Daily Health Policy Report

Thursday, July 26, 2012

Last updated: Thu, Jul 26

KHN Original Reporting & Guest Opinion



Administration News

Capitol Hill Watch

Campaign 2012

Health Care Marketplace

International AIDS Conference

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Michael Weinstein: 'We Have A Long Way To Go' In The U.S. (Video)

In this Kaiser Health News video, Weinstein, the president and co-founder of the AIDS Healthcare Foundation, tells Joanne Silberner that it is important to keep public policy focused on proven methods for controlling AIDS (7/25). Watch the video or read the transcript.

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Capsules: Medicaid Expansion Reduces Mortality, Study Finds

Now on Kaiser Health News' blog, Matthew Fleming reports: "As states decide whether to expand their Medicaid programs to cover low-income childless adults, the impact of their choices became clearer today in a study showing a reduction of mortality in states that have already made that move" (Fleming, 7/25). Check out what else is on the blog.

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Words Can Wound: How The Media Describe The Mentally Ill And Disabled

In this story, which was written by advanced reporting students at the University of Maryland's Philip Merrill College of Journalism in conjunction with Kaiser Health News, Kirsty Groff and May Wildman write: "NPR correspondent Nina Totenberg threw herself into the center of a word usage debate in February when she asked the lawyer for a man who had lied about receiving a Congressional Medal of Honor, 'So, is your client a nut case?' ... So why was there such a strong reaction to the national radio reporter's word choice? And should the media in general be more careful about the language used to describe mental illness and disability?" (Groff and Wildman, 7/26). Read the story.  

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Political Cartoon: 'Medical History'

Kaiser Health News provides a fresh take on health policy developments with "Medical History" by Bob and Tom Thaves.

Meanwhile, here's today's health policy haiku:


Is crop insurance
Equal to Obamacare?
That's what Colbert thinks

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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Study: Medicaid Expansion Has Potential To Be A Lifesaver

A Harvard study published in the New England Journal of Medicine indicates that low-income residents of three states that expanded Medicaid generally lived longer, were healthier and had better access to health care than residents of neighboring states that did not expand the program.

Los Angeles Times: Medicaid May Help People Live Longer, Study Indicates
As states consider whether to expand their Medicaid insurance programs for the poor under President Obama's healthcare law, new research indicates the decision may have life-and-death consequences. A study published Wednesday in the New England Journal of Medicine indicates that residents of states that expand coverage will probably live longer, be healthier and have better access to medical care (Levey, 7/25).

The New York Times: Medicaid Expansion May Lower Death Rates, Study Says
Into the maelstrom of debate over whether Medicaid should cover more people comes a new study by Harvard researchers who found that when states expanded their Medicaid programs and gave more poor people health insurance, fewer people died (Belluck, 7/25).

The Wall Street Journal: Death Rates Vary In Medicaid Study
States that opted for larger Medicaid programs had lower death rates, according to a study released Wednesday in the New England Journal of Medicine. The findings come as states struggle with the growing financial burden of the health-insurance program for the poor, and weigh whether to take part in its expansion under President Barack Obama's health-care law (Dooren, 7/25).

The Associated Press: Study: New Medicaid Expansion Could Be A Lifesaver
States that expand their Medicaid programs under President Barack Obama's health care law may end up saving thousands of lives, a medical journal report released Wednesday indicates. Until now, the Medicaid debate has been about budgets and states' rights. But a statistical study by Harvard researchers in the New England Journal of Medicine found a 6 percent drop in the adult death rate in Arizona, Maine and New York, three states that have recently expanded coverage for low-income residents along the general lines of the federal health care law (Alonso-Zaldivar, 7/25).

Kaiser Health News: Capsules: Medicaid Expansion Reduces Mortality, Study Finds
Now on Kaiser Health News' blog, Matthew Fleming reports: "As states decide whether to expand their Medicaid programs to cover low-income childless adults, the impact of their choices became clearer today in a study showing a reduction of mortality in states that have already made that move" (Fleming, 7/25).

NPR: Flaws And All, Medicaid Can Improve Adults' Health
Among the reasons some governors say they're considering not expanding their Medicaid programs under the Affordable Care Act is that Medicaid is, well, not a very good program. … But a study just published online by the New England Journal of Medicine adds to a growing body of evidence that Medicaid, in fact, does improve the health of those it covers (Rovner, 7/25).

Bloomberg: Deaths Fell In States That Expanded Medicaid, Harvard Study Says
Expanding U.S. state Medicaid programs may contribute to reduced death rates, as the poor, elderly and other vulnerable people benefit from greater access to health care, Harvard University researchers said in a report. Three states that expanded Medicaid in 2001 and 2002, New York, Arizona and Maine (BSTIME), collectively saw a 6.1 percent decline in the death rate for people age 20 to 64 compared to neighboring states, according to the study published in the New England Journal of Medicine. Researchers at the Harvard School of Public Health, led by assistant professor Benjamin Sommers, found larger reductions among minorities and low-income people (Wayne, 7/26).

McClatchy Newspapers: Medicaid May Help People Live Longer, Study Indicates
As states consider whether to expand their Medicaid insurance programs for the poor under President Barack Obama's health care law, new research indicates the decision may have life-and-death consequences. A study published Wednesday in the New England Journal of Medicine indicates that residents of states that expand coverage will likely live longer, be healthier and have better access to medical care. Researchers at the Harvard School of Public Health - who compared states that voluntarily expanded their Medicaid programs over the last decade with neighboring states that did not - found mortality rates were more than 6 percent lower in states with more generous coverage (Levey, 7/25).

