Daily Health Policy Report

Monday, July 28, 2014

Last updated: Mon, Jul 28

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Limitations Of New Health Plans Rankle Some Enrollees

Kaiser Health News staff writer Julie Appleby reports: “Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers. … In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him. Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect” (Appleby, 7/28). Read the story, which also ran in USA Today.

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Political Cartoon: 'Relapse?'

Kaiser Health News provides a fresh take on health policy developments with "Relapse?" by Bob Englehart.

Meanwhile, here's today's haiku:


It's almost recess...
Countdown hastens lawmakers'
deal for vets' health care.

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

Deal Said To Address VA's Short- And Long-Term Needs

Negotiators on Sunday reported reaching an agreement, which is expected to authorize billions of dollars in emergency spending to bring more physicians, nurses and clinic sites to the Veterans Affairs system. Legislation is to be unveiled today. Lawmakers have only about five working days before the August break to finalize the agreement.  

Politico: Deal Reached On VA Reforms
Sen. Bernie Sanders and Rep. Jeff Miller have reached an agreement to reform the Department of Veterans Affairs, according to an aide briefed on the matter. The legislation, which is to be unveiled Monday, will touch on "both the short-term and long-term needs of the VA," the aide said (French, 7/27).

The Associated Press: After 6 Weeks, Finally A Deal On VA Health Care
The chairmen of the House and Senate Veterans Affairs committees have scheduled a news conference Monday afternoon to unveil a plan expected to authorize billions in emergency spending to lease 27 new clinics, hire more doctors and nurses and make it easier for veterans who can't get prompt appointments with VA doctors to obtain outside care (Daly, 7/28).

The Washington Post: House, Senator Negotiators Reach Deal On Veterans Bill 
Aides said that Sanders and Miller had worked out final language on the agreement, which would be circulated among lawmakers on Monday ahead of the formal announcement. One House aide, not authorized to speak publicly about the talks, said that the final agreement more closely mirrors a Senate measure overwhelmingly approved by Democrats and Republicans last month (O’Keefe, 7/27).

The Washington Post’s Federal Eye: The New VA-Reform Deal, And How The Costs Shrank Over Time
After a weekend of talks, House and Senate negotiators say they have reached a deal to help the troubled Department of Veterans Affairs address extensive wait times at VA medical centers, one of the root causes of the agency’s recent scheduling scandal. Lawmakers now have about five working days to recommend changes and vote on the agreement before Congress begins its August recess. Sen. Bernie Sanders (I-Vt.) and Rep. Jeff Miller (R-Fla.), who lead the Senate and House veterans affairs committees, respectively, will try to round up support for sending the measure to President Obama before then (Hicks, 7/28).

The New York Times: Lawmakers Reach Deal On A Fix for V.A.’s Health Care System
Talks on the legislation had grown acrimonious last week, particularly over the amount of spending that would be required, but lawmakers were also under enormous pressure to reach a deal before Congress begins a monthlong recess later this week. Officials on Sunday did not outline specific details of the agreement, or the cost, which is expected to be in the tens of billions of dollars (Oppel Jr., 7/27).

Los Angeles Times: VA Healthcare: Tentative Deal Reached In Congress
Congressional negotiators have reached a tentative agreement on legislation to bolster healthcare funding and reforms at the troubled Department of Veterans Affairs, salvaging a deal after talks imploded last week. The accord comes none too soon: Lawmakers are poised to leave town at the end of the week for the long August break. A stalemate could politically damage the already unpopular Congress (Mascaro, 7/27).

The Wall Street Journal: Congress Reaches Deal To Help Fix VA
One primary disagreement stemmed from the aspect of the bills that would provide an injection of funding to the VA to make other immediate fixes at the department, including expanding allowances for veterans to receive care from non-VA doctors. Mr. Miller said last Thursday he was willing to provide $10 billion, while Mr. Sanders said he wanted the bill to authorize as much as $25 billion. Funding became an even more central topic to the negotiations when Sloan Gibson, the acting VA secretary said last Wednesday at a House hearing the department needs $17.6 billion over the next three years to address issues like hiring more doctors and nurses (Kesling, 7/27).

