Daily Health Policy Report

Friday, July 26, 2013

Last updated: Fri, Jul 26

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Fraud & Abuse

Health Care Marketplace

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Law Boosts Status Of Alternative Medicine -- At Least On Paper

Kaiser Health News staff writer Ankita Rao reports: "Complementary and alternative medicine -- a term that encompasses meditation, acupuncture, chiropractic care and homeopathic treatment, among other things -- has become increasingly popular. About four in 10 adults (and one in nine children) in the U.S. are using some form of alternative medicine, according to the National Institutes of Health. And with the implementation of the Affordable Care Act, the field could make even more headway in the mainstream health care system. That is, unless the fine print -- in state legislation and insurance plans -- falls short because of unclear language and insufficient oversight" (Rao, 7/26). Read the story.

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Political Cartoon: 'Go Figure?'

Kaiser Health News provides a fresh take on health policy developments with "Go Figure?" by Nate Beeler.

Meanwhile, here is today's health policy haiku:


Teddy Roosevelt
is stepping up to the plate.
A health law home run?

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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Capitol Hill Watch

Some GOP Lawmakers Advance Plan For Health Law Showdown

Politico reports that a feud is brewing among Republicans about whether to use a government funding measure to choke off funding for the law's implementation ahead of this fall's budget battles.

Politico: GOP Feuds Over Obamacare Tactics
A brewing Republican versus Republican fight over whether to use a government funding measure to choke off Obamacare is splitting the party ahead of this fall’s budget battles. A growing number of Republicans are rejecting calls from leading conservatives, including Sens. Marco Rubio, Ted Cruz and Rand Paul, to defund the president’s health care law in the resolution to keep the government running past Sept. 30. The rift exposes an emerging divide over how the GOP can best achieve its No. 1 goal — to repeal Obamacare — while highlighting the spreading fears that Republicans would lose a public relations war if the dispute leads to a government shutdown in the fall (Raju and Sherman, 7/25).

The Associated Press/Washington Post: Health Care Funding, More Spending Cuts Are Obstacles to Averting Government Shutdown In Fall
There hasn’t been a government shutdown in nearly two decades, but top lawmakers on Capitol Hill are finding trickier-than-usual obstacles in their path as they try to come up with must-do legislation to keep federal agencies running after Sept. 30. Conservatives making a last stand against President Barack Obama’s new health care law and Senate Democrats’ resistance to a $20 billion spending cut wanted by many, if not most, Republicans are two of the major problems confronting House Speaker John Boehner, R-Ohio, and other GOP leaders (7/26).

Reuters/The Washington Post: Republicans Prepare For 'Obamacare' Showdown, With Eye To 2014 Elections
With the Obama administration poised for a huge public education campaign on healthcare reform, Republicans and their allies are mobilizing a counter-offensive including town hall meetings, protests and media promotions to dissuade uninsured Americans from obtaining health coverage (7/25).

Politico: Republicans Pen Obamacare Letter To John Boehner
More than 60 Republicans have signed a letter urging Speaker John Boehner to defund Obamacare when Congress funds the government in September. The letter, being circulated by the office of freshman Rep. Mark Meadows, doesn't explicitly say that supporters will vote against a government funding bill if it does not strip funding for Obamacare. But it says that signers of the letter are "urging [Boehner and Majority Leader Eric Cantor (R-Va.)] to defund the implementation and enforcement of the Patient Protection and Affordable Care Act in any relevant appropriations bill brought to the House floor in the 113th Congress, including any continuing appropriations bill" (Sherman and Bresnahan, 7/26).

Politico: Marco Rubio Doubles Down On Obamacare Defunding Rhetoric
Rubio and other Senate Republicans have already signed a letter promising not to support a continuing resolution or appropriations bill that funds further implementation or enforcement of the law. Depending on how many lawmakers follow their lead, the Affordable Care Act could turn into a central sticking point over raising the debt ceiling, which the government is expected to hit sometime between Oct. 1 and the end of the year (Cunningham, 7/25).

In related news -

The Hill: Bill Targets ObamaCare 'Honor System'
Legislation introduced this week in the House would prohibit the distribution of federal subsidies to ObamaCare exchanges until a system is in place to counter fraud. The bill, introduced by Rep. Diane Black (R-Tenn.), comes in response to hundreds of pages of new regulations setting forth, among other provisions, verification rules for those applying for insurance under the law (Goad, 7/25).