Reuters: Medicaid Expansion In U.S. States Found To Cut Death Rates
State expansions of the Medicaid health insurance program for poor Americans reduced adult mortality rates by more than 6 percent compared to states that did not broaden eligibility for their plans, according to a study released on Wednesday. The findings published in the New England Journal of Medicine could fuel a political furor over new plans for a nationwide expansion of Medicaid that erupted after the U.S. Supreme Court's ruling to uphold President Barack Obama's healthcare law in late June (Krauskopf, 7/25).

Medpage Today: Medicaid Expansion Could Cut Death Rate
Expanding Medicaid programs might actually reduce mortality in low-income adults, a three-state study found, calling into question states opting out of the Affordable Care Act's (ACA) Medicaid expansion in light of last month's landmark Supreme Court ruling. All-cause mortality in New York, Maine, and Arizona dropped by 19.6 deaths per 100,000 adults -- a 6.1% decrease (P=0.001) -- over a 10-year period when Medicaid coverage was expanded, a study published online in the New England Journal of Medicine found (Jasmer, 7/25).

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CMS: Doughnut Hole Provision In Health Law Has Saved Seniors $4B

According to the Obama administration, seniors have saved on average $629 on their medications during the first half of this year.     

The Hill: HHS: Health Law Has Saved Seniors Nearly $4B On Medications
The Obama administration touted the health care law Wednesday for saving seniors billions of dollars on prescription drugs. The Medicare agency released figures showing that millions of seniors and people with disabilities have saved $3.9 billion on medications since the law was enacted. The data also showed that since the beginning of the year, more than 1 million Medicare beneficiaries have saved an average of $629 on prescriptions in the "doughnut hole" coverage gap (Viebeck, 7/25).

CQ Healthbeat: CMS Releases New Donut Hole Numbers
The Obama administration continues to tout the impact of the health care overhaul on Medicare recipients who have up to now fallen into the prescription drug coverage gap. Out Wednesday with new figures, the administration says that in the first half of the year, more than 1 million beneficiaries have saved an average of $629 on their medicine. Since the law was passed in 2010, officials said, more than 5.2 million seniors and people with disabilities have saved more than $3.9 billion on prescription drugs. Under the law, the so-called Part D donut hole is gradually being closed -- first with a rebate check, then drug discounts. The Centers for Medicare and Medicaid Services says the coverage gap for brand name and generic drugs will be eliminated by 2020 (7/25).

Baltimore Sun: Maryland Seniors Save $56.5 Million In Prescription Drug Charges Under Health Reform
Seniors in Maryland have saved $56.5 million on prescription drug costs because of a provision under health care reform that has eased the Medicare donut hole, new government data has found. The savings were achieved with rebates and discounts to ease the burden of the donut hole, when patients reach certain limits that require them to pay 100 percent of their prescription drug costs. The $56.5 million in savings has occurred since health reform was adopted, according to The Centers for Medicare & Medicaid Services. In the first half of this  year 15,784 seniors with Medicare in Maryland saved $10.3 million (Walker, 7/25).

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Administration News

Obama Administration And Insurers To Unveil New Plan To Crack Down On Health Care Fraud

The New York Times: Obama And Insurers Join To Cut Health Care Fraud
President Obama and health insurance executives plan to announce a new joint effort on Thursday to crack down on health care fraud by sharing and comparing claims data, administration officials say (Pear, 7/25).

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Capitol Hill Watch

Labor-HHS Bill Offers Teachable Moment Regarding Sequester Threat

Some public health organizations are using this legislation as an illustration of what the sequester's impact would be on health programs.

Politico Pro: Health Groups: Labor-HHS Cuts A 'Wake-Up Call'
Public health groups would love to rally their supporters to fight the sequester, but they have one problem -- no one understands it. So now they’re looking at a new strategy: Use the House Labor-HHS bill as an illustration of how life could look under the sequester (Dobias, 7/25).

Meanwhile, lawmakers scrutinize a Medicare Advantage demonstration program -- 

Modern Healthcare: Lawmakers Press CMS Official On Advantage Plan Bonus Pilot
The CMS official overseeing a controversial Medicare insurance pilot program told a congressional panel that he has seen anecdotal evidence that it is working. But that evidence is based "not on a scientific model." Jonathan Blum, director of the Center for Medicare at the CMS, testified Wednesday before the House Oversight and Government Reform Committee about an $8.3 billion demonstration program -- by far the largest in the agency's history -- for Medicare Advantage insurance plans (Daly, 7/25).

Politico Pro: Issa: CMS Program Intended To 'Buy' Election
A House committee chairman accused the Obama administration Wednesday of seeking to "buy an election" by plowing billions of dollars into private Medicare plans at a time when seniors are bracing for steep cuts. According to Rep. Darrell Issa (R-Calif.), chairman of the House Oversight and Government Reform Committee, an $8.3 billion CMS demonstration offering payments to private Medicare plans that improve performance is nothing more than a thinly veiled attempt to blunt the impact of Medicare cuts until after the vote (Cheney, 7/25).

In other news, former Supreme Court Justice Sandra Day O'Connor offers her take on Chief Justice John Roberts' health care opinion during a Senate Judiciary Committee hearing --

Los Angeles Times: Sandra Day O'Connor Defends John Roberts' Health Care Ruling
Attacks on Chief Justice John G. Roberts Jr. as a traitor to conservative ideals for voting to uphold most of President Obama's health care law reflect a lack of knowledge about how the American justice system works, retired Supreme Court Justice Sandra Day O'Connor said. "It's unfortunate because I think comments like that demonstrate only too well a lack of understanding that some of our citizens have about the role of the judicial branch," O'Connor said at a Senate Judiciary Committee hearing Wednesday in response to a question from Chairman Patrick J. Leahy (D-Vt). Roberts' deciding vote provoked a backlash from conservatives, who had expected the appointee of Republican President George W. Bush to side with the conservatives on the court (Goldberg, 7/25).