Bloomberg: Veteran Hospital Aid Deal Said To Be Reached By Lawmakers
Sanders on July 24 accused Republicans of being "not serious about negotiations," while Miller said Sanders had "moved the goal posts." The VA has a $160 billion budget and runs the nation’s largest integrated health-care system. An internal audit in June showed that more than 120,000 veterans hadn’t received a medical appointment or were waiting more than 90 days for care. That number was cut to about 42,400 by July 1, VA data show (Wallbank and Bender, 7/28). 

The VA deal is only one of the challenges facing Congress before its five-week recess:

The Wall Street Journal: Congress Set To Leave A Full Plate
Congress loves a deadline. But this year, even that may not be enough. With just a week left before the start of a five-week August recess, it is increasingly likely that Congress will wrap up for the summer having cobbled together only the bare minimum to keep the government functioning without addressing a list of expiring laws and a pileup of potential national crises. … The two chambers, for example, haven't figured out how to respond to the surge of Central American families crossing the southern border. Lawmakers also had struggled over a bill aimed at mitigating mismanagement and long wait times at Veterans Affairs hospitals, though spokesmen for the top negotiators said Sunday that a deal had been reached (Peterson, 7/27).

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Health Reform

Plan Renewals, Narrow Networks Draw Scrutiny

Some industry officials say the automatic renewal of some health law insurance plans could have a negative impact on the financial aid that consumers receive. Meanwhile, narrow networks continue to be the subject of backlash.   

The Associated Press: Plan To Simplify 2015 Health Renewals May Backfire
If you have health insurance on your job, you probably don’t give much thought to each year’s renewal. But make the same assumption in one of the new health law plans, and it could lead to costly surprises. Insurance exchange customers who opt for convenience by automatically renewing their coverage for 2015 are likely to receive dated and inaccurate financial aid amounts from the government, say industry officials, advocates and other experts (Alonso-Zaldivar, 7/27).

Kaiser Health News: Limitations Of New Health Plans Rankle Some Enrollees
Nancy Pippenger and Marcia Perez live 2,000 miles apart but have the same complaint: Doctors who treated them last year won’t take their insurance now, even though they haven’t changed insurers. … In Plymouth, Ind., Pippenger got similar news from her longtime orthopedic surgeon, so she shelled out $300 from her own pocket to see him. Both women unwittingly bought policies with limited networks of doctors and hospitals that provide little or no payment for care outside those networks. Such plans existed before the health law, but they’ve triggered a backlash as millions start to use the coverage they signed up for this year through the new federal and state marketplaces. The policies’ limitations have come as a surprise to some enrollees used to broader job-based coverage or to plans they held before the law took effect (Appleby, 7/28). 

Des Moines Register: Few Take Chance To Gripe About Health Insurance
Public hearings over proposed premium increases by three health insurers drew a grand total of two Iowans who wanted to take the microphone to gripe Saturday morning. "I figured there'd be more people. Evidently, people don't care about this," said Ed Tiernan of Des Moines, one of the two consumers who bothered to speak. In past years, dozens of Iowans took the chance to complain publicly about large rate increases proposed by the state's dominant health insurer, Wellmark Blue Cross & Blue Shield. But that was not the case Saturday morning, when state Insurance Commissioner Nick Gerhart presided over hearings centering on proposed premium increases from Coventry Health Care, CoOportunity Health and Assurant Health. About 24,000 Iowans would be affected by the three companies' rate increases. Most of them are covered by Coventry or CoOportunity, which are the main Iowa carriers selling policies on the new electronic marketplace set up under the Affordable Care Act (Leys, 7/26). 

Denver Post: Coloradans Could Lose Medical Choices, But Save Money
Consumers might not like the trend among insurance carriers to control costs and reduce premiums by narrowing their choices of doctors and hospitals, but it's one of the few tools that payers have left. Under the Affordable Care Act, insurers can't cut costs by discriminating against people with pre-existing conditions. They can't offer spare coverage because health care reform mandates minimum essential elements. Instead, insurers or payers are turning to narrow or "high value" networks to reduce escalating health care costs. The narrow network gives insurers greater leverage in negotiating prices with providers. ... United Healthcare, the largest Medicare provider in the country, said it is reducing its Medicare physician network in the Denver market — letters went out last week telling customers they might need to select a new physician (Draper, 7/27). 