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Health Reform

Look Who Is Talking About Obamacare ...

The Obama administration is enlisting help in educating the public about the health law from a range of sources -- female bloggers, a comedy website and even the Washington Nationals' presidential mascot.

The Associated Press/Washington Post: Health Secretary Sebelius Urges Female Bloggers To Educate Public About Health Law Benefits
President Barack Obama's administration is courting female bloggers to play a role in a massive campaign aimed at informing the public about the benefits of the new health care law. Over breakfast at a blogging conference Thursday in Chicago, U.S. Health and Human Services Secretary Kathleen Sebelius asked a banquet hall full of bloggers -- most of them women -- to help spread the word about new health insurance opportunities that begin this fall under the Affordable Care Act (7/25).

The Wall Street Journal's Washington Wire: HHS Drafts Teddy Roosevelt To Promote Obamacare
The Obama administration hasn't found much support among the GOP for promoting health insurance this fall, but they have won over at least one Republican: Teddy Roosevelt. The long-suffering presidential mascot for the Washington Nationals baseball team starred in a video promo last night with Health and Human Services Secretary Kathleen Sebelius to promote Obamacare. The video aired before the Nationals game last night with the Pittsburgh Pirates (Schatz, 7/24).

The Hill: Comedy Site Eager To Promote ObamaCare
Writers at the popular comedy website Funny or Die are already busy coming up with ideas to spread the word about Obamacare. Mike Farah, the site's president of production, was among the entertainment industry figures who met earlier this week with President Obama and his administration about ways to encourage young people to buy health insurance (Baker, 7/25).

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Buying Obamacare Coverage Online May Require More Than Clicks

The Associated Press notes that shopping online for health insurance this fall may not be as easy as supporters have described since some tools may not be in place by Oct. 1. Meanwhile, Politico reports on warnings by Rep. Michael Burgess, R-Texas, that consumers who misreport their income to qualify for insurance subsidies will have to pay them back the following year.

The Associated Press/Washington Post: Getting Health Coverage Through Obama Law Not As Easy As Shopping On Travelocity Or Amazon
You may have heard that shopping for health insurance under President Barack Obama’s health care overhaul will be like using Travelocity or Amazon. But many people will end up with something more mundane than online shopping, like a call to the help desk (7/26).

Politico: Michael Burgess Warns Of Obamacare Enrollment Fallout
Overeager Obamacare boosters could put the law’s first customers in a tight spot, a House Republican warned Thursday. The health law provides tax subsidies for people to purchase health insurance based on their projected income for the year. But if they earn more than projected, the law also requires them to return a portion of their subsidy. Rep. Michael Burgess (R-Texas) says that if Obamacare enrollment advocates push too hard to hit their targets, they could persuade a lot of people to claim subsidies only to have to pay them back at the end of the year (Cheney, 7/25).

CNN Money: Who Loses Out Under Obamacare
When the state-based insurance exchanges open next year under Obamacare, many Americans should finally have access to affordable insurance. But millions of others will most likely be left out in the cold and remain uninsured. These folks -- mainly low-income adults in the 21 states that aren't expanding Medicaid -- will not be eligible for either the long-standing government health insurance program for the poor, or for premium subsidies in the new exchanges (Luhby, 7/25).

Here's a sampling of state-based coverage regarding the online insurance marketplaces -

MPR News: Clocks Ticks Down To Start Of MNsure Exchange
The state health-insurance exchange known as MNsure is getting ready to begin operating on its mandated launch date of Oct. 1. On the way to meeting that date, MNsure staff have asked the federal government for $40 million more, on top of the $110 million the program has already received in federal funds. Minnesota is one of 17 states that have proceeded with plans to set up their own exchanges. Seven others have decided to establish exchanges in partnership with the federal government, but the majority — 27 states — have chosen not to act, meaning that the federal government will operate exchanges for them (7/25).

CT Mirror: New Insurer Lowers Proposed Rates For Obamacare Health Plans
HealthyCT, a new insurer, has significantly reduced what it’s proposing to charge customers who buy health plans through the new marketplace created by the federal health reform law. The new proposals would make the average rates offered by HealthyCT the lowest to be offered through the marketplace, known as Access Health CT. If approved, the average monthly cost for a HealthyCT plan for an individual would be $271, and the average for a small group would be $408, although those figures would vary considerably based on a person’s age, location and the specific plan selected (Becker, 7/25).

