamacare Is Ending, And Other Nonsense
It's too soon to panic -- or celebrate, as the case may be: Obamacare isn't dead. And given the flimsy logic of the latest legal argument against it, there's a good chance it never will be (7/22).

Bloomberg: Courts Can't Fix Obamacare
Supporters of Obamacare have been lamenting that the law shouldn't be crippled by a mere "drafting error." But it's not at all clear that restricting tax credits to state-established exchanges was a drafting error. If Obamacare had proven more popular, or resistance to it weaker, then most states would have established exchanges. And if the law were put in place as written -- with the restriction on tax credits -- then the few holdouts would be under pressure to establish exchanges to get credits for their residents. Other health-care legislation before Congress at the same time as Obamacare had the same restriction (Ramesh Ponnuru, 7/22).

Bloomberg: Add Fraud To The List Of Obamacare Disasters
It sounds like the systems that are supposed to check identity, immigration status and income simply aren’t working at all; the system just assumes that you are who you say you are. This isn’t the only major part of the system that’s still missing .... the system that pays insurers still seems to be MIA. Presumably, the emergency team called in to fix the exchanges prioritized the bits that the public could see, leaving everything else for later. Compared to what was described by the Barack Obama administration (and the law), the system still seems to be half-built (Megan McArdle, 7/23).

The Fiscal Times: Obamacare OK’s Fake Accounts And Fake Promises
To this day, the federal exchange still lacks the “back end” needed to determine how many sign-ups actually have coverage and are paying their premiums, leaving the number of successful enrollments a guessing game based more on surveys than hard data. Now, however, the problem has expanded from failed enrollments to successful enrollments that shouldn’t have made it. The Government Accountability Office (GAO) conducted a small test of the Healthcare.gov site, which the Obama administration claims is functional now, to see whether the system could prevent fraudulent enrollments. In twelve attempts, the GAO succeeded in eleven fictitious enrollments (Edward Morrissey, 7/24).

The Wall Street Journal: McConnell's Campaign Lesson For The GOP
His Democratic opponent, Alison Lundergan Grimes, appeared in an ad sitting with a retired miner who wanted to know why Mr. McConnell "voted to raise my Medicare costs by $6,000. How are my wife and I supposed to afford that?" He and Ms. Grimes then stared at the camera for five seconds, before Ms. Grimes said, "I don't think he's going to answer that." He did answer, in 24 hours, in a video with clips of local and national media calling the charge "false," "misleading" and "laughable" since he didn't vote for the measure the miner cited. (It was a House proposal that never reached the Senate and wouldn't have raised the miner's Medicare costs.) The video even included footage of Ms. Grimes being pressed by Kentucky reporters to defend the ad. Then the McConnell campaign flipped the issue, reminding voters that President Obama's Affordable Care Act cut Medicare and saying that Ms. Grimes is "Obama's Kentucky candidate. Obama Needs Grimes. Kentucky Needs Mitch McConnell" (Karl Rove, 7/23).

The New York Times: Do Personhood Laws Protect Or Harm?
Ms. DeSamito and Ms. Loyola have been arrested or detained because of the increasing nationwide push to pass so-called personhood laws. These laws, though they vary state to state, by and large recognize fetuses, embryos and fertilized eggs as persons who are separate from the mothers who carry them. The laws seek to protect this category of persons, whether from strangers or from the mothers themselves. Jennifer Mason, a representative of the pro-life group Personhood USA, said on NPR’s "Fresh Air" in November that "the 14th Amendment requires equal protection under the law for everybody, and so we believe that every human being, regardless of their location, whether they're in the womb or out of it, deserves those protections and those rights." These laws now exist in 38 states, and some say they harm the mothers whose fertilized eggs, embryos and fetuses they aim to protect (Anna Altman, 7/23).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.