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Tape Recording Reveals Health Subsidy 'Gotcha Moment' For Health Law Architect

Tape-recorded comments made by MIT economist Jonathan Gruber in 2012 are being used by backers of the latest legal challenge to the health law to support the argument that the overhaul's subsidies were not intended to be used by consumers shopping for coverage on the federal exchange. 

The Wall Street Journal’s Washington Wire: Health Law Architect's Taped Remarks Fuel Subsidy Debate
Backers of the latest legal challenges to the Affordable Care Act are seizing on comments made in 2012 by an MIT economist, often referred to as the law’s architect, to support their argument that only people who buy health coverage through a state exchange – not exchanges run by the federal government – can get tax credits towards the cost of premiums (Radnofsky and Kendall, 7/25).

Politico: An Obamacare Gotcha Moment
One of Obamacare's chief architects, MIT professor Jonathan Gruber, just handed conservatives a gotcha moment. Health law opponents and conservative academics are highlighting a two-year-old video of Gruber — who has advised both the Obama administration and then-Gov. Mitt Romney’s Massachusetts health reform effort — in which he seems to agree that the law's health insurance subsidies can't be awarded through federal-run exchanges, only through the state-run markets (Winfield Cunningham, 7/25).

The Boston Globe: Health Care Law Debate Heats Up
Jonathan Gruber, a major architect of the Affordable Care Act, twice made comments in 2012 that seem to support legal arguments advanced by opponents who are challenging the federal health insurance law in court. The remarks were captured in two separate recordings, one video and one audio, which bounced around social media Friday after surfacing on conservative websites. But Gruber, a Massachusetts Institute of Technology economics professor, said Friday that it was all a mistake (Freyer, 7/25).

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States Explore Strategies To Protect Exchanges, Subsidies From Court Decisions

News outlets report that states are working hard to demonstrate that they are now or will soon be operating their own online insurance marketplaces. Meanwhile, states are pushing for more time and support from the federal government for exchange planning and construction.  

The Wall Street Journal: States Try To Protect Health Exchanges From Court Ruling
A number of states are scrambling to show that they—not the federal government—are or will soon be operating their insurance exchanges under the 2010 health law, in light of two court decisions this week. The efforts are aimed at ensuring that millions of consumers who get insurance through the exchanges would be able to retain their federal tax credits if courts ultimately rule against the Obama administration (Radnofsky, 7/25).

Modern Healthcare: States Will Face Pressure To Keep Subsidies Jeopardized By Ruling
The ramifications of this week's federal appellate court ruling in Halbig v. Burwell—assuming the decision is upheld by the U.S. Supreme Court—could be immense. If individuals in states that haven't established their own exchanges can't access subsidies, more than 7 million people would lose access to $36 billion in healthcare subsidies, according to a study by the Urban Institute. That has the potential to fatally undermine the fledgling exchanges and the entire Patient Protection and Affordable Care Act. (Demko, 7/25).

Politico: States Want More Time On ACA Funds
States running their own Obamacare exchanges were supposed to wean themselves off federal funding by the end of this year, but some of them want that Obama administration spigot open a bit longer. The states aren’t asking for the feds to dole out more money on top of the $4.6 billion already dedicated to exchange planning and construction. But they do want to be able to spend their federal exchange grants into 2015 as they grapple with core components of the insurance portals that are balky, unfinished or in disrepair (Cheney and Wheaton, 7/25).

And, from New Mexico -

The Associated Press: New Mexico to Continue With Federally Operated Health Insurance Exchange
New Mexico decided Friday to stick with a federal online system for another year to enroll individuals in health insurance plans. The state's health insurance exchange governing board voted 11-1 to continue using the federal computer system for determining eligibility and to enroll individuals starting in November when the next open enrollment begins (7/25).

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New Wave Of Patients Boosting Hospital Earnings

Earnings reports offered last week by two hospital operators offer evidence that the health law's coverage expansion is leading more patients to seek treatment.