Oregonian: State Will Pay Groups To Help Small Businesses Get Health Coverage
The state will pay business associations to spread the word about changes in health coverage that are about to kick in. Cover Oregon, the state's health insurance marketplace, is offering $750,000 in grants to help small businesses learn about changes in health coverage and enrollment that start in October. The changes stem from the federal Affordable Care Act, or Obamacare (Budnick, 7/25).

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CVS To Help Customers Learn About Health Law's Coverage Options

CVS Caremark plans to launch an outreach campaign this fall that will include having so-called "navigators," or specially trained guides, working in stores to give people individualized help.

The Wall Street Journal’s Washington Wire: CVS Plans To Help Customers Sign Up for Obamacare
CVS Caremark Corp. will roll out an outreach campaign this fall to help uninsured Americans find out about their insurance options under the Affordable Care Act. Federal and state governments are planning to launch online insurance exchanges or marketplaces starting Oct. 1 that will allow people to shop for private health insurance or Medicaid if they qualify. Coverage would start Jan. 1 (Dooren, 7/25).

Politico: CVS Caremark Will Help Promote Obamacare
CVS Caremark is joining the effort to encourage Americans to sign up for Obamacare insurance programs, company executives announced Thursday. CVS officials told POLITICO that they're planning to use pharmacies at their 7,400 North American stores as a gateway for the uninsured to learn about new coverage options — especially subsidized insurance coverage available to low-income people on state-based insurance exchanges (Cheney, 7/26).

CQ HealthBeat: Chain Drug Stores: Major Force In Enrolling Uninsured
CVS Caremark plans to roll out a program at its 7,400 retail drug stores and 6,500 clinics to educate customers about coverage opportunities under the health care overhaul law. The program includes trying to have "Navigator" organizations set up on site to give people individualized help in learning about the law, their coverage options, and the costs involved (Reichard, 7/25).

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New Poll Gauges 'Politically Precarious' Status Of Health Law

Also in the news, the vice president of a popular restaurant chain discusses how his business might respond to the health law's coverage mandates.

National Journal: Poll: Even Supporters Of Obamacare Are Ambivalent About The Law
Opponents of President Obama's health care law overwhelmingly believe the Affordable Care Act will worsen the quality of their care, and even a plurality of the law's supporters don't think it will improve their health care, though they think it will benefit the poor and uninsured. These findings from this week's United Technologies/National Journal Congressional Connection Poll underscore why the law has become so politically precarious for the White House (Shepard, 7/25).

Los Angeles Times: White Castle VP Talks Part-Time Workers In Response To Health Care Law
As President Obama's health care law rolls out in the coming years, business owners are figuring out how they will comply with coverage mandates. One popular restaurant chain, White Castle, may in the future hire only part-time workers once the law is fully implemented, according to Vice President Jamie Richardson. Richardson told NPR in an interview that the company is trying to figure out how to keep costs down (Lopez, 7/25).

And on the topic of alternative medicine --

Kaiser Health News: Health Law Boosts Status Of Alternative Medicine -- At Least On Paper
Complementary and alternative medicine -- a term that encompasses meditation, acupuncture, chiropractic care and homeopathic treatment, among other things -- has become increasingly popular. About four in 10 adults (and one in nine children) in the U.S. are using some form of alternative medicine, according to the National Institutes of Health. And with the implementation of the Affordable Care Act, the field could make even more headway in the mainstream health care system. That is, unless the fine print -- in state legislation and insurance plans -- falls short because of unclear language and insufficient oversight (Rao, 7/26).

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Health Care Fraud & Abuse

Deals Between Surgeons, Medical-Device Makers Draw Scrutiny

The Wall Street Journal reports on a civil investigation into a network of physician-owned spinal-implant distributorships. Also, the Center for Public Integrity notes that budget cuts could cause several high-profile federal health-care fraud and abuse investigations to be scaled back.

