Daily Health Policy Report

Thursday, July 3, 2014

Last updated: Thu, Jul 3

KHN Original Reporting & Guest Opinion

Health Reform

Administration News

Women's Health


Health Care Marketplace

Public Health & Education

State Watch

Weekend Reading

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Did The Supreme Court Tip Its Hand On Contraception Cases Yet To Come?

Kaiser Health News staff writer Julie Rovner reports: "The Supreme Court’s opinion Monday holding that some for-profit firms do not have to provide women the contraceptive coverage required under the Affordable Care Act if they have religious objections addressed only half of the ongoing legal battle over the birth control mandate. But those on both sides of the issue think the court’s majority may have telegraphed which way it could rule when one of those other cases reaches the justices" (Rovner, 7/2). Read the story.

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The Latest In Medical Convenience: ER Appointments

Kaiser Health News staff writer Anna Gorman and The San Francisco Chronicle's Victoria Colliver report: "Scott Paul knew he needed to head to the emergency room on a recent Sunday after his foot became so painful he couldn't walk. The one thing that gave him pause was the thought of having to wait several hours next to a bunch of sick people. But his wife, Jeannette, remembered she'd seen Dignity Health television commercials featuring a woman sitting in a hospital waiting room and then cutting to the same woman sitting on her living room couch as words come up on the screen: 'Wait for the ER from home'" (Gorman and Colliver, 7/2). Read the story.


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Political Cartoon: 'A Pointed Argument?' By Matt Wuerker

Kaiser Health News provides a fresh take on health policy developments with "A Pointed Argument?" by Matt Wuerker.

Meanwhile, here's today's haiku:


Hot dogs on the grill
Family and friends gathering
Independence Day

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Administration Cites Hobby Lobby Ruling To Religious Nonprofits

The Obama administration cites the Supreme Court's opinion Wednesday to buttress its claim it has offered religious nonprofits an acceptable compromise to the health law's contraceptive coverage mandate. Meanwhile, House Democrats craft legislation that would bar for-profit companies from denying birth control coverage to their employees.

The Wall Street Journal: Administration Points To Hobby Lobby Ruling In Wheaton College Case
In the latest battle over the Affordable Care Act, the Obama administration Wednesday cited the Supreme Court's Hobby Lobby ruling to buttress the claim it has offered religious nonprofits an acceptable compromise to opt out of contraceptive coverage in employee health plans. U.S. Solicitor General Donald Verrilli made the arguments in a Wednesday filing involving Wheaton College, a Christian institution in Illinois, that is seeking to avoid complying with the contraceptive-coverage alternative while litigation over its challenge continues in lower courts (Bravin, 7/2).

Kaiser Health News: Did The Supreme Court Tip Its Hand On Contraception Cases Yet To Come?
The Supreme Court’s opinion Monday holding that some for-profit firms do not have to provide women the contraceptive coverage required under the Affordable Care Act if they have religious objections addressed only half of the ongoing legal battle over the birth control mandate. But those on both sides of the issue think the court’s majority may have telegraphed which way it could rule when one of those other cases reaches the justices (Rovner, 7/2).

Associated Press: Health Care Law Still Facing Another Birth Control Challenge
Business owners who don’t want to pay for employees’ birth control are ending that coverage after the Supreme Court said they could choose on grounds of religious belief not to comply with part of the health-care law. Some owners are already in touch with their brokers in the wake of Monday’s ruling. Triune Health Group wants to know how soon it can change its coverage to stop paying for all contraceptives, said Mary Anne Yep, co-owner of the Oak Brook, Ill., company that provides medical-management services (Rosenberg, 7/2).

The Hill:  House Dems Drafting Legislation To Reverse Birth Control Decision
House Democrats are crafting legislation that would prevent privately held companies from denying birth control coverage to their employees. Reps. Diana DeGette (D-Colo.) and Jerrold Nadler (D-N.Y.) said the Supreme Court made a mistake on Monday when it ruled that that some private companies can opt out of the birth control mandate under the Religious Freedom Restoration Act (Al-Faruque, 7/2).  

Politico: Hobby Lobby Decision: 5 Takeaways
The Supreme Court waited until the very end to deliver its most hotly anticipated decision of the term: declaring in a 5-4 ruling that for-profit companies can use religious objections to avoid paying for contraception coverage required under Obamacare. The sharply divided result in Burwell v. Hobby Lobby immediately touched off a wave of analysis and speculation about how large a hole the court put in the side of President Barack Obama’s signature health care law — just two years after Chief Justice John Roberts sided with liberals to save the measure’s individual mandate from legal oblivion (Gerstein and Nather, 7/1).

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Health Law Still Looms As Issue In Midterms

Nearly seven in 10 adults say their view of the health law will factor in their congressional voting decisions this fall, a new Bankrate.com survey finds. Other stories look at positions staked out by candidates in Tennessee, Kansas and Oregon.

The Fiscal Times: Obamacare Still Likely To Haunt the Midterm Elections
Most Americans headed to the polls this November say Obamacare will be on their minds while casting their voting ballots.  But that’s not necessarily good news for either party. A new Bankrate.com survey released Wednesday found nearly 7 in 10 adults said their opinion of the president’s health care law will play a role in their decision of which House of Representatives candidate to vote for in the midterm elections. Of those people, 44 percent said Obamacare would play a major factor in their voting decisions, while 24 percent said it would only play a minor role (Ehley, 7/2).

The Wall Street Journal: Sen. Lamar Alexander Resurrects Health-Care Fights In Ad
Sen. Lamar Alexander would like Tennessee Republicans to focus on his early questioning of the Affordable Care Act as he seeks to fend off an insurgent challenger. Mr. Alexander’s campaign on Wednesday released a TV ad that will begin airing statewide Sunday showing him confronting President Barack Obama at a February 2010 White House health-care summit with senators. ... The ad’s release comes two days after Mr. Alexander appeared with Sen.Rand Paul (R., Ky.) and local health-care executives in Nashville to discuss health care (Epstein, 7/2).

Associated Press:  Foes In Kansas Senate Race Both Sign Health Pledge
Kansas Sen. Pat Roberts and Republican primary opponent Milton Wolf have both signed a pledge to fight for repeal of the federal health care overhaul. But Wolf was getting credit Wednesday from the Washington-based conservative group behind the pledge for signing it first. It calls for blocking funding to administer the health overhaul and repealing the 2010 law championed by Democratic President Barack Obama (7/3).

The Oregonian: Monica Wehby Calls Hobby Lobby Ruling 'Very Limited In Scope'; Jeff Merkley Supporters Disagree
The rival Oregon Senate campaigns argued Wednesday over the importance of this week's U.S. Supreme Court decision that allowed two companies, on religious grounds, to limit the scope of contraceptive coverage they provide to employees. Republican candidate Monica Wehby told reporters at an Oregon City event that she thought the decision was "very limited in scope" because it involved a narrow range of contraceptive products and a relatively small group of closely held companies. The re-election campaign of Sen. Jeff Merkley, D-Ore., held a conference call with reporters to argue that the decision could threaten contraceptive coverage for millions of women -- although participants on the call did acknowledge that Oregon law requiring contraceptive coverage could limit the scope of the Supreme Court decision here (Mapes, 7/2).

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N.Y., Colo. Insurers Seek Large 2015 Premium Increases; Ga. Sees Drop In Rates

In New York, insurer requests for rate increases on the health law's exchange averaged 13 percent, while Denver Health is asking state regulators for a 17.5 percent hike next year. Georgia has a different story: Two companies are planning to enter the exchange next year, and Blue Cross, the only statewide plan on the exchange this year, says it will drop rates by 7 percent.

The New York Times: Insurers On New York State's Health Exchange Seek Significant Rate Increases
Some New Yorkers are in sticker shock after receiving notices from their insurance companies saying that they have asked for significant rate increases through the state’s health exchange next year. The exchange, which has prided itself on being affordable, is now facing requests for increases as high as 28 percent for some customers of MetroPlus, a new entry to the individual insurance market and one of the least costly -- and most popular -- plans on the exchange this year. ... Overall, including plans inside or outside the exchange, insurance companies asked for average rate increases of 13 percent in 2015, the state’s Financial Services Department said Wednesday (Hartocollis, 7/2).

Health News Colorado: Sicker Denver Patients Prompt Hikes While Rates Stay Flat In Mountains
Sicker patients have prompted Denver Health to ask for a 17.5 percent hike next year in health insurance rates while the biggest carrier in western Colorado, Rocky Mountain Health Plans, is working to keep rates flat in high-cost resort counties. When Colorado’s insurance regulators unveiled proposed 2015 rates for health insurance last week, the numbers were all over the map. Denver Health proposed the biggest increase among carriers in Colorado, while other insurance companies proposed modest increases. New Health Ventures, which markets plans called Access Health Colorado, proposed a 22 percent cut in rates while the Colorado HealthOP wants to cut rates by about 10 percent overall (McCrimmon, 7/2). 

Georgia Health News: An Early, Encouraging Glimpse Of 2015 Rates
At least three health insurers plan to offer insurance statewide in Georgia’s exchange for 2015. This year, only one health plan -- Blue Cross and Blue Shield of Georgia -- went statewide in the exchange. And the proposed Blue Cross rates for next year’s exchange will decrease by an average of 7 percent (Miller, 7/2).

Minnesota officials explain some errors in applications on their exchange --

The Star Tribune: State Errors Leave 16,