The Associated Press: O'Connor Says Criticism Of Roberts 'Unfortunate'
Retired Supreme Court Justice Sandra Day O'Connor on Wednesday said attacks on Chief Justice John Roberts over his key vote to uphold President Barack Obama's health care overhaul are "unfortunate." She also said that Obama's comments while the court was still considering the health care law -- that overturning it would be unprecedented and extraordinary -- were "not ideal" (Sherman, 7/25).

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Campaign 2012

Obama Campaign's Health Care Message Tailored To Minority Populations

Politico reports on the White House's focused outreach to minority groups that have very high rates of uninsurance. In a National Urban League appearance, President Barack Obama offered a defense of the health law and other policies.

Politico: White House Tailors Minority Health Care Pitch
The message: Blacks and Hispanics, among whom uninsured rates are significantly higher than among whites, stand to benefit disproportionately under the health law, gaining access to free preventive care and other services that will help reduce existing health care disparities. The sustained outreach from the White House aims to make voters eligible for new benefits aware of them and how to get them (Epstein, 7/26).

The New York Times: Obama Delivers Defense Of His Policy Efforts
President Obama wrapped up a three-day fund-raising swing with an emotional appearance here at the National Urban League conference, issuing a robust defense of his efforts to make higher education more affordable, to increase training programs for young people and to expand access to health care (Cooper, 7/25).

Meanwhile, in the Wisconsin Senate race -

Politico: Tommy Thompson Haunted By Ties To 'Obamacare'
Tommy Thompson has attacked "Obamacare" relentlessly during his Senate campaign in Wisconsin, calling the sweeping health care law a "budget-busting government takeover," intruding into the lives of private citizens. But as a private citizen, the Republican had a much different experience with the legislation: He held positions with eight companies and organizations that either benefited from Obamacare, strongly supported its passage or were considered models for the national law (Raju, 7/25).

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Health Care Marketplace

Trend Report: Health Care Jobs Move Overseas

Los Angeles Times: Worries Grow As Healthcare Firms Send Jobs Overseas
After years of shipping data-processing, accounting and other back-office work abroad, some healthcare companies are starting to shift clinical services and decision-making on medical care overseas, primarily to India and the Philippines. Some of the jobs being sent abroad include so-called pre-service nursing, where nurses at insurance firms, for example, help assess patient needs and determine treatment methods (Lee, 7/25).

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WellPoint's Second-Quarter Profits Fall

The nation's second-largest insurer reported earnings that were below expectations this week, citing job cuts that reduced the number of people covered by employer-sponsored health plans as part of the reason for the company's performance.

Los Angeles Times: Health Insurer WellPoint Cuts Profit Forecast And Shares Slide
WellPoint, which runs Anthem Blue Cross in California and health plans in 13 other states, lowered its 2012 adjusted earnings forecast to a range $7.30 to $7.40 a share, down from $7.57 a share. The consensus estimate of analysts was for $7.76 a share, according to FactSet. In contrast, rival UnitedHealth Group Inc. raised its full-year profit estimate when it reported second-quarter results last week (Terhune, 7/25).

The Associated Press: WellPoint Cuts Outlook As 2Q Profit Falls 8.3 Pct
WellPoint Inc., the nation's second-largest health insurer, surprised Wall Street on Wednesday by cutting its 2012 forecast and reporting second-quarter earnings that both fell and missed expectations. … The insurer said it lowered earnings expectations after enduring a rough month of May and seeing enrollment slip. That fall was largely due to job cuts, which reduce the number of people covered by employer-sponsored health insurance (Murphy, 7/25).

Reuters: WellPoint Cuts Forecast As Quarterly Profit Misses View
WellPoint Inc's quarterly profit missed analysts' estimates and the health insurer cut its full-year profit forecast on Wednesday on rising medical costs and lower membership, sending its shares and those of its rivals down sharply. WellPoint executives said they were refusing to cut prices that could hurt profit margins in the face of competitive pressure among health plans, leading to lower enrollment (Krauskopf, 7/25).

Market Watch: WellPoint Disappoints; Sector Gets Pummeled
Lower-than-expected earnings and a reduced outlook for WellPoint Inc. took a big bite out of the health insurance giant's shares Wednesday, and the company’s forecast sent a shiver up the spine of the managed-care sector. … WellPoint said it's seeing decreased membership numbers, as the number of those in its medical programs dropped by 126,000 during the quarter and was down 639,000 over the last 12 months. The company said it also is getting hit by higher medical costs (Britt, 7/25).

The Wall Street Journal: Wellpoint Hit Hard But Supports CEO
In the wake of disappointing earnings that dinged the stock and sharpened questions about the company's direction, WellPoint Inc.'s board made an unusual statement of support for the insurer's leadership under CEO Angela Braly (Mathews and Kamp, 7/25).

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International AIDS Conference

A Key Question At AIDS Conference: How To Pay The Costs Of Treatment?

A roundup of news from the International AIDS Conference taking place this week in Washington.

NPR: Treating Everybody With HIV Is The Goal, But Who Will Pay?
The big question hanging over the International AIDS Conference this week is whether all 34 million people in the world with HIV can possibly get antiviral drug treatment (Knox, 7/26).

Politico: AIDS Advocates Pushing For Medicaid Expansion
The expansion of the Medicaid program — or the lack thereof — has emerged as a major focus of U.S. AIDS advocates at the 2012 International AIDS Conference this week. An estimated 1.1 million Americans are infected with the HIV virus — and 1 in 5 doesn't know it. HIV/AIDS advocates say Medicaid expansion could help identify many of the infected people — and get them into treatment. It could also provide comprehensive treatment for low-income patients receiving limited care now (Norman, 7/25).