The Wall Street Journal: Surgeons Eyed Over Deals With Medical-Device Makers
Federal prosecutors' scrutiny of Dr. Sabit is part of a broader civil investigation into a network of physician-owned spinal-implant distributorships operated by two former medical-device company employees, the people with knowledge of the matter say. This network, which was run out of Utah and comprised at least 11 physician-owned distributorships in six states, generated tens of millions of dollars in profits for its investors over six years (Carreyou, 7/25).

The Center for Public Integrity/Washington Post: Budget Cuts force Scale Back Of Health-Care Fraud Investigations
Facing major budget and staff cuts, federal officials are scaling back several high-profile health-care fraud and abuse investigations, including an audit of the state insurance exchanges that are set to open later this year as a key provision of the Affordable Care Act (Schulte, 7/25).

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Health Care Marketplace

Florida Blue To Get Reorganization Hearing Despite Conflict Worries

Florida Blue -- which covers 4 million in that state -- will get a hearing about its proposed reorganization despite conflict-of-interest concerns from some.

The Associated Press: Fla. Blue's Proposed Restructure To Get Hearing
Health insurance giant Florida Blue, one of the state's largest employers and political donors, wants to restructure itself, but critics warn the move could create a conflict between turning a profit and the obligation to provide low-cost insurance to its 4 million policy holders (Kennedy, 7/25).

Health News Florida: State Reviews Florida Blue Plan As Watchdogs Question How Law Changed
A proposed reorganization of the state's largest health insurer comes before a state insurance hearing Thursday in Miami, but a watchdog group says it is disappointed by the handling of legislation Gov. Rick Scott signed June 7 that Florida Blue sought to help it expand after the change (Elmore and Singer, 7/25).

In the meantime, Georgia officials plan to change a bid process for a state employees health benefits contract after UnitedHealthcare protested one contract award -

Georgia Health News: United Protests State's Contract Award To Blue Cross
UnitedHealthcare has launched a protest of the apparent award of the state employees health benefits contract to Blue Cross and Blue Shield of Georgia, according to an AJC report Thursday. The AJC article says that United has alleged that the Department of Community Health held a secret bid that kept the Minnesota-based company from competing for the business (Miller, 7/25).

Georgia Health News: Bid Process To Change For One Benefits Contract
The Georgia agency overseeing the state employees health plan said Thursday that it will change the procedure for one of two contracts connected with the plan. A Department of Community Health statement, from new Commissioner Clyde Reese, said a review found that a project for the State Health Benefit Plan (SHBP) to obtain a "regional vendor," begun in May, was "not properly inclusive" (Miller, 7/25).

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State Watch

Coalition Begins Effort For Ballot Initiative To Lift California's Malpractice Cap

Supporters hope their proposal will qualify for the November 2014 ballot. In response, a second coalition -- this one consisting of doctors and hospitals -- is working to defeat the measure.  

Los Angeles Times: Watchdog Group, Father Begin Medical Malpractice Initiative Campaign
Santa Monica-based Consumer Watchdog and the father of two children killed by a drug-abusing driver have taken the first step toward waging an initiative campaign to raise limits on medical malpractice "pain and suffering" jury awards. ... Supporters hope to qualify for the November 2014 general election ballot. The campaign wants voters to change a 38-year-old California law that puts a $250,000 cap on the amount of money that juries can award for non-economic damages resulting from a medical provider's malpractice. A key element would hike the cap by accounting for inflation since 1975 and then adjusting it annually as needed. In today's dollars, the current cap would be about $1 million (Lifsher, 7/25).

Sacramento Bee: Initiative To Lift California Medical Malpractice Cap Filed
The drive to raise the amount victims can recover in medical malpractice lawsuits may be going to California's ballot box. A coalition that includes the Consumer Attorneys of California, an organization representing trial lawyers, has been lobbying the Legislature aggressively this year to lift a $250,000 ceiling on pain and suffering damages in malpractice cases (White, 7/25).

Los Angeles Times: Doctors, Hospitals Join To Fight Changes To Malpractice Awards
The fight to raise the cap on awards in medical malpractice cases was officially joined on Thursday with groups backed by litigators filing a ballot initiative that could be before voters next year, and a coalition of doctors and hospitals responding with a new political committee to defeat the proposal (York, 7/25). 

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State Highlights: Officials Fight N.Y. Hospital Reopening After Sandy

A selection of health policy stories from New York, North Carolina, Arkansas, Florida and California.

