Daily Health Policy Report

Thursday, July 25, 2013

Last updated: Thu, Jul 25

KHN Original Reporting & Guest Opinion

Health Reform


Health Care Marketplace

Capitol Hill Watch

Coverage & Access

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

IOM Finds Differences In Regional Health Spending Are Linked To Post-Hospital Care And Provider Prices

Kaiser Health News staff writer Jordan Rau reports: "Big health spending variations throughout the country are largely driven by differences in the use of post-acute services such as skilled nursing homes and home health care by Medicare beneficiaries, and by higher prices that some hospitals and doctors charge commercial insurers, according to an Institute of Medicine report released Wednesday" (Rau, 7/24). Read the story.

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Capsules: WellPoint Sees Small Employers Dropping Health Coverage; Schizophrenia, Suicide And One Family's Anguish; Current Insurance Costs For Individual Policies Vary Widely

Now on Kaiser Health News’ blog, Jay Hancock reports on news from WellPoint: "As the nation prepares to roll out the next phase of Obamacare, the second biggest medical insurer said Wednesday that it expects to lose members in health insurance plans sponsored by smaller employers. At the same time, WellPoint expects membership gains in self-insured employer plans and in the kind of individual plans that will be sold in subsidized exchanges starting Oct. 1" (Hancock, 7/24).

In addition, WNPR's Jeff Cohen, working in partnership with KHN and NPR, reports on a family that had to confront schizophrenia and suicide: "Homer Bell was 54 years old when he committed suicide in April in a very public way — he laid down in front of a bus in his hometown of Hartford, Conn. It was the culmination of three decades of suffering endured by Bell and his family because of his illness, schizophrenia" (Cohen, 7/24).

Also on Capsules, Julie Appleby details a GAO report examining variations in individual insurance policy costs: "Now, the Government Accountability Office is weighing in with its own analysis of how much it costs now for policies offered in each of the 50 states. The report released Wednesday is based on prices reported by insurers to a government database and shows that consumers face a wide range of premium prices, deductibles and annual exposure to out-of-pocket costs, often depending on their age, health history, family size and where they live" (Appleby, 7/24). Check out what else is on the blog.

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Letters To The Editor: In Defense Of Shorter Shifts For Interns, Medicaid Managed Care Oversight, Emergency Room Frequent Flyers And Other Topics

Kaiser Health News: Letters To The Editor: In Defense Of Shorter Shifts For Interns, Medicaid Managed Care Oversight, Emergency Room Frequent Flyers And Other Topics
Letters to the Editor is a periodic KHN feature. We welcome all comments and will publish a selection (7/24). Here are readers' thoughts on specific stories.

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Political Cartoon: 'The Sum Of All Fears?'

Kaiser Health News provides a fresh take on health policy developments with "The Sum Of All Fears?" by David Fitzsimmons.

Meanwhile, here is today's health policy haiku:


Judging hospitals:
Skill counts, for sure. But how does
the price tag fit in?

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

Success Of Health Law's Exchanges Rides On Young People

Meanwhile, the Associated Press estimates that outreach and advertising for the law will cost more than $684 million.

The Wall Street Journal: New Health-Care Law's Success Rests On The Young
Interviews here with more than two dozen single workers of modest income between 24 and 31 years old suggest that insurance plans will be a hard sell. Subsidies for 26-year-old workers range from $118 a month for someone earning under $16,000 to less than $1 a month for one earning $26,500, according to an analysis of insurance data (Weaver and Radnofsky, 7/25).

The Associated Press: Ad Blitz For Obama's Health Care Law Will Cost At Least $684 Million
It will make you stronger. It will give you peace of mind and make you feel like a winner. Health insurance is what the country is talking about, so don't be left out. Sound like a sales pitch? Get ready for more. As President Obama's health care law moves from theory to reality in coming months, its success may hinge on whether the best minds in advertising can reach one of the hardest-to-find parts of the population: people without health coverage (7/24).

Fox News: Voters Say Repeal ObamaCare, Expect New Law Will Cost Them
Voters think ObamaCare is going to hurt their wallet and over half want the law repealed, according to a new Fox News national poll. By a large 47-11 percent margin, voters expect the 2010 health care law will cost them rather than save them money in the coming year. Another 34 percent think the law won’t change their family’s health care costs. Those negative expectations come at a time when a majority of the public remains unhappy with the way thing are going in the country (63 percent dissatisfied), and over half say they haven’t seen any signs the economy has started to turn the corner (57 percent) (Blanton, 7/25).