The Wall Street Journal: Bill Gates Pushes For More Advances To Fight AIDS
Much of the conversation at the XIX International AIDS Conference here this week is about how to use science already at hand to "turn the tide" on the 31-year-old pandemic. Over at his foundation's offices a few blocks away, Bill Gates is reaffirming his faith in scientific advances yet to come. "Without much better tools it is not at all realistic to think you can end this epidemic. It's just not realistic," he said in an interview this week (McKay, 7/25).

Los Angeles Times: HIV Drug Resistance Is Spreading In Africa, Experts Say
Scaling up the distribution of HIV medication over the last decade has vastly increased the number of people receiving treatment around the world.  An estimated 8 million infected people received the antiretroviral drugs in 2011, compared to just 400,000 in 2003. But with this massive roll-out comes an inevitable and potentially dangerous consequence: The AIDS virus can more easily develop resistance to these life-saving drugs (Loury, 7/25).

The Associated Press: AIDS Experts: Focus On Pregnant Women Not Enough
Even in the U.S., infections increasingly are concentrated in poor communities. Here, 1 in 4 people living with HIV is female and most are African-American or Hispanic. The Affordable Care Act is expected to improve treatment for many uninsured Americans with HIV, but a number of states say they may not expand Medicaid services, one key part of that law. A report from the 30 for 30 Campaign, a women's coalition, found those are states with high numbers of HIV-infected women (Neergaard, 7/26).

Kaiser Health News: Michael Weinstein: 'We Have A Long Way To Go' In The U.S. (Video)
In this Kaiser Health News video, Weinstein, the president and co-founder of the AIDS Healthcare Foundation, tells Joanne Silberner that it is important to keep public policy focused on proven methods for controlling AIDS (7/25).

Medpage Today: Applause, Boos Greet Politicians At IAC
Amid chanting, jeers, and cheers, congressional leaders pledged to continue a bipartisan approach to the HIV/AIDS pandemic, both at home and abroad. "We have to keep our eyes on the prize" and not let partisan politics derail a decade of progress, said Rep. Barbara Lee (D-Calif.) during a special session at the International AIDS Conference here. Lee said that she and others from both sides of the aisle had worked with former President George W. Bush to pass the President's Emergency Plan for AIDS Relief (PEPFAR), which, "quite frankly, has saved millions of lives" (Smith, 7/25).

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State Watch

Mo. Gov. Expects Health Law Questions To Be Settled By Lawmakers In 2013

States are implementing the health law: In Missouri, the governor says legislators will likely wait until the 2013 legislative session to settle their decisions on the health law's Medicaid expansion and exchanges, Texans get insurance rebates and Georgia works to define "basic" health coverage.

St. Louis Beacon: Nixon Expects Legislators To Tackle Medicaid Expansion, Health Insurance Exchange In 2013
As he keeps his options open, Missouri Gov. Jay Nixon said Wednesday that he expects it will be next winter -- after the general election ends and the next legislative session begins -- before the General Assembly is ready to address two key health care issues: Whether to expand the state's Medicaid rolls and/or set up an exchange for the uninsured to buy insurance (Mannies, 7/26).

Texas Tribune: Millions In Rebates Doled Out To Insured Texans
As if perfectly cued to election season, multimillion-dollar rebates are being doled out across America by insurance companies thanks to a new rule in the federal Affordable Care Act, or ACA. Although the much-maligned "Obamacare" remains a prime target for Texas Republicans on the campaign trail, Democrats and other political consultants say the tangible benefits of the ACA now taking effect could change voters' perspectives on President Obama's signature legislative package (Aaronson, 7/26).

Georgia Health News: State Seeks To Define 'Basics' For Health Coverage
The health reform law has spawned many new terms related to its provisions, such as "individual mandate" and "health insurance exchanges." Here's another one: "essential health benefits." The Affordable Care Act requires all insurance plans to offer a comprehensive set of benefits starting in 2014. States are allowed to choose a benchmark plan that would define those benefits that are considered essential. Georgia insurance department official Jay Florence said Tuesday that the agency is reviewing potential benchmark plans offering coverage to individuals and small businesses (Miller, 7/25).

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Hospitals May Give Free Care To Some Colo. Theater Shooting Victims

Several hospitals are giving some free care to or forgiving the bills of the victims of the Colorado theater shooting.

The Associated Press: No Medical Bills For Some Colo. Shooting Victims
Some of the victims fighting for their lives after being wounded in the movie-theater shooting rampage may face another challenge when they get out of the hospital: enormous medical bills without the benefit of health insurance. Members of the public, along with Warner Bros., the studio that released the Batman movie "The Dark Knight Rises," have contributed nearly $2 million to help victims, though it's not clear how much of that will cover medical expenses. One family is raising money on its own online. And three of the five hospitals treating victims said Wednesday they will limit or completely wipe out medical bills (Slevin and Wyatt, 7/25).

Denver Post: Children's Hospital To Give Free Care To Aurora Theater Shooting Victims
Children's Hospital said Wednesday that it will forgive the unpaid medical bills for those they treated in the Aurora shooting -- including co-pays and deductible-related expenses for those with health insurance. Two adults remain hospitalized there, and three have been released. Children's treated five people, and one patient died (Sherry, 7/26).