The Wall Street Journal: Health-Law Patients Boost Hospital Profits
A wave of newly insured patients helped boost hospitals' earnings in recent months, two hospital operators said Friday, a sign the law's coverage expansion is leading more patients to seek treatment. Universal Health Services Inc. UHS 's revenue rose 10% for the second quarter compared with a year earlier. LifePoint Hospitals Inc.'s profit rose to $39.1 million for the quarter, a 44% increase compared with last year's quarter. Those results arrive on the heels of HCA Holdings Inc. HCA's announcement of strong earnings last week ahead of its July 29 earnings call (Weaver,7/25).

The Wall Street Journal: Universal Health Services Profit Down On Higher Operating Charges
"The reduction in uncompensated care at our acute care hospitals resulting both from healthcare reform and improvements in the underlying economy partially reverses a trend that had been hindering our results for an extended period of time," said Alan B. Miller, the company's chief executive (Armental, 7/24).

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Ga. Working Through Medicaid Application Backlog After Federal Scrutiny

In the meantime, some in Alabama say no Medicaid expansion there is hurting economic development in rural parts of the state.

Georgia Health News: State Says It’s Hard At Work On Medicaid Backlog
A state health agency says it’s working though the application backlog for Medicaid that recently provoked federal scrutiny. The Department of Community Health has made decisions on eligibility for up to 70 percent of the 88,854 “account transfers” from Georgia’s insurance exchange, the agency said Friday. The backlog in Georgia is linked to the thousands of people expected to join Medicaid and PeachCare this year as a result of the Affordable Care Act (Miller, 7/25). 

AL.com: Lack Of Medicaid Expansion Hampers Economic Development In Rural Alabama, Official Said
Alabama's unwillingness to expand Medicaid is adding to the economic distress of the state's rural communities and further impeding their economic development efforts, officials said today. Danne Howard, senior vice president of government relations and emergency preparedness for the Alabama Hospital Association, was the lead speaker of a rural economic development session to kick off the Economic Development Association of Alabama's summer 2014 conference. She said a dozen rural hospitals have closed across the state and more than a dozen more could be lost over the next two years (Tomberlin, 7/27).

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Hardship Exemptions Allow Some To Continue To Buy Coverage On Health Law's Marketplaces

Elsewhere, the San Jose Mercury News examines who can opt out of the health law's mandate to have insurance on religious grounds.

Philadelphia Inquirer: Medical-legal Alliances Help Low-income Patients
It took Sheena Sheard two hours on two buses, towing two children and a three-wheeled stroller, to get to St. Christopher's Hospital for Children. It would have been three buses but the trio legged out the final stretch to ensure Sheard could see her lawyer. That's right, her lawyer. Sheard was going to see Eileen Carroll at St. Christopher's to determine whether she qualified for a hardship exemption that would allow her to buy health insurance on the now-closed Affordable Care Act marketplace (Calandra, 7/27). 

The San Jose Mercury News: Obamacare: 'Health Care Sharing Ministries' Increase Membership In Wake Of New Law
Go to church, be faithful to your spouse and shun tobacco, booze and drugs. Promising to adhere to that "biblical lifestyle," more than 300,000 Americans are taking advantage of a little-known provision in the nation's health care law that allows them to avoid the new penalties for not having health insurance. Long before Christian groups and Obamacare opponents cheered last month's Supreme Court ruling that allows many private businesses to stop offering certain types of birth control they find immoral, the 4-year-old law gave its blessing to Americans to opt out of the insurance mandate if they object on religious grounds (Seipel, 7/26).

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Medicare Turns Up Heat On Fraud Investigations

One U.S. attorney in South Dakota says such cases will be one of the fastest-growing areas of criminal investigations, while some providers are crying foul.

Philadelphia Inquirer: Costs Of Expanded Audits Aimed At Medicare Fraud Hit Health Care Firms
In a bid to cut Medicare spending and help pay for health-care changes, the Obama administration has significantly expanded audits designed to recover improper payments from health care providers. "We are taking, I would say, a brutal spanking, those that are fully compliant and within regulation," said Tim Fox, founder and chief executive of Fox Rehabilitation, a Cherry Hill company that provides physical therapy and other services to the elderly. The government has to "recoup those dollars from somewhere, so what they're going to do is fight and recoup dollars in fraud and abuse," said Fox, whose firm employs 905, including 709 clinicians who visit patients in their homes in eight states. The experience at Fox Rehab, founded in 1998, is just one example of how the Affordable Care Act is roiling the industry, forcing providers to find new ways to do things with less (Brubaker, 7/27). 