The Associated Press/Washington Post: N.Y. Fights Reopening Of Hospital Damaged By Sandy, Says Facility Has Long Been Bleeding Money
Officials at the last hospital still closed after Superstorm Sandy are engaged in a nasty public feud with the state Health Department, which says the facility has been bleeding money for years and should merge with its closest competitor if it wants to continue providing health services (7/25).

The Associated Press/New York Times: North Carolina: Abortion Curbs Await Governor's Decision
The state's Republican-led legislature has approved new abortion rules that backers say will make the procedure safer but that critics say aim to restrict the ability of women to have abortions by forcing clinics to close. The State Senate gave final approval on Thursday to a measure empowering the state Department of Health and Human Services to develop rules to regulate abortion clinics based on the same standards as those set for outpatient surgery centers (7/25).

The Associated Press: Legislators Mull Risk To Arkansas Health Centers Funding
Directors of community health centers that serve some of the poorest Arkansans in areas with a dearth of medical providers told legislators Thursday that they oppose a provision in a health care expansion plan that could lower their revenue. The centers provide medical, dental and mental health services mainly to people with no health insurance or limited coverage (7/25).

Health News Florida: FL Near Bottom On Fed Grants
Since the Affordable Care Act was signed, most state governments have made the most of the federal grants flowing from Washington for health-system reform. Not Florida. State agencies in Tallahassee have either not competed for grants or, on occasion, have won them but then given the money back (Gentry, 7/25).

HealthyCal: Laws Expand Birth Control Access
Recent federal and state laws strive to make it easier for women to access birth control in California, but clinics and insurers say that the changes have not increased demand for contraceptives. A state law that took effect earlier this year allows registered nurses to dispense hormonal contraceptives to expand access to women in rural areas, where doctors and nurse practitioners are harder to come by than in urban areas. Federal Affordable Care Act provisions also went into effect in August 2012 requiring private insurers to cover all Federal Drug Administration approved methods of contraception (Flores, 7/25).

California Healthline: 6% Need New Providers In Transition From Healthy Families To Managed Care
That relatively low level of disruption reflects the effort and care the state has shown in implementing this transition, according to Rene Mollow, deputy director of benefits and eligibility at the Department of Health Care Services, which is overseeing the transition. "I believe, unequivocally, that the department has been successful in this transition," Mollow said. … So far, roughly 614,000 children have been shifted to Medi-Cal, and roughly 40,000 of those children have needed to change providers. That's a little more than 6 percent of kids with new providers. According to DHCS numbers, less than 1 percent of transitioned children had to change health plans (Gorn, 7/25).

California Healthline: California Behind National Scope-Of-Practice Curve, Nurse Practitioners Say
Many states, including California, are working on legislation aimed at changing the way nurse practitioners, physician assistants, pharmacists and other providers do their jobs. Many non-physician providers argue they could and should be doing more for patients than state regulations allow. These efforts are not new, but with Affordable Care Act deadlines looming, they're gaining more attention -- and in some cases more momentum. "I think there's growing acceptance that something needs to be done and a lot of states are looking at this now with a new sense of urgency," said Stephen Ferrara, executive director of the Nurse Practitioner Association New York State (Lauer, 7/25).

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Health Policy Research

Research Roundup: Even Parents With A Pediatrician Often Choose Retail Clinics

Each week, KHN reporter Alvin Tran compiles a selection of recently released health policy studies and briefs.

Health Affairs: States With The Least Restrictive Regulations Experienced The Largest Increase In Patients Seen By Nurse Practitioners – Although primary care is considered a key focus of health reform, the number of medical students choosing that practice has declined from 60 percent in 1998 to less than 30 percent today. One proposal to help meet the need for more primary care is to expand the practicing privileges of nurse practitioners. Using Medicare data, researchers in this study aimed to assess the impact of state regulation on the use of advanced practice nurses. "The number of Medicare patients receiving care from nurse practitioners rose fifteenfold between 1998 and 2010," the authors write. They found that state laws, particularly those giving or prohibiting power to prescribe medication, contribute strongly to increasing the number of nurse practitioners and the number of patients they treat. "Modifying state regulations of [nurse practitioners'] practice is one path to expanding access to primary care," the authors conclude (Kuo et al., 7/2013).