In the meantime officials continue or launch investigations of hospital practices in Texas and Massachusetts --

The Dallas Morning News: Monitors Say Parkland Hospitals Lags Behind In Meeting Patient-Safety Mandates
In the month of June alone, safety monitors observed 756 instances in which Parkland Memorial Hospital staff violated infection-control standards by failing to use proper hand hygiene. The monitors also found that "critical vacancies" remain in the troubled psychiatric department, including permanent physicians to oversee mental-health patients seeking emergency care. … Those are among several troubling signs in a June report card for the Dallas public hospital as it enters a critical stretch of its regulatory probation. By the end of September, the federal government expects to see evidence that all 400 mandates designed to rid the hospital of dangers to patients are met (Moffeit, 7/25).

Boston Globe: Federal Agency Investigating Exeter Hospital
The Centers for Medicare & Medicaid Services is investigating the infection control procedures at a New Hampshire hospital where, federal prosecutors say, a worker caused an outbreak of hepatitis C. David Kwiatkowski, a former medical technician at Exeter Hospital, was arrested last week and ­accused of infecting at least 30 patients with hepatitis C by stealing a powerful anesthetic prepared for use on patients and replacing it with dirty syringes (Conaboy, 7/25).

Florida hospital quality is examined by Medicare, California legislators offer a bill that would require local health districts to contract with CEOs, and charity care is up in Iowa --

Health News Florida: FL Hospitals Score Best. And Worst.
When it comes to the revolving-door syndrome, Florida hospitals are among the best and the worst.
Only two hospitals in the entire nation scored the equivalent of an "A-plus" on a Medicare analysis of readmission rates, and both are in Florida. Meanwhile, this is the only state that had two hospitals flunk all parts of the test (Gentry, 7/26).

HealthyCal: Salinas Hospital Spurs Legislation On CEO Contracts
As Salinas Valley Memorial Healthcare System's board of directors looks for a financial partner to pull it out of a bind that threatens future service in the community, a state politician is taking aim at one of the policies that put the Salinas hospital in a precarious state. Assemblyman Luis Alejo, who represents District 28, authored a bill that received unanimous support from the Assembly and is now being heard on the state Senate floor. Assembly Bill 2115, dubbed the "Hospital Accountability Bill," requires that local health care districts enter into a written contract with their hospital administrators (Flores, 7/26).

Des Moines Register: Charity Care Jumps At Iowa Hospitals Amid Economic Slump
Iowa hospitals gave 83 percent more free care last year than they did in 2007, a new survey shows. The jump in charity care came amid an economic slump and a growing number of uninsured Iowans. The Iowa Hospital Association said today that its 118 members gave out $600 million last year in charity care, which is defined as care for which no payment is sought (Leys, 7/25).

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Ariz.'s New Abortion Restrictions Get Scrutiny

Bloomberg reports how Arizona's new ban on abortions after 20 weeks, set to take effect Aug. 2, is emblematic of a growing number of state efforts to diminish access to the procedure or target those who provide it.

Bloomberg: Arizona's Ban At 20 Weeks Shows Country's Shift on Abortion Law
Jennifer Hercegovac and her husband picked out a name, set up a nursery and sold her business so she could be a stay-at-home mother….In less than a decade, Arizona has gone from a state that abortion-rights groups viewed as friendly to one that's hailed by abortion foes as a national model in their fight to protect the unborn. The shift is emblematic of the nation's, as lawmakers push to diminish access to the procedure and target those who provide it (Crawford and Deprez, 7/26).

Bloomberg: Arizona Doctors Seek to Block Law Banning Some Abortions
The Center for Reproductive Rights urged a judge to block an Arizona law, set to take effect Aug. 2, that makes it a crime for physicians to perform abortions after 20 weeks of pregnancy. U.S. District Judge James Teilborg in Phoenix heard arguments today on a request by three doctors for an order preventing that part of the statute from being enforced while they seek a ruling that it’s preempted by the U.S. Supreme Court's 1973 Roe v. Wade decision. The doctors are backed by lawyers at the reproductive rights group and the American Civil Liberties Union.

In Colorado, a judge is expected to rule on the health law's mandate that employers offer contraception coverage in their health plans --

Politico Pro: Contraception Policy Ruling Expected Friday
A Colorado judge is expected to rule Friday on a request from a small business owner to block the Obama administration’s requirement that employers provide insurance coverage of contraceptives. The policy is due to go into effect Aug 1 (Haberkorn, 7/25).

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State Roundup: Ore. Gov. Suggests Malpractice Reform; Mass. Gov. Proposes Scrutiny Of Health Providers

A selection of health policy stories from Oregon, Massachusetts, Texas, Minnesota, California, Iowa and Kansas.

The Oregonian: John Kitzhaber Recommends Reform For Oregon Medical Malpractice Laws
The state can cut health care costs and reduce the number of medical-related lawsuits by requiring earlier notification of injuries as well as pretrial mediation, according to a recommendation Gov. John Kitzhaber issued Wednesday. The product of closed-door talks between representatives of interest groups including the Oregon Medical Association and the Oregon Trial Lawyers Association, Kitzhaber's recommendation now goes to a work group including lawmakers, a trial lawyer and doctor that begins public meetings next week (Budnick, 7/25).

Boston Globe: Patrick Proposes New Way To Target Providers That Abuse Market Power
As legislative leaders go down to the wire negotiating a major health care cost-control bill, Governor Deval Patrick has proposed a new approach for targeting large, expensive hospitals and doctors groups that may be driving up fees by abusing their market power. The governor's plan requires the administration to conduct a "cost and market impact review" of any medical provider it suspects is engaging in or plans to engage in anticompetitive behavior (Kowalczyk, 7/25).