California Healthline: Health Reform Polls Are Inconsistent And Confusing. Should We Still Pay Attention?
Ambiguity is no reason to "throw away the polls," Julie Phelan, senior research analyst at Langer Research Associates, tells California Healthline. In fact, Phelan says the results might not be as "logically inconsistent" as they seem at first glance. Phelan's firm conducts research for ABC and Bloomberg News, among other clients. … Mollyann Brodie -- senior vice president for executive operations and director of public opinion and survey research for the Kaiser Family Foundation, which produces a series of tracking polls on the ACA -- notes that public opinion on the law has been "unbelievably stable" since it was enacted (Wilson, 7/24).

NPR: Full-Time Vs. Part-Time Workers: Restaurants Weigh Obamacare
Many businesses that don't offer health insurance to all their employees breathed a sigh of relief earlier this month when they learned they'd have an extra year to comply with the new health care law or face stiff penalties (Ydstie, 7/24).

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Crunch Time In The Countdown To Health Exchanges' Opening Day

News reports also offer insights to how these online marketplaces are taking shape in Oregon and Connecticut.

CNN: Gearing Up For Health Exchanges: Crunch Time For Obamacare
A calendar on the office wall of senior White House communications adviser Tara McGuinness counts the days until marketplaces under the sweeping health care law championed by President Barack Obama open in states nationwide. McGuinness and others working to insure the uninsured have fewer than 10 weeks until open enrollment in state and federally managed insurance exchanges begins on October 1. Then they'll have just six months to educate as many people as possible about the Affordable Care Act, a 2010 law that for many is just a political attack line (Aigner-Treworgy, 7/24).

The Wall Street Journal: Low-Cost Insurance Offer Limits Federal Subsidies For Portland Buyers
Federal subsidies in the new health-care law will help offset the cost of insurance for lower-income buyers. But in the Portland area, the subsidies will be smaller than expected because of the low prices offered by a regional insurer. The subsidies are based on the cost of the second-cheapest midlevel plan, as well as annual incomes (Weaver and Radnofsky, 7/24).

The Associated Press: Apple-Inspired Conn. Stores Planned For Health Law
Besides television and radio advertisements, billboards and signs on buses, Connecticut's new insurance marketplace is planning to open storefronts inspired by Apple to help get the word out about President Barack Obama's health care law and coming enrollment. Officials at Access Health CT, the state's marketplace, believe Connecticut is the only state running its own marketplace that plans to set up insurance stores modeled after computer giant Apple's establishments (Haigh, 7/24).

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For Many States, Medicaid Expansion Plans Remain Unsettled

Federal officials remind Florida lawmakers that it is not too late to opt into the program, while in Virginia, Politico reports the issue could be decided by this fall's gubernatorial election. Also, an Arizona push to get the issue on the ballot in November may fail because of paperwork errors and the Michigan Senate considers a tweaked expansion bill that requires co-pays for new Medicaid enrollees.

Politico: Race May Sway Virginia Medicaid Expansion
You won't see it listed on the ballot, but a major piece of Obamacare could be decided by Virginia voters this November. The fate of the Medicaid expansion in Virginia could hinge on whether Democrat Terry McAuliffe or Republican Attorney General Ken Cuccinelli — who boosted his national profile with his fight against the health care law — moves into the governor’s mansion next year. And the preliminary skirmishes already have drawn tea party attention (Millman, 7/25).

The Associated Press: Feds Say It's Not Too Late For Medicaid Expansion
The Obama administration reminded Florida lawmakers Wednesday that it's not too late to expand Medicaid to more than 1 million residents in the state. Health and Human Services officials laid out many of their same talking points during a telephone conference with reporters (Kennedy, 7/24).

Miami Herald: Feds To Florida: Not Too Late For Medicaid Expansion
Federal officials on Wednesday renewed calls for Florida lawmakers to accept an estimated $50 billion over the next 10 years to expand Medicaid, the joint state and federal health insurance program for the poor, to cover an additional one million Floridians who would otherwise remain uninsured even after Jan. 1 when healthcare reform begins in earnest. Saying it’s not too late for Florida to accept federal funds available for Medicaid expansion, officials with the U.S. Department of Health and Human Services held a conference call with reporters to reiterate the economic and social benefits of expanding the healthcare safety net for the state’s poorest residents (Chang and McGrory, 7/24).

Arizona Republic: Flaws Seen In Medicaid Ballot Push
Organizers of a petition drive to refer Medicaid expansion to the November 2014 ballot have made significant errors in their paperwork that could doom the effort, attorneys for pro-Medicaid forces say. Kory Langhofer, representing the pro-expansion Restoring Arizona, wrote to Secretary of State Ken Bennett this week urging him to get involved. Supporters of the anti-expansion group, United Republican Alliance of Principled Conservatives, or URAPC, should know that their efforts may be for nothing, he wrote (Reinhart, 7/24).