JAMA Pediatrics: Parents' Experiences With Pediatric Care At Retail Clinics –Retail clinics, set inside stores such as Walgreens and CVS, offer convenient but limited primary care services to adults and children. But while the number of such clinics in the country is expected to grow beyond 6,000 by 2013, little is known about their use for pediatric care. In this study, researchers  surveyed nearly 1,500 parents in waiting rooms of 19 pediatric offices in the Midwest. They found that more than 23 percent of parents—who had established contacts with a pediatric practice—had used retail clinics for their children's care, many of them multiple times. Most of the visits to the retail clinics, the parents reported, occurred when their pediatricians' offices were open. "Many parents first considered going to the pediatrician for care but were unable to or believed they would be unable to get a convenient, timely appointment for an office visit; or thought the illness was not severe enough to warrant an office visit or bother their [primary care provider] after hours," the authors write. Pediatricians, the authors conclude, need to directly address parents' need for convenient access to care, should set up communications with retail clinics to insure patients' quality of care and cut down duplication of services and make clear to patients that if they seek care at a retail clinic, they should let the pediatricians know so that care can be coordinated (Garbutt et al., 7/22).

JAMA: Characteristics Associated With Differences In Survival Among Black And White Women With Breast Cancer – In this study, researchers examined the extent of the disparity between white and black breast cancer patients by analyzing differences in treatments between 1991 and 2005. Their study included 107,273 Medicare beneficiaries who were newly diagnosed with breast cancer. While only 7,375 patients in their study population were black, the large number of white patients allowed the researchers to sequentially match and then compare patients of both races. "Racial differences in breast cancer survival did not substantially change among women diagnosed between 1991 and 2005," the authors write. They found the breast cancer survival rate among black women to be three years shorter compared to white women. Black women, they add, had more advanced cancers when they first sought treatment. "These differences in survival appear primary related to presentation characteristics at diagnosis rather than treatment differences," the authors conclude (Silber et al., 7/24).

The Kaiser Family Foundation: Health Coverage For Blacks In The United States Today And Under The Affordable Care Act – The federal health law has important implications for the black Americans, who make up more than a tenth of the total population. The law aims to reduce the number of uninsured individuals by expanding state Medicaid programs, which provide health coverage to people with low incomes, and by opening state-based online health marketplaces that will offer insurance plans and help people with lower incomes get subsidies to help pay for that coverage. According to the authors of this report, "Many uninsured Blacks could benefit from these new pathways to coverage, which would help increase their access to care and promote greater equity in health care." The report provides national and state-by-state data on the economic situation of African-Americans and their health coverage.  "Given that most uninsured Blacks are in low-income families, the majority would be in the income range to qualify for the ACA coverage expansions, particularly the Medicaid expansion. As such, state decisions to implement the ACA Medicaid expansion have particularly important implications for Blacks," the authors write. "If a state does not implement the expansion, poor uninsured adults will not gain a new coverage option and will likely remain uninsured. Currently, Blacks are at the highest risk of continuing to face coverage gaps due to state expansion decisions. Even with the coverage expansions, targeted outreach and enrollment assistance will be important for ensuring eligible individuals enroll in coverage" (Duckett and Artiga, 7/24).

Here is a selection of news coverage of other recent research:

NBC News: Obamacare Won’t Slash Workers' Hours, Report Finds
Opponents of Obamacare say it will kill jobs, and they specifically say provisions forcing employers to offer health insurance to workers will encourage smaller businesses to cut jobs and cut hours. But a new report finds that, if anything, fewer people are working part-time this year than the year before. The report, from the left-leaning Center for Economic and Policy Research, says data show companies have not been cutting hours in anticipation of the law. It contradicts business owners who say they’ve already started cutting back (Fox, 7/24). 

Medscape: Missed Diagnoses Trigger Primary Care Malpractice Claims
Most malpractice claims against primary care physicians are a result of missed diagnoses, especially of cancer and myocardial infarction in adults and meningitis in children, and medication errors, according to an analysis of data from 34 published studies of malpractice claims. Emma Wallace, MB Bch, BAO, a clinical research fellow in the Health Research Board Centre for Primary Care Research at the Royal College of Surgeons in Ireland Medical School in Dublin, and colleagues report their findings in an article published online July 18 in BMJ Open (Brown, 7/18).