Texas Tribune: Texas Has Offered HPV Vaccine For Years
Gov. Rick Perry's failed 2007 effort to mandate that girls in Texas be inoculated against a cancer-causing, sexually transmitted disease may have haunted him on the presidential campaign trail, but health providers say the state and federal governments' ongoing efforts to keep the HPV vaccine available to poor children for free is preventing thousands statewide from suffering the long-term effects of the STD. Though the Legislature shot down Perry’s executive order requiring 12-year-old girls to be vaccinated with Gardasil to prevent the transmission of human papillomavirus (HPV), the Department of State Health Services' Texas Vaccines for Children Program began offering the vaccination in February 2007 (Tan, 7/25).

The Lund Report: Tribal Health Advocates Worry About New CCO System
Health care advocates are concerned that American Indians who choose not to participate in a coordinated care organization (CCO) will have difficulty getting access to specialty care. On August 1, CCOs begin integrating physical, dental and mental health care for about 650,000 people who qualify for Medicaid (Rendleman, 7/25).

CQ Healthbeat: Dentists' Studies Question Costs Of New Mid-Level Dental Providers
Some states are considering whether to license these alternatives to dentists as one way of making it easier for poor people to get better oral health care, but dentists have strongly resisted the idea. The studies, commissioned by the dentists and conducted by ECG Management Consultants, examined the costs and expenses that would be associated with authorizing mid-level providers in five states: Connecticut, Kansas, Maine, New Hampshire and Washington. The state-by-state studies projected that under most scenarios, the new providers would be operating at a net loss once their training costs, operation costs, salaries, academic debt and projected revenue were taken into account (Norman, 7/25).

(St. Paul) Pioneer Press: Report Says Minnesota Health Costs Moderated Through 2010
Health cost inflation moderated significantly in Minnesota during 2010, but a category of expenses called "non-medical" costs jumped by nearly 13 percent. Those were two key findings from a Minnesota Department of Health report released earlier this month that found total health care spending grew by 2.2 percent from 2009 to 2010, to $37.7 billion. That was the smallest annual rate of increase in more than 10 years and likely stemmed from decreased demand for medical services due to the slow economy (Snowbeck, 7/25).

The Lund Report: Advocates Gain Traction In Insurance Coverage For Autism
Advocates have strengthened their hand in seeking additional insurance coverage for applied behavioral analysis (ABA) treatment. Throughout the West Coast, they've achieved victories in the court system and, in Oregon, are focusing their attention on legislative changes. … A partial settlement has been reached in Washington involving a class of public employee members with autism who filed legal action against the Washington State Health Care Authority. They're seeking coverage for ABA therapy recommended by an autism expert that deals with a person's behavior impacting their development, communication or adjustment. Coverage would also include therapy in natural settings, such as a child's home or community by assistants working under the supervision of licensed providers (Jorgensen, 7/24).

California Healthline: 'Where You Live Matters' To Your Health
Health care numbers are interesting to Angela Russell but they only become important when you remember what they represent, Russell said. "Data rankings are a starting point, not an endpoint, and the key is using that information to take action," Russell said. "You have to remember, this data is alive. It represents families and individuals and communities." Russell is the engagement lead for the County Health Rankings and Roadmaps program at the University of Wisconsin Population Health Institute. Yesterday, she was in the Capitol Building to talk about using federal and state health care data to make policy changes at the local level (Gorn, 7/26).

Des Moines Register: 27% Of Iowa Adults Have Pre-Existing Health Problems, National Group Says
Families USA, which supports the Affordable Care Act, used federal health and Census data to calculate how many people have pre-existing health conditions that could cause denials if they ever applied for individual policies. The group calculated that 27 percent of non-elderly Iowa adults have such conditions. That's a bit higher than the 25 percent national average (Leys, 7/25). 

Kansas Health Institute News: Report: More Than 565,000 Kansas Adults Have Pre-Existing Conditions
More than 565,000 Kansans between the ages of 19 and 65 have one or more pre-existing medical conditions that could lead to their being denied health insurance coverage between now and Jan. 1, 2014. According to a Families USA report, "Worry No More: Kansans with Pre-Existing Conditions Are Protected by the Health Care Law," released Wednesday, the 10 most common pre-existing conditions were mental illness, obesity, lung disease, heart disease, cancer, diabetes, rheumatoid arthritis, liver disease, angina, and substance abuse. The report was designed to call attention to consumer protections in the Affordable Care Act (Ranney, 7/25).

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Weekend Reading

Longer Looks: Religious Health Care; 'The Big Lie' About Expanding Medicaid

KHN's Matthew Fleming selected these interesting articles from around the Web for weekend reading options.

The Atlantic: A Christian Alternative To Health Insurance
The Affordable Care Act has a section that exempts members of health care sharing ministries from purchasing insurance. The Amish, Mennonite, and Indian tribe communities also are exempt from the penalty that will be incurred on Americans who fail to purchase health insurance by 2014. Since the law was passed in 2010, membership for Medi-Share and Samaritan Ministries has risen by about 40 percent. Christian health sharing ministries are largely unregulated, except by themselves. This means members cannot go to an insurance commissioner with a complaint, rates aren't reviewed by an independent regulator, and there is no way to ensure they are following anti-discrimination laws (Kimberly Leonard, 7/20).

The Nation: 'We Can't Afford It':  The Big Lie About Medicaid Expansion
In his letter to Health and Human Services Secretary Kathleen Sebelius rejecting the expansion of Medicaid under the Affordable Care Act, Texas Governor Rick Perry tells a whopper. Expanding Medicaid, he writes, would "threaten even Texas with financial ruin."… In the first six years of the expansion, from 2014 to 2019, the total cost of insuring these Texans would be about $55 billion—not an inconsiderable sum. But the federal government would pay more than 95 percent of that amount; Texas's share would be just $2.6 billion. That's not chump change—but threaten Texas with financial ruin? Not by a long shot (Richard Kim, 7/20). 