The Associated Press: U.S. Attorneys Turn Up Heat on Health Care Fraud
The top federal prosecutors from South Dakota and North Dakota say they have increased their efforts to fight health care fraud. U.S. Attorney Brendan Johnson of South Dakota said he has restructured his office to allow lawyers in the criminal and civil divisions to devote "significant time" to investigating medical fraud. He predicted it will be among the fastest-growing area of criminal investigation and wants his office to be in position to pursue increasing "complex and egregious" cases (7/27).

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State Watch

Health Law Playing Key Role In Virginia Politics

News outlets examine how the overhaul is factoring into the state's Senate race and changing the political landscape.  

The Richmond Times-Dispatch: Warner-Gillespie Debate Offers Look At The Politics Of Health Care
When Sen. Mark R. Warner faces his Republican challenger Ed Gillespie in their first debate today at The Greenbrier resort in West Virginia, the two are likely to clash over the Democrat’s support for the Affordable Care Act, which Gillespie wants to see repealed. But seven months after entering the race, seven weeks after his nomination as the GOP candidate and three months before the November election, Gillespie, who has repeatedly attacked his opponent for “casting the deciding vote” for the health care law, has yet to roll out his own ideas for policies that would replace the measure. “I do believe there are reforms that would be helpful,” the former GOP strategist and chairman of the Republican National Committee said in an interview last month. “(But) I haven’t finalized or settled on these in terms of the policy moving forward” (Schmidt, 7/25).

The New York Times: In Politics, The ‘Virginia Way’ No Longer Reflects Its Genial Southern Roots
The polarization of Richmond mirrors Washington, part of a nationalization of politics in state capitals with divided government across the country. The Legislative session that recently ended featured teeth-spitting acrimony between Gov. Terry McAuliffe, a Democrat, and Republicans in the General Assembly, which nearly led to a government shutdown. … The issue that nearly ground government to a halt was expanding Medicaid under President Obama’s health care law. Mr. McAuliffe, the most liberal Virginia governor of modern times, favored it. The Republican-led Legislature, influenced by its Tea Party wing, strongly opposed it, even though many of the working poor who would have gained health insurance under the Affordable Care Act were from rural districts represented by Republicans (Gabriel, 7/27).

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State Highlights: Va. Lt. Gov. Juggles Politics And Pediatrics

A selection of health policy news from Virginia, Maryland, Florida, New York, Wisconsin, Washington state, New Jersey and Kansas.

The Washington Post: Ralph Northam, Va.’s Low-Key Lieutenant Governor, Juggles Politics And Pediatrics
Ralph S. Northam read Noah’s electroencephalogram and sent the 7-year-old home from the hospital with a dose of powerful anti-seizure medication and instructions to return for more tests. Northam’s work as a doctor is a far cry from his other day job, presiding over the Virginia Senate, where he welcomes visitors to Mr. Jefferson’s Capitol and enforces the chamber’s arcane rules. Most Virginians don’t know that the lieutenant governor spends much of his time treating sick children as a pediatric neurologist. More to the point, most Virginians don’t know who the lieutenant governor is (Portnoy, 7/27).

The Baltimore Sun: Maryland Hospitals Aren’t Reporting All Errors and Complications, Experts Say
While hospitals are supposed to report serious medical errors to state regulators, the mostly confidential system still doesn't capture all of those happening in the Maryland facilities, patient safety experts and regulators acknowledge. Confusion over reporting rules and fear of legal or financial repercussions can thwart disclosure, they say. Details about even the most severe and deadly mistakes, called "adverse events," only become public if someone sues, or if regulators catch a hospital failing to report and launch an inquiry, the results of which are subject to open records laws (Cohn, 7/26).