Reuters: U.S. HPV Vaccination Rates Far From Goal, Officials Say
Only slightly more than half of U.S. girls aged 13 to 17 had been vaccinated against a virus that can cause cervical and other cancers last year, and a top U.S. health official said on Thursday that more must be done to bring the rate up to the long-term goal of 80 percent. The vaccination rate to protect against human papillomavirus (HPV) was 53.8 percent last year for teen-age girls, just marginally higher than the 53 percent rate a year earlier, the Centers for Disease Control and Prevention reported on Thursday (Abutaleb, 7/25).

Medscape: Operating Room Errors: Equipment-Related Failures Common
Equipment-related errors make up approximately one fifth of all errors that occur in the operating room, according to the findings of a systematic review. Ruwan A. Weerakkody, PhD, from Imperial College London in the United Kingdom, and colleagues published their findings online July 25 in BMJ Quality and Safety. In the study, the researchers searched various electronic databases to identify quantitative studies that assessed operating room errors and adverse events (Barber Jr., 7/25).

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Editorials and Opinions

Viewpoints: Rubio Says Vote To Keep Government Funded Should Include Stripping All Obamacare Spending; Govs. Jindal and Walker Blast Exchange Implementation; Sen. Paul To Offer Alternative To Medicare

Fox News: America, It's Not Too Late To Stop ObamaCare
But most workers and small business owners are counting on the men and women they elected to be their eyes, ears and voices. If we are to truly speak for them, we should take their opinions into account when deciding whether to move forward on the most important issues before us: the implementation of ObamaCare. ... This September, Congress will have to pass another short term spending bill to fund the federal government. We should pass one that keeps the government open, but doesn't waste any more money on ObamaCare. The president and his allies – and even some Republicans – will accuse us of threatening to shut down the government. In fact, it is President Obama who insists on shutting down the government unless it funds his failed ObamaCare experiment (Sen. Marco Rubio, R-Fla., 7/25). 

The Wall Street Journal: Unworkable ObamaCare
Remember when President Obama famously promised that if you like your health-care plan, you'll be able to keep your health-care plan? It was a brilliantly crafted political sound bite. Turns out, the statement is untrue. Aside from that small detail, the slightly larger problem is that the Obama administration doesn't have a health-care plan. Yes, the White House has a law with thousands of pages, but the closer we get to Oct. 1, the day government-mandated health-insurance exchanges are supposed to open, the more we see that the administration doesn't have a legitimate plan to successfully implement the law (Louisiana Gov. Bobby Jindal and Wisconsin Gov. Scott Walker, 7/25). 

The New York Times: Republican Health Care Panic
Better-informed people on the right seem, finally, to be facing up to a horrible truth: Health care reform, President Obama's signature policy achievement, is probably going to work. And the good news about Obamacare is, I'd argue, what's driving the Republican Party's intensified extremism. Successful health reform wouldn't just be a victory for a president conservatives loathe, it would be an object demonstration of the falseness of right-wing ideology. So Republicans are being driven into a last, desperate effort to head this thing off at the pass (Paul Krugman, 7/25). 

The Washington Post's The Plum Line: The Core Contradiction At The Heart Of The GOP Campaign to Sabotage Obamacare
Do Republicans believe that Obamacare is a disaster in the making? Or is it such an appealing program that they have to take extraordinary steps to undermine it? Reuters reports today that conservative groups are taking their campaign to undermine the law to ever new heights. As the Tea Party group FreedomWorks puts it: "We're trying to make it socially acceptable to skip the exchange." The game plan — which will include ads and social media — is to target the "young healthies" who are needed in the insurance pools in order to make the exchanges work. The goal isn't just to getting to oppose the Affordable Care Act; it's far too late for that. Rather, the goal is to use "town hall meetings, protests and media promotions to dissuade uninsured Americans from obtaining health coverage" (Jonathan Bernstein, 7/25). 

Atlanta Journal Constitution: Cruz Explains Why GOP Is Willing To Play Chicken Over ObamaCare
So let me try to follow [Sen. Ted] Cruz's logic here: ObamaCare is going to be a disaster, a trainwreck, a total mess. In fact, it's going to be such a trainwreck that if we allow it to be implemented, the American people are going to absolutely love it and will never allow it to be repealed. Confused? (Jay Bookman, 7/25).