Detroit Free Press: Tweaked Medicaid Expansion Bill Introduced In State Senate
The guts of the Medicaid expansion bill passed in the state House of Representatives in June remains in the Senate bill introduced Wednesday by its sponsor, Sen. Roger Kahn, R-Saginaw. The bill that was developed by a work group over the past month requires a 5% co-pay from new Medicaid recipients that will go up to 7% after 48 months. If a person has a chronic disease or is mentally ill, the co-pay would remain at 5% past 48 months. But the new bill, which could be voted on in late August, also adds some carrots — incentives for people who reach healthy lifestyle goals — and sticks for people who don’t contribute toward their co-pays (Gray, 7/24).

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GAO Analysis: Health Premiums Vary Widely

The Government Accountability Office report, which is based on prices reported by insurers, shows that consumers face a wide range of premium prices, deductibles and annual exposure to out-of-pocket costs. 

The Washington Post's Wonkblog: Our Data On Health Premiums Has Been Pretty Bad. Not Anymore.
On Monday, the Government Accountability Office sent back a thick stack of insurance data, broken down by state, explaining the cost of health insurance. Analysts there used data from HealthCare.Gov, a new site created under the Affordable Care Act where insurers post their offerings and how much they cost. The database, the GAO analysts admit, isn't perfect. About 20 percent of insurers don't post their plan data, which means we're missing about one-fifth of the marketplace. There's no enrollment data, which means some of the options listed may not have any subscribers. Still, this is probably the best data set we have on insurance premiums so far (Kliff, 7/24).

Kaiser Health News: Capsules: Current Insurance Costs For Individual Policies Vary Widely
Now, the Government Accountability Office is weighing in with its own analysis of how much it costs now for policies offered in each of the 50 states. The report released Wednesday is based on prices reported by insurers to a government database and shows that consumers face a wide range of premium prices, deductibles and annual exposure to out-of-pocket costs, often depending on their age, health history, family size and where they live (Appleby, 7/24). 

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IOM Urges Congress Not To Shift Medicare Payments To Pay More In Areas With Low Costs

A panel of experts says the government should by wary of suggestions that cutting payments to high cost areas and rewarding low-cost areas would help improve care and reduce Medicare costs.

The New York Times: Don't Shift Payments By Medicare, Panel Says
Adjusting Medicare payments to reward doctors and hospitals in regions that provide high-quality care at low cost would be a bad idea, the National Academy of Sciences said Wednesday. After a three-year study, the academy's Institute of Medicine rebuffed arguments by members of Congress from states like Minnesota and Iowa who say Medicare has shortchanged their health care providers for decades (Pear, 7/24).

Kaiser Health News: IOM Finds Differences In Regional Health Spending Are Linked To Post-Hospital Care And Provider Prices
Big health spending variations throughout the country are largely driven by differences in the use of post-acute services such as skilled nursing homes and home health care by Medicare beneficiaries, and by higher prices that some hospitals and doctors charge commercial insurers, according to an Institute of Medicine report released Wednesday (Rau, 7/24).

Modern Healthcare: Reform Update: IOM Won't Back Geographically Based Value Index
Congress should not adopt a geographically based value index for Medicare because healthcare decisions are not made at the regional level, but rather at the physician or organizational level, an Institute of Medicine committee concluded in a report released Wednesday. The findings in the 178-page study reiterate the committee's preliminary observations in an interim report this year: Because individual physician performance varies, an index that is based on regions is not likely to encourage more efficient behavior among providers and is unlikely to improve the overall value of care (Zigmond and Evans, 7/24).

MedPage Today: IOM Criticizes Geographic Pay Plan In Medicare
While it's long been known that Medicare spending varies greatly across geographic regions, the IOM committee sought to understand if cutting payment to high-cost areas would save money without affecting quality, or would incentivize providers to be more cost-effective. After reviewing spending and outcomes data, the committee concluded that health care involves a wide array of players from solo practitioners to large hospital systems and "opportunities for value improvement exist at all levels of healthcare decision-making" (Pittman, 7/24).

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Health Care Marketplace

WellPoint 2nd Quarter Earnings Jump 24%; Company Lists Future Possibilities

The nation's second-largest health insurer also outlined the benefits it expects to reap from the health law and other growth opportunities.

Los Angeles Times: WellPoint Earnings Jump 24% In Second-Quarter As Medical Costs Drop
WellPoint Inc., the country's second-largest insurer, beat Wall Street expectations with a second-quarter profit jump of 24% as lower medical costs partly helped the Indianapolis company post strong results. "We are pleased with our second-quarter results and encouraged by the positive momentum we have across the organization," said Joseph Swedish, WellPoint's chief executive since March (Lopez, 7/24).