National Journal: States Wrestle With Medicaid Budget Bind – Even As They Expand Coverage
Many blue states are finding themselves in a Medicaid bind these days. Several, including Illinois, have warmly embraced major expansions of their programs as part of President Obama's landmark health care law. At the same time, budget pressures have forced them to wring cost savings out of existing programs, often by cutting benefits, reducing payments to providers, or eliminating coverage for optional populations.  The latest California budget includes more than $1 billion in Medicaid cuts. Maine is eliminating coverage for more than 15,000 beneficiaries. Minnesota cut provider pay rates in 2010 and again in 2011. Connecticut cut provider rates and reduced benefits last year, including dental and vision. In the last two fiscal years, every state in the country has cut its program in some way, according to a Kaiser Family Foundation study, including 46 that cut rates paid to providers over the two-year period, and 18 that cut benefits in the last fiscal year alone (Margot Sanger-Katz, 7/25).

Forbes:  "David Clause" In Obamacare Ready To Slay The Healthcare Cost Beast
I have called this new model "concierge medicine for the masses." Officially, it is called Direct Primary Care (DPC). ... Proponents of DPC state that the best way to pay for healthcare is to pair DPC with a high-deductible wraparound policy. The idea is you use insurance what it's best for — rare items (house fires, cancer, major car accident). For day-to-day healthcare, DPC is paid for in a model that is akin to a gym membership — a flat monthly fee regardless of how much one uses it (though some have co-pays mainly due to state insurance regulations). As an observer of the evolution of health plans, I've been stunned by how slow insurance companies have been to capitalize on the DPC opportunity (Dave Chase, 7/24). 

Mother Jones: Top Obamacare Critic's Op-Eds Drafted By PR Firm That Reps Drug, Health Care Clients
Last Tuesday, a week after the Supreme Court's ruling upholding Obamacare, Sally Pipes appeared before the House Oversight and Government Reform Committee to enumerate the evils of the law. The president of the Pacific Research Institute, a San Francisco-based free-market think tank, Pipes warned members of Congress that if they didn't act quickly Americans would soon suffer the rationed care and long waits supposedly plaguing her native Canada. … All of this cemented her status as a leading voice of Obamacare opposition. Along with a constant stream of op-eds and TV appearances in recent years, she has also authored three books since 2008 lambasting health care reform. If Pipes seems supernaturally prolific, there's a good reason. To assist with her written output, PRI employs a DC-based ghostwriting and PR firm with drug and health care industry clients (Stephanie Mencimer, 7/19).

The Oregonian: The ABCs Of Getting Your Zzz's:  Why We Need Sleep, And How We Can Get More
One glance at U.S. coffee sales will give you a sense of America's sleep habits.  Sales of the caffeinated beans rose 19 percent last year and have continued to thrive in the first half of 2012. Americans, more than ever before, apparently are sleep-deprived masses muddling through the day in a zombie-like state. Studies have linked lack of sleep to issues ranging from judgment lapses and poor academic performance to obesity and stroke. And getting five hours per night during the week, then compensating with an 11-hour weekend sleep marathon doesn't cut it (Kelly House, 7/24).

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Editorials and Opinions

Viewpoints: AIDS Spread In U.S. South; Abortion Opponents Battle In Ariz.; GOP's Costly Effort To Kill Health Law

Los Angeles Times: AIDS – The South's Shame
More than 30 years into the AIDS epidemic, a combination of safe-sex education and a new generation of pharmaceuticals has left many Americans convinced that HIV/AIDS is a problem that has been, if not solved, at least addressed. But that's certainly not true in the American South, which accounts for nearly 50% of all new HIV infections in the United States (Lisa Biagiotti, 7/26).

McClatchy Newspapers: We Need To Be More Strongly Committed To End AIDS
On July 23, at the 19th annual International AIDS Conference, held in Washington, D.C., Secretary of State Hillary Clinton said the Obama administration is committed to creating an "AIDS-free generation." But we're a long way from that here at home - especially in the black community. African Americans represent half of all new HIV/AIDS cases in the United States. And if black America were a country, it would have the 16th-highest HIV/AIDS epidemic rate in the world. The biggest obstacle is the myth that AIDS is cured (Akilah Bolden-Monifa, 7/25).

Baltimore Sun: AIDS Conference Reflects Baltimore's Strategy For Containing The Epidemic
The city wants to launch a … public health campaign aimed at gay and bisexual black men, but it has had difficulty persuading the Maryland Transit Authority to allow the display of some ad posters in the city buses it operates. One poster, aimed at the underground gay "ballroom" subculture in which young gay men compete in elaborate, costumed dance contests, has been deemed inappropriate by the MTA because it's slogan — "HAVE BALLS. GET TESTED." — contains a double entendre that transit officials rejected as too risque. … At a time when the whole world is focused on testing, treatment and prevention as the front lines of the global struggle against AIDS, Baltimore should be leading the effort to find and identify those most at risk. It shouldn't have to fight the MTA on top of the disease in order to get its message out (7/25).

The New York Times: Anti-Abortionists On Trial
The state-by-state assault on women’s rights and the Constitution by Republicans faced an important challenge on Wednesday in Phoenix, where plaintiffs in a federal lawsuit are trying to block an extreme Arizona anti-abortion law from taking effect next week (7/25).

Des Moines Register: Report Trips Up GOP On Health Reform
Opponents of the health reform law say it will drive up the federal deficit and debt. Presidential candidate Mitt Romney claims it will do so by "trillions" of dollars. … There's one problem: Repealing the law will make the federal government’s financial situation worse. That little nugget of truth comes this week from the nonpartisan Congressional Budget Office (7/25).