The Washington Post Wonkblog: Republicans Had A Plan To Replace Obamacare. It Looked A Lot Like Obamacare
Remember "repeal and replace"? That was the Republican party’s 2010-vintage response to the Affordable Care Act. ... They wouldn't just repeal the bill. They’d replace it with something better. But what? The Romney campaign was very vague on this point, and the few points of commonality Congressional Republicans have on the issue don't add up to a full replacement. Four years ago, however, they did. It was called the Patients' Choice Act, it was proposed by Sen. Tom Coburn (R-Okla.) and Rep. Paul Ryan (R-Wis.), two of the most influential Congressional Republicans on the issue, and it was a credible way of covering almost all Americans. ... Obamacare bears a heavy resemblance to basically every real universal health-care plan that Republican legislators have proposed in the past half century (Dylan Mathews, 7/25).

Kansas City Star: Can We Get Real About Repealing Obamacare?
OK, class, let’s talk about repealing Obamacare. Some of us are having a little trouble envisioning what that would look like, but I know all you smart Republicans have some great ideas. So, let’s get started. ... Repealing Obamacare is the plan. The only plan. But then what will you do when families lose everything when somebody gets sick and can’t hold down a job? What do you say to people who have been canceled by their insurers because they’ve reached lifetime limits? How do you rationalize having the most expensive health care system in the developed world and some of the poorest results? (Barbara Shelly, 7/25).

Philly.com: Obamacare Opponents Are Starting To Look Desperate
Obamacare's rollout has entered the homestretch. The new insurance exchanges are scheduled to open for business in just over two months. Three months after that, the policies they sell will take effect. At that point, every American will enjoy guaranteed access to health insurance regardless of health status. With the finish line in sight, opponents have become more strident than ever. Having failed to block the law in Congress, in the Supreme Court, and in the last presidential election, they are promising to throw everything else they can think of in its way (Robert I. Field, 7/26).

Bloomberg: Will Obamacare Kickstart Health Care Revolution
But in a cavernous room in New York’s SoHo district, a group of entrepreneurs is working to render the entire Washington conversation over Obamacare obsolete. There, Obamacare is no longer a political controversy: It's a business opportunity. And a trio of young technologists have raised $40 million to take advantage of it (Ezra Klein, 7/25).

The Washington Times: Health Care For Seniors
As a physician, I understand the reliance many Americans have on Medicare. However, wasteful spending in Washington has drained the Medicare trust fund. The combination of massive debt, fewer active workers and more retirees is pushing Medicare into bankruptcy. Medicare is nearly $40 trillion unfunded. Simply put, this is an unsustainable path and Obamacare is not the answer. ... next week I will reintroduce the Congressional Health Care for Seniors Act of 2013. The plan is simple: All seniors will be enrolled in the same health care plan as their members of Congress and other federal employees. By all accounts, elected officials and federal employees receive some of the best health insurance in the country, and it is time for every senior to have access to the best health care in America as well (Sen. Rand Paul, R-Ky., 7/26).

The Texas Tribune: The Economic Debate Behind The Political Debate
The 2007 bill would have ended all abortions, and it’s relatively easy to put a number to that. In 2011, the most recent year for which figures are available, 70,003 pregnancies were terminated in Texas, according to the Department of State Health Services. The new Texas law will make it more difficult for women in some parts of the state to obtain abortions and might close some of the clinics that now provide abortions, but it is much more difficult to say how many babies might be born that would not have been. Only a handful of the state's abortion clinics currently meet the new standard, prompting opponents to argue that the legislation will limit access to abortion facilities while leaving the procedure itself legal. Without that number of babies in hand, it is difficult to estimate a cost to the state — if there is one, and if people want to talk about it (Ross Ramsey, 7/26).

San Jose Mercury News: El Camino Hospital Ruling Saves Quality Care
Santa Clara County Superior Court Judge Socrates Manoukian has returned sanity to El Camino Hospital's world. Manoukian ruled unconstitutional the hospital employee union's vindictive ballot measure that voters, amazingly, passed last fall, saying an initiative to limit executive compensation could not be applied to health care districts (7/25).

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Andrew Villegas

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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.