The Associated Press/Washington Post: WellPoint's 2nd Quarter Profit Soars 24 Pct; Insurer Details Overhaul Growth Possibilities
Shares of WellPoint Inc. hit an all-time high Wednesday, after the nation's second-largest health insurer trounced second-quarter earnings expectations and detailed how it expects to benefit from the health care overhaul and other growth opportunities over the next few years. The Indianapolis company's stock had already climbed 44 percent so far this year as of Tuesday, as investors have grown more comfortable with both the insurer's current performance and how the overhaul will affect it (7/24).

Kaiser Health News: Capsules: WellPoint Sees Small Employers Dropping Health Coverage;
As the nation prepares to roll out the next phase of Obamacare, the second biggest medical insurer said Wednesday that it expects to lose members in health insurance plans sponsored by smaller employers. At the same time, WellPoint expects membership gains in self-insured employer plans and in the kind of individual plans that will be sold in subsidized exchanges starting Oct. 1 (Hancock, 7/24).

The Wall Street Journal: Meet The CEO With Most At Stake In Health Law
Now four months into his stint atop the second-biggest U.S. insurer, [Joseph] Swedish is working to deliver. It is a tall order for the veteran hospital leader, 62 years old, who hasn't been an executive at a health plan before. Much of the federal overhaul law goes into effect next year, and WellPoint may be the company with the most at stake. "It's a revolutionary time in health care," Mr. Swedish said in an interview. "We've got to get this right" (Mathews, 7/24).

In other marketplace news -

Los Angeles Times: Kaiser's Rising Premiums Spark Employer Backlash
For years, Kaiser Permanente has won accolades for delivering high-quality care at an affordable price. The Oakland company's unique HMO model kept a lid on costs, and big employers flocked to enroll their workers to the point that Kaiser has become the largest health plan in California, grabbing more than 40% of the market. Now, some of Kaiser's biggest customers are complaining that the company is no longer a bargain and, even worse, standing in the way of controlling healthcare costs (Terhune, 7/24).

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Capitol Hill Watch

Two GOP Senators Push To Choke Off IRS Health Law Implementation Funds

Also in the news, Sen. Marco Rubio, R-Fla., is positioning himself to be the lead sponsor of legislation that would ban abortions after 20 weeks. Meanwhile, the nursing home industry is stepping up its lobbying efforts to protect its Medicare funding.

Politico: GOP Senators Target IRS On Obamacare
Republican senators are pushing separate amendments on a spending bill this week that would choke off funding to the IRS to implement Obamacare and suggests that President Barack Obama, Vice President Joe Biden, White House staff and others participate in the insurance exchanges. The IRS amendment to the transportation appropriations bill comes from Sens. John Cornyn (R-Texas) and Ron Johnson (R-Wis.), who say that IRS targeting of conservative groups could affect the organization’s impartiality in implementing the health care law (Everett and Haberkorn, 7/24).

Texas Tribune: Cruz, Cornyn Still Prominent Critics Of Health Care Law
While addressing a group in Iowa last week, U.S. Sen. Ted Cruz said that conservatives should not approve funding for any government agencies unless the federal Affordable Care Act, commonly known as Obamacare, is defunded. "We can defund Obamacare if conservative leaders who tell their constituents they're conservative stand up and act like they’re conservative," he said, according to the Des Moines Register (Luthra, 7/25).

Politico: Marco Rubio Wants To Be Lead Sponsor On Anti-Abortion Bill
Sen. Marco Rubio said unequivocally Wednesday that he hopes to be the lead sponsor of a bill banning abortions after 20 weeks. "If someone else would like to do it instead of me, I'm more than happy to consider it. But I'd like to be the lead sponsor," the Florida Republican said. "I feel very strongly about this issue. And I'd like to be the lead sponsor on it if we can find language that we can unify people behind" (Everett, 7/24).

The Hill: Nursing Home Industry Ready For Battle Over Medicare Funding
The nursing home industry is facing a major test of its lobbying clout as lawmakers weigh whether to slash its Medicare funding. Nursing homes got a pass in January when Congress approved a short-term "doc fix" for Medicare spending that left hospitals to foot the bill for the second year in a row (Viebeck, 7/25).

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Coverage & Access

Some Warn Of 'Overwhelming' Mental Illness Care Cost Without New Research Investment

Scientists warn health systems could face "overwhelming" costs of treating mental illness if no new money is invested in research.

Reuters: Scientists Warn Of Overwhelming Costs Of Mental Illness
Health systems could be "overwhelmed" by the costs of coping with mental illnesses such as dementia, depression and addiction if nothing is done now to boost investment in research, leading neuroscientists said on Thursday (Kelland, 7/24).

News outlets look at treatment, and new models, for mental health patients -

Kaiser Health News: Capsules: Schizophrenia, Suicide And One Family's Anguish
Homer Bell was 54 years old when he committed suicide in April in a very public way -- he laid down in front of a bus in his hometown of Hartford, Conn. It was the culmination of three decades of suffering endured by Bell and his family because of his illness, schizophrenia (Cohen, 7/24).