Reuters: U.S. Appeals Court Backs Florida Law In Barring Docs From Asking Patients About Gun Ownership
A U.S. appeals court ruled on Friday in favor of a Florida law that bars doctors from asking patients about gun ownership, overturning a decision in the so-called "Docs v. Glocks" case by a lower court that had struck it down. Florida's Republican-led legislature passed the law after a north Florida couple complained that a doctor asked them if they had guns, and refused to see them after they declined to answer. A federal judge ruled the law unconstitutional in 2012, and the state swiftly appealed a panel of the 11th U.S. Circuit Court of Appeals, in a 2-1 vote, vacated the federal judge's ruling and described the law as a "legitimate regulation" of professional conduct that simply codified good medical care. Any restrictions it places on physicians' speech was entirely incidental, the appeals court said, since it "was intended to protect patient privacy and curtail abuses of the physician-patient relationship" (7/25).

NPR: New York Debates Whether Housing Counts As Health Care
Brenda Rosen, the director of Common Ground, the organization that manages the building, says The Brook offers a full range of services to keep its residents healthy: social workers, security, a doctor and even an event planner. And while these services don't come without a cost -- an apartment at The Brook runs at about $24,000 a year -- Rosen says they are cheaper than the estimated $56,000 per year that the city spends on the emergency room visits, and stays at shelters and jails, where many people with severe mental illness end up (Aronczyk, 7/28).

The Associated Press: Relatives Run Health Clinic In Madison
Dr. Schenck received his doctorate in 1978 and finished his residency in 1981. He briefly latched on with a practice in Orange before coming to Culpeper to practice, where he was tasked with opening the Culpeper Nursing Home and Rehab. He also set up and ran his practice at the Wilderness Medical Center in Locust Grove from 1982 until 2002. A hospitalist at Culpeper Regional Hospital from 2002 until 2006, he and his wife Lisa -- his registered nurse -- both moved to the Madison practice in 2008 (7/27).

Seattle Times: Becker Slams Insurance Office Report's 'Selective Use Of Facts'
State Sen. Randi Becker, R-Eatonville and chair of the Senate Health Care committee, isn’t going to let go of Insurance Commissioner Mike Kreidler’s tangle with his administrative-law judge, who was placed on leave in May after accusing her supervisor at the insurance office of trying to influence her on insurance cases she adjudicates. Becker, who has been displeased with Kreidler’s office in the past, slammed the investigator’s “selective use of facts,” but said it was “no surprise” (Ostrom, 7/25).

Bloomberg: Christie Call To Cool Abortion Talk Follows Curbs In N.J. 
Chris Christie, who last week prodded Republicans to drop anti-abortion rhetoric to appeal to more voters, has steadily weakened access to the procedure in New Jersey. Even with a Democratic-controlled legislature committed to reproductive rights, the second-term governor’s annual funding cuts for women’s health services have prompted at least six clinics to close since 2010, according to lawmakers. Christie, a possible White House contender in 2016, told Republican leaders in Colorado on July 25 that they need to recast how they promote their views on social issues without altering their positions. The first New Jersey governor to publicly declare himself against abortion since the 1973 Roe v. Wade ruling says he favored the right until he heard his unborn daughter’s heartbeat. Voters whose most important issue is abortion would “look at his record of action,” she said (Young, 7/28). 

The Associated Press: Kansas City Area Clinic to Offer HIV Drug
A Kansas City, Kansas, clinic is offering a medication used to prevent infection in people at high risk of getting the AIDS virus. The U.S. Food and Drug Administration two years ago approved the HIV drug, Truvada, for HIV prevention. The Centers for Disease Control and Prevention issued guidelines in May recommending that doctors offer Truvada to people at substantial risk of HIV infection, such as those in a sexual relationship with someone who is HIV-positive, The Kansas City Star reported (7/26).

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Editorials and Opinions

Viewpoints: GOP's 'Political Sideshow;' Boehner Says House Must Defend The Constitution; Jonathan Gruber On Center Stage About Subsidies

USA Today: GOP Lawsuit Looks Like Political Sideshow: Our View
This week, before the House leaves for its August recess, the GOP majority is expected to approve a lawsuit against Obama. Speaker John Boehner, R-Ohio, says it will accuse the president of unconstitutionally abusing his executive power by delaying the Obamacare requirement that larger companies provide health insurance or pay a fine — the so-called employer mandate. ... A fair-minded look at the suit's merits suggests it's really more of a political grudge match, one in which the GOP is seeking an outcome it hasn't been able to achieve at the polls or through the legislative process (7/27). 