Milwaukee Journal Sentinel: Repeal Health Care Law? Go Ahead, Bust The Budget
The American way of health care with its historical emphasis on a fee-for-service model that encourages quantity over quality needs to change. And the best way to start is by building on the ideas expressed in the new health care law - and improving those ideas as experience dictates. Simply repealing the law without a good alternative would be the real budget buster (7/25).

Houston Chronicle: U.S. Lifestyles to Blame For High Health Costs
The conclusion drawn by many, and especially supporters of the ACA, is that this higher cost is evidence of an inefficient delivery system. That may be, but there are other, and I would argue more cogent, reasons why our health care tab is so much higher. ... There is no doubt that our health care costs are on an unsustainable trajectory. The effect the ACA will have on that trajectory is anyone's guess. But I seriously doubt it is going to have much effect on Americans' dietary habits, the incidence of diabetes, our penchant for cosmetic surgery or our cultural choices around end-of-life decisions (Bill King, 7/25).

Journal of the American Medical Association: The Battle For Control Of Medical Care
Suppose you could change the entire spectrum of care for the patients in your practice so that it matches what you believe to be best: people get the care they need when they need it, and care that is wasteful or duplicative is eliminated. As a result of this, people would receive higher-quality medicine. Would medical spending rise or fall? I have asked this question to a large number of physicians, in groups large and small. The sample is an informal one, to be sure, but the conclusions are common: the typical doctor guesses that medical spending would fall by 25% to 40% if the medical system worked better (David M. Cutler, 7/25).

The New York Times: What We Can Learn From Third-World Health Care
With all the most advanced technology and equipment, spending far more on health care than any other nation — a whopping $2.6 trillion annually, or over 17 percent of our gross domestic product — the United States consistently underperforms on some of the most important health indicators. Our infant mortality rates, for example, are worse than those in countries like Hungary, Cuba and Slovenia. Our life expectancy rates are not much better; in global rankings, we sit within spitting distance of Cuba, Chile and Libya. This quality conundrum dogs us, even as our best and brightest have tried to imagine a more cost-efficient system (Dr. Pauline W. Chen, 7/26). 

The New York Times: The Story So Far
History may someday settle on one of the competing and contradictory narratives now running rampant within the virtual Beltway to explain the decision by Chief Justice John G. Roberts Jr. to save the Affordable Care Act. Since that day seems far off, here in quick summary are the emerging story lines (Linda Greenhouse, 7/25).

Boston Globe: Health Reform Bill Needs To Protect Community Hospitals
From world-class teaching hospitals and cancer research centers to neighborhood health clinics and community hospitals, Massachusetts' healthcare providers come in all shapes and sizes. And just as doctors know that what works for one patient doesn’t necessarily work for another, the Massachusetts Legislature must realize that regulations aimed at containing healthcare costs can't be a one-size-fits-all approach (Michael V. Sack and Kevin F. Smith, 7/25).

The Billings Gazette: Consider Options To Cover Montana's Uninsured
Since the Supreme Court ruled that Medicaid expansion is optional for states, Montana leaders ought to negotiate with the federal government for flexibility. Maybe the state can set up an adult program similar to CHIP. Perhaps, the state could do a pilot program enrolling some low-income adults in private insurance plans with low out-of-pocket costs and the state paying the premiums. Most Montana Medicaid spending is on elderly and disabled people. Montanan's uninsured are predominantly young adults who will cost much less per person than the Medicaid population already covered (7/24).

Sacramento Bee: Should States Opt Out Of Medicaid Expansion In Health Care Reform? Yes.
It's probably too much to ask Gov. Jerry Brown and a Democratic Legislature to rethink what, at a superficial glance, looks like a pretty deal for states. But the proposed Medicaid expansion under Obamacare harbors risks that California and other struggling state governments can ill afford. ... What's to stop a Congress facing ever-greater pressure to cut the budget deficit and control a multitrillion-dollar debt from reducing Medicaid subsidies further, placing an even heavier burden on the states? (Ben Boychuck, 7/26).

Sacramento Bee: Should States Opt Out Of Medicaid Expansion In Health Care Reform? No.
It would be a cruel joke, indeed, if holdout states abandoned childless adults who have little or no income. ... The federal government will pick up 100 percent of the cost for the newly eligible individuals the first three years; that rate gradually decreases to 90 percent by 2020. That's a whole lot better than the 50 percent to 83 percent the federal government pays today – and every state finds it beneficial to participate (Pia Lopez, 7/26).

Baltimore Sun: Flexibility Needed For Affordable Care Act Medicaid Requirement
Twenty million Americans live at or below the federal poverty line and are uninsured. The Supreme Court ruling on the Affordable Care Act (ACA) could leave many without access to affordable health insurance — but only if we let ideological warfare triumph over practical policy solutions. The court upheld the Medicaid expansion under the ACA as constitutional but stated that the federal government cannot punish states that opt out of this provision by taking away existing Medicaid funding for current enrollees. Some state officials now say that they plan to opt out of the Medicaid expansion. In the ongoing theatrics and shrill debates over health reform, it is hard but necessary to declare a ceasefire and develop a "peace plan" (Jack Meyer and Karoline Mortensen, 7/25).

The Lund Report:  Good News And Bad News For Oregon’s Dual Eligibles
Two weeks ago, Oregon was granted a federal waiver to conduct a demonstration that will change our state’s Medicaid managed care model to a coordinated care delivery model. This waiver firmly sets Oregon on the course to better health care and to take advantage of the 2013 Medicaid expansion financing available in the Affordable Care Act. But it also harbors a not-so-good option for our state's most vulnerable, or those individuals who are eligible for both Medicaid and Medicare coverage, often referred to as dual-eligible patients (Chris Bouneff, 7/25).

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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.