The New York Times: Mental Health Cuts In Utah Leave Patients Adrift
Still, the changes have shaken providers and recipients of mental health care in Utah while testing the resilience of its safety net as hundreds of Medicaid patients try to find new psychiatrists and counselors and wonder who will fill their next prescription. Some patients said they felt whipsawed by the shift, and were reluctant to part with counselors or support groups they had known for a decade or more (Healy, 7/24).

The Medicare NewsGroup: Treatment Of Seriously Mentally Ill Beneficiaries On Trend With Integrated Care
Historically, treating these individuals has been a process fraught with frustrations for patients and providers alike, as patients often don’t take medications on schedule, miss appointments and are not attentive to their physical health. That has created an increasing number of seriously mentally ill people with co-occurring chronic medical conditions including diabetes, hypertension and emphysema. One such effort to improve treatment and curb spending on this high-cost, high-use population is the coordinated care model, in which a single provider acts as the main point of engagement for the patient (Pasternak, 7/24).

In the meantime, a former congressman says the Obama administration will soon issue final rules to implement the 2008 Mental Health Parity Act -

Medpage Today: Mental Health Parity Rules Coming Soon
The Obama administration will release in a few months final rules implementing the 2008 mental health parity law, a former congressman said Wednesday. The law -- the Mental Health Parity and Addiction Equity Act -- states that health plans must cover the treatment of mental illness or drug or alcohol abuse at the same level as they cover other health care treatment. But full scale-up of the law has been delayed because rules haven't been issued outlining treatment limits for some nonquantitative services -- rules that would define exactly how mental health services are comparable to physical medical care (Pittman, 7/24).

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State Watch

State Highlights: D.C. To Use Cash Reserves To Pay Medicaid Providers Off

A selection of health policy stories from the District of Columbia, Texas, California, Oregon, Connecticut, North Carolina and Pennsylvania.

The Washington Post: Lawmakers Won't Weigh In On Chartered Health Plan Settlement
How do you spend $48 million in unbudgeted taxpayer money without getting an OK from elected lawmakers? In the District of Columbia, there's pretty much only one way, and that's the way Mayor Vincent C. Gray is proposing to settle a high-stakes dispute with D.C. Chartered Health Plan. Gray spokesman Pedro Ribeiro confirmed Wednesday that the plan is to pay the District's share of the settlement -- a little over $35 million, with federal Medicaid dollars accounting for the rest -- out of the city's contingency cash reserve (DeBonis, 7/24).

Texas Tribune: AG, Planned Parenthood Affiliate Reach $1.4M Settlement
The Texas attorney general's office announced Wednesday that it obtained a $1.4 million settlement with Planned Parenthood Gulf Coast for overbilling the state's Medicaid program. "Texas' ability to help the poor is hampered by actions like those Planned Parenthood Gulf Coast was accused of committing," Texas Attorney General Greg Abbott said in a statement (Aaronson, 7/24).

California Watch: Despite Need, No Plans To Add Veterans Health Centers At More Colleges
As a community college classmate brushed off the significance of civilian war casualties, Daniel Acree, a machine gunner in the Iraq War, felt a searing pain, his body filling with rage. In Iraq, Acree had watched powerlessly as a 5-year-old boy died in a rocket-propelled grenade attack. That was all he could think of as the professor turned to him for perspective (Glantz, 7/25).

The Lund Report: Big Changes Ahead For Insurance Rate Review, Accountability
Oregon's new insurance commissioner thinks there's an opportunity to make insurance companies more accountable to consumers and drive health care costs down as the Affordable Care Act is implemented and the state seeks ways to bolster its rate review process. "We have a responsibility [to consumers] that insurance companies are charging an appropriate rate," Laura Cali said. "We need to be very strong in terms of the questions we ask [and] the documents we request" (Waldroupe, 7/24).

CT Mirror: Connecticut Takes On Abuse Of Prescription Painkillers
Connecticut is one of 17 states whose residents are more likely to die from unintentional drug overdoses than in motor vehicle accidents, with the majority of those deaths caused by common prescription opioid painkillers. From 1998 to 2010, the latest year for which data are available, an average of 272 people, ages 20 to 64, died each year in Connecticut of unintentional overdoses, while the average number of motor vehicle deaths was 201, according to state Department of Public Health statistics. Overall deaths from drug overdoses have tripled since 1990. Today, most of those deaths are caused not by street drugs like heroin, but by prescription painkillers like Vicodin, OxyContin and Percocet. The Centers for Disease Control and Prevention refers to this as a growing and deadly epidemic (Gambina, 7/24).