USA Today: Boehner: We're Defending The Constitution
President Obama has overstepped his constitutional authority — and it is the responsibility of the House of Representatives to defend the Constitution. ... On the advice of legal experts, the House action will focus on his decision to extend — twice — the deadline to institute the employer mandate in his health care law. We believe this targeted lawsuit offers the best chance of success. ... I oppose the employer mandate in the president's health care law. The House of Representatives has voted to delay or eliminate it (and we will do so again if we prevail in court). But it is the letter of the law that was passed by Congress and signed by President Obama. He simply cannot unilaterally rewrite it (Speaker John Boehner, R-Ohio, 7/27). 

The New York Times: The Fight Over 'Impeachment Lite'
Rather than getting on with the country's business and focusing solely on can't-wait issues before they jet out of town this weekend — like the unfinished bill to fix veterans' health care and the stalled bill to deal with the humanitarian crisis of Central American children arriving at the border — House Republicans are gearing up for a grand maneuver: an apparently unprecedented move by the House to sue the president over his use of executive orders. Talk about misplaced priorities (Charles M. Blow, 7/27). 

Bloomberg: Killing Obamacare Even if It Hurts
I don’t think Republicans believe that damaging Obamacare so that it provides middle-class subsidies in some (mostly blue) states while providing none at all in other (mostly red) states is actually a better policy outcome than the status quo. They just hope that it will weaken the law sufficiently to lead somehow to its collapse and eventual repeal. That's clearly the motivation behind House Speaker John Boehner's proposed lawsuit against President Barack Obama for deferring the law's employer mandate. And we’ve seen the same agenda in other instances as well, including the advertising campaign, sponsored by conservative groups, to convince young people that they are better off without health insurance. It's hard to believe that Republicans think that adding to the numbers of uninsured Americans is actually a desirable policy goal. Yet Republicans are willing to encourage such negative outcomes if that increases the chances of scuttling the law (Jonathan Bernstein, 7/25).

The Wall Street Journal: Obamacare’s Insider Testimony
As Jonathan Gruber will tell you, the MIT economist helped to write ObamaCare and remains one of its fiercest defenders. So it's no surprise that on Friday the Web was full of chatter that Mr. Gruber had at least twice made public assertions that support the latest legal challenge to the health law. The D.C. Circuit Court of Appeals ruled last week in Halbig v. Burwell that the plain language of ObamaCare says that subsidies for health insurance can only be delivered through state, not federal, exchanges. The Administration claims this ignores the clear intent of the law, but someone didn't tell Mr. Gruber (7/27). 

The New Republic: Jonathan Gruber: 'It Was Just A Mistake'
Did the people who designed Obamacare intend to deprive millions of people of health insurance, just because officials in their states decided not to operate their own insurance marketplaces? A lawsuit making its way through the federal judiciary, and perhaps on its way to the Supreme Court, claims the answer is yes. ... now there’s a video from 2012 in which one of the law’s best known advocates and architects—MIT economist Jonathan Gruber—makes the same basic argument that the lawsuit does. Among those who say they are surprised by the statement is Gruber himself, whom I was able to reach by phone. "I honestly don't remember why I said that," he said, attempting to reconstruct what he might have been thinking at the time. "I was speaking off-the-cuff. It was just a mistake" (Jonathan Cohn, 7/25).

Bloomberg: Obamacare's Smoking Gun Fires Again
I believe that Gruber sincerely does not remember making these remarks. Memory is fallible; at some point, Gruber probably changed his mind and forgot that he had ever believed otherwise. ... But though I do not fault his honesty, I also think that in January 2012, Gruber did believe that premium tax credits would only be available on state-created exchanges, and that this would give states a strong incentive to create exchanges. We can draw two conclusions from this: First, the reading of the law by Halbig's plaintiffs is clearly not ridiculous or dishonest; if it is a mistake, it is a mistake that one of the law's chief architects could make. And second, we should be very skeptical of people who are now telling us, four years later, what the legislative intent was. Memory really is extraordinarily unreliable, and as we see here, it's very easy to forget what you believed even a couple of years ago (Megan McArdle, 7/25).