North Carolina Health News: Health & Human Services Budget -- The Winners
State lawmakers in both the North Carolina House and Senate voted for final passage of the biennial budget late Wednesday afternoon. The $20.6 billion plan reflects the revenue goals created in the tax reform bill passed last week and cuts $53 million from last year’s budget total (Hoban, 7/25).

CQ HealthBeat: Refusing To Comply With Wellness Program Will Cost Penn State Workers
Pennsylvania State University is joining an increasing number of large employers by rolling out a comprehensive wellness program this fall. But the educational giant has decided to use a stick rather than a carrot to get its workers to participate (Bunis, 7/25).

California Healthline: Penalty Checks Arriving For Late Hearings
State penalty checks for some people in the Community-Based Adult Services program have begun to arrive in the mail, but a consumer advocacy group said yesterday that cashing those checks could have unintended consequences. "Medi-Cal benefits are not affected in any way. But some people could lose SSI (Social Security Income) dollars" from the unexpected windfall of penalty money, according to Elizabeth Zirker, staff attorney at Disability Rights California. The state has to pay penalties to some people who were initially denied eligibility to the CBAS program. If the state took more than 90 days to process a request for a hearing and the appeal was granted, a penalty is owed (Gorn, 7/24).

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Weekend Reading

Weekend Reading: The Mystery Of Some Innovations That Are Slow To Be Accepted; Myths About The Obesity Crisis

Every week reporter Ankita Rao selects interesting reading from around the Web.

The New Yorker: Slow Ideas
Why do some innovations spread so swiftly and others so slowly? Consider the very different trajectories of surgical anesthesia and antiseptics. ... On October 16, 1846, at Massachusetts General Hospital, Morton administered his gas through an inhaler in the mouth of a young man undergoing the excision of a tumor in his jaw. ... By February, anesthesia had been used in almost all the capitals of Europe, and by June in most regions of the world. ... In the eighteen-sixties, the Edinburgh surgeon Joseph Lister ... perfected ways to use carbolic acid for cleansing hands and wounds and destroying any germs that might enter the operating field. The result was strikingly lower rates of sepsis and death. You would have thought that ... his antiseptic method would have spread as rapidly as anesthesia. Far from it. ... In our era of electronic communications, we've come to expect that important innovations will spread quickly. Plenty do ... But there's an equally long list of vital innovations that have failed to catch on. The puzzle is why (Dr. Atul Gawande, 7/29).

The New Republic: Weight Loss Is Not The Answer: What Michelle Obama Doesn’t Get About Obesity
The biggest mystery when it comes to obesity is not how to prevent it. It's how to treat it. Don’t get me wrong. We need to know what expands our girth so that millions more don’t suffer the type 2 diabetes and heart disease that follow. But millions are obese, right now, and the medical establishment doesn’t really know how to help them. I learned that to my dismay when I tried to find a program for a relative who seemed too young for stomach bands and gastric bypasses. The problem is simple and well known. It’s hard but not impossible to lose weight. But it’s nearly impossible to keep it off (Judith Shulevitz, 7/23).

The Atlantic: Answering To Patient Who Yell The Loudest
Few people would argue that scarce medical resources should simply go to patients and families who yell the loudest, but the recent case of a ten year-old Pennsylvania girl with cystic fibrosis shows how such a strategy can work. The parents of Sarah Murnaghan went to court to demand that their daughter be placed on the transplant list for new lungs.  The court agreed, and she has now received a second set of lungs after her immune system rejected the first set. There is a long—and storied—history of activist patients bucking the system to obtain treatments initially denied to them. ... But in an era of rising health care costs and passage of the Affordable Care Act (ACA), which seeks to reign and regulate spending, the privileges of activist patients need to be reexamined (Dr. Barron Lerner, 7/23).

New Scientist: Why Is The Rich U.S. In Such Poor Health?
Americans die younger and experience more injury and illness than people in other rich nations, despite spending almost twice as much per person on health care. That was the startling conclusion of a major report released earlier this year by the U.S. National Research Council and the Institute of Medicine. … As distressing as all this is, much less attention has been given to the obvious question: Why is the United States so unwell? The answer, it turns out, is simple and yet deceptively complex: It's almost everything. ... we can hope that the evidence of a health disadvantage in the United States is now so compelling that the terms of the conversation and even the political calculus will begin to change. Then, perhaps, we can start addressing that disadvantage and stop paying for it with our lives (Laudan Aron, 7/15).

Boston Globe: Hypothermia Making A Comeback In Medicine
The last Dr. Peter Franklin remembers, he was lying on a table in the cardiac catheterization lab in a Miami hospital when his chest started to hurt. Then he died. The medical team raced to restart Franklin's heart, then placed a stent in a blocked artery to allow blood to again flow freely. His doctors also worked to save his brain, using a technique that's as old as ancient Greece — hypothermia. With recent studies lending scientific credibility to the practice, doctors now know that lowering a patient's body temperature — using methods including cooling blankets or an infusion of cold fluid — can improve brain recovery in patients who are comatose after cardiac arrest (Dr. Daniela J. Lamas, 7/22).

The New England Journal of Medicine: The Residency Mismatch
For generations, the supply of practicing physicians in the United States has swung from too small to too large and back again. In 2006, alarmed about a growing physician shortage, the Association of American Medical Colleges (AAMC) recommended that medical school enrollments be increased by 30% over the next decade. ... But there's another barrier to creating enough practicing physicians: there are insufficient residency posts to accommodate all these medical graduates. ... The absence of health-workforce planning, a hallmark of the freewheeling U.S. market economy, may come back to haunt policymakers, particularly when physician shortages become more apparent as the ACA's coverage expansion takes hold (John K. Iglehart, 7/25). 

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Editorials and Opinions

Viewpoints: Doctors' Sway Over Medicare Pay; Hospital Rankings Not All They Seem; Legal Immigrants' Health Needs Overlooked

The Washington Post: Do Doctors Have Too Much Sway Over Medicare Payouts?
Reporters Peter Whoriskey and Dan Keating have opened Post readers' eyes to the fact that Medicare pays for physician services — a $69.6 billion item in 2012 — according to an arcane and little-known price list, over which doctors themselves exercise considerable and less-than-totally-transparent influence (7/24).

The Wall Street Journal: Medicare By The Scary Numbers
Even before the latest Medicare trustees report came out at the end of May, the White House spin masters had already crafted a story to go with it. Medicare's finances have improved, we're being told. The trust fund will last longer. The unfunded liability is lower. One of the reasons is said to be ObamaCare. The core of the new health reform doesn't kick in until next year, but already it's improving things for seniors? Here's the real story (John C. Goodman and Laurence J. Kotlikoff, 7/24).

The Wall Street Journal: Those Hospital Rankings Could Use A Healthy Dose Of Skepticism
The U.S. News & World Report "Best Hospitals" rankings for 2012-13 were released last week, followed by the usual media hoopla and a few chest-thumping press releases from hospitals at the top of the list. Whether the rankings actually mean anything is an entirely different story. The highest-ranked hospitals are always quick to tout their rankings in hopes of attracting new patients who will pay top dollar (Ezekial J. Emanuel and Andrew Steinmetz, 7/24).

Los Angeles Times' Capital Journal: Big-Bucks Battle Shaping Up Over Bid To Raise Malpractice Award Limit
You don't need to be a Nobel economist to understand that dollars today aren't anything close to their worth four decades ago. Gasoline, real estate, medical care—they've all skyrocketed in cost. Everything's gone up, that is, except damage awards for pain and suffering caused by medical malpractice (George Skelton, 7/24). 

The New England Journal of Medicine: Observation Care — High-Value Care Or A Cost-Shifting Loophole?
Current CMS policy on observation care promotes cost shifting without rewarding higher value, since payment is time-based and does not reward the use of evidence-based clinical pathways or hospital units designed to provide efficient care for this group of patients. ... Not all observation care is the same; payment reforms should protect patients from excessive out-of-pocket expenses and reward the efficient care delivered in observation units, which prevents prolonged hospitalizations (Drs. Christopher W. Baugh and Jeremiah D. Schuur, 7/25).

The New England Journal of Medicine: Stuck Between Health And Immigration Reform — Care For Undocumented Immigrants
Although there are valid perspectives on multiple sides of the immigration debate, there are stark public health implications of continuing to permit the existence of a medical underclass comprising more than 10 million people. Neither the recent national health reform law nor the immigration bill currently being considered solves these vexing problems; indeed, these policies may increase the barriers for some undocumented immigrants. For the foreseeable future, undocumented immigrants will remain on the outskirts of our public programs and safety net, a controversial reminder of ongoing inequities in our health care system (Dr. Benjamin D. Sommers, 7/24).

The New England Journal of Medicine: Holes in the Safety Net — Legal Immigrants' Access to Health Insurance
While Congress debates whether publicly supported health care should be available to undocumented immigrants who may be placed on a path to citizenship under immigration reform, the health care needs of already legal immigrants continues to be overlooked. More than 12 million immigrants are lawfully present in the United States. ... Public policies that deny legal immigrants equal access to public insurance programs leave lawful residents and their health care providers unnecessarily vulnerable when injuries and illness strike. By encouraging immigrant-only programs, such policies also perpetuate needless complexity in the health care system (Wendy E. Parmet, 7/24).

The New England Journal of Medicine: Rationing Lung Transplants — Procedural Fairness In Allocation And Appeals
The well-publicized cases of two pediatric candidates for lung transplants have shaken the transplant community with emergency legal injunctions arguing that current lung-allocation policy is "arbitrary and capricious." Although the resulting transplantation seemingly provided an uplifting conclusion to an emotional public debate, this precedent may open the floodgates to litigation from patients seeking to improve their chances of obtaining organs. These cases questioned the potential disadvantaging of children and the procedural fairness in lung allocation. But legal appeals exacerbate inequities and undercut public trust in the organ-transplantation system (Keren Ladin and Dr. Douglas W. Hanto, 7/24).

The New England Journal of Medicine: Accountable Prescribing
As insurance coverage expands, we must ensure that greater access to prescription drugs confers better health, not harm. The need to advance performance measures as health care reform proceeds is well recognized. Ideally, we should assess outcomes valued by patients, but for reasons of feasibility, many measures focus instead on surrogate end points. To improve health, such end points must be based on strong evidence, and how you get there matters (Drs. Nancy E. Morden, Lisa M. Schwartz, Elliott S. Fisher and Steven Woloshin, 7/25). 

The New York Times: Justice For The Mentally Disabled
Gov. Andrew Cuomo closed out a shameful period in New York's history earlier this week when he agreed to give about 4,000 mentally ill people held in highly restrictive institutional settings the option of moving into supported housing, where they can live independently with the help of social service organizations. The agreement, outlined in a consent decree filed in federal court in New York City, ends a long legal battle and could bring a new day for people isolated in inadequate, for-profit residences that make their disabilities that much harder to bear (7/24).

The New York Times: Realities In Global Treatment Of H.I.V.
The World Health Organization recently issued aggressive new guidelines for treating people infected with H.I.V., the virus that causes AIDS. The guidelines are a welcome step forward but fall short of the treatment goals that could and should be set (7/24). 

JAMA: Why Obamacare Needs Millenials
One of the primary goals of the Affordable Care Act (ACA)—now known more commonly as Obamacare—is to make health insurance more accessible, particularly for people with preexisting conditions. … This focus on reaching young and healthy people is almost strangely ironic in that the new health insurance exchanges and Obamacare proponents appear to be engaging in the same "cherry picking" for which they have criticized insurers (Larry Levitt, 7/24).

National Journal: The Unprecedented – And Contemptible – Attempts To Sabotage Obamacare
When Mike Lee pledges to try to shut down the government unless President Obama knuckles under and defunds Obamacare entirely, it is not news—it is par for the course for the take-no-prisoners extremist senator from Utah. When the Senate Republicans' No. 2 and No. 3 leaders, John Cornyn and John Thune, sign on to the blackmail plan, it is news—of the most depressing variety (Norm Ornstein, 7/24).

Chicago Tribune: Looking Back To 2013
On Monday, Gov. Pat Quinn signed into law the state's massive Medicaid expansion. With that flick of his pen, 342,000 low-income Illinois citizens will be newly eligible for Medicaid starting in January. State officials also expect as many as 171,000 others who are now eligible but haven't signed up to do so as an Obamacare marketing campaign rolls out. If so, the number of Medicaid recipients would grow from today's 2.8 million to 3.3 million — more than 1 in 4 Illinoisans. ... We also hope that, a decade or two from now, Illinois citizens don't look back to 2013 and say: What were they thinking? How could the politicians be so willfully blind to the billions that the Medicaid expansion would cost taxpayers? (7/24).

Pittsburgh Post-Gazette: Much Is At Stake For Minorities In Medicaid Debate
As Pennsylvania decides whether to expand its Medicaid program, a new study says the decision will have a major impact on the state's racial and ethnic minorities. A Kaiser Family Foundation analysis found that 15 percent of African Americans in Pennsylvania are without health insurance and nearly two-thirds of them would qualify for coverage under federal poverty level criteria set out by the Affordable Care Act if Medicaid were expanded (Steve Twedt, 7/25).

Sacramento Bee: Use Health Law To Fight Tooth Decay In Kids
Tooth decay is the most common chronic health problem in children, according to the Centers for Disease Control and Prevention. More than a quarter of kids have decay in their baby teeth by the time they enter kindergarten. Nearly 68 percent of teenagers 16 to 19 have decay in their permanent teeth. The Affordable Care Act provides an opportunity to improve children's access to dental care starting in January 2014 – if the California state health exchange, called Covered California, does things right (7/25). 

The Huffington Post: Decline In Cost Of Health Care In America
Undeniably, over the past several years the singular focus of conversation among policy makers has shifted from simply more care and better quality of care to better value in health care, where value is defined as quality over cost. ... Yet if history is any indicator, as our economy strengthens costs of health care will rise once again. So, last month the Bipartisan Policy Center (BPC) made 50 bold recommendations on how to sustain the lower growth of health care costs (Dr. Manoj Jain and Dr. Bill Frist, 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.