The Wall Street Journal’s Washington Wire: The Stakes Beyond The Halbig Lawsuit
A lot of attention is being paid to the dueling decisions in two U.S. appeals courts about whether the U.S. government can provide tax credits to people in federal- as well as state-run insurance exchanges. In human terms, the stakes are high: Millions of moderate-income people will not be able to afford health coverage without a subsidy, and a court ruling could gut coverage expansion in the 36 states with federally run insurance exchanges, unless states decide to set up their own exchanges. ... Amid the reaction, little attention has been paid to whether Americans will perceive Halbig as a legitimate legal question or as more inside-Washington politics (Drew Altman, 7/25). 

The Wall Street Journal's Washington Wire: Obamacare Challenges: Where The Conventional Wisdom Falls Short
Since the U.S. Court of Appeals for the D.C. Circuit struck down an Internal Revenue Service regulation implementing Obamacare, some observers have predicted that the IRS rule would ultimately be upheld. The regulation extends federal subsidies to individuals purchasing insurance from federal exchanges and not just state-run exchanges, as the Affordable Care Act specifies. But when it comes to legal challenges regarding the health-care law, the conventional wisdom has sometimes been wrong (Chris Jacobs, 7/25). 

The Chicago Sun-Times: Obamacare’s Never-Ending Story
Obamacare appears headed for another rendezvous with the U.S. Supreme Court. The justices bent over backward, well mainly Chief Justice John Roberts did, to save the Affordable Care Act two years ago. Will similar legal gymnastics be found to rescue President Barack Obama and Democrats from the clear text of the law this time? At issue is explicit language saying that subsidies to purchase health insurance should go only to Americans who buy coverage through "an Exchange established by the State." There’s reason to believe that the law was written this way to compel states to establish exchanges so their citizens would get subsidies. But the law proved so unpopular that 36 states did not set up marketplaces (Steve Huntley, 7/25).

Los Angeles Times: College Campuses Are Fertile Ground For Promoting Obamacare
Much has been made of the need to enroll "young invincibles" under the Affordable Care Act. These are young adults who, according to many, are often uninsured because they think they don't need insurance. They are also critically important to the success of the ACA. Without their participation, state and national insurance pools in the new marketplaces such as Covered California will be older, sicker and costlier. Insurance premiums will be higher (Walter A. Zelman, 7/27). 

In other health care issues -

The Wall Street Journal: Let Patients Decide How Much Risk They'll Take
Earlier this month, at a private conference for the CEOs of his portfolio companies, venture capitalist Vinod Khosla interviewed Google co-founders Sergey Brin and Larry Page, asking them if the company might jump into health care. "It's just a painful business to be in," Mr. Brin replied, later noting that "the regulatory burden in the U.S. is so high that I think it would dissuade a lot of entrepreneurs." Mr. Brin is right. As a neurosurgeon-scientist and entrepreneur who co-founded a bioelectronic medicine company that deploys implantable technology to supplant drugs, I wish he were wrong. But rampant misalignment of incentives is hampering technology in the U.S. health industry (Kevin J. Tracey, 7/27). 

Marketplace: We Really Are Living In The (Medical) Future
We live in the future. That's not my phrase; it is my daughter Madeleine's invention. True, the monorails remain few and far between, but every once in a while I get a reminder that some of what was once science fiction is no longer fiction. Recently, I got to spend a bit of time with a physicist and physician who says she is trying to do for medicine what Google did for information technology. Her idea is democratize healthcare so that the big stuff doesn't always have to go through professional gatekeepers (David Brancaccio, 7/28).

The Boston Globe: Farewell To The Routine Pelvic Exam?
While the American College of Obstetricians and Gynecologists still endorses routine exams, the American College of Physicians, which includes internists like me, does not. Citing 60 years of data from several sources, the ACP last month recommended that doctors stop performing routine annual pelvic exams on women who are not pregnant, not due for a Pap test (which is no longer recommended annually for most women), and who have no history or symptoms of pelvic disorders. The ACP concluded that the low chance of detecting an asymptomatic gynecologic condition — including ovarian cancer, for which no effective screening test exists — doesn’t justify the pain, fear, anxiety, and embarrassment that a high percentage of women report after having a pelvic exam. I’ve been trying to figure out why the ACP’s announcement left me feeling a little sad (Suzanne Koven, 7/27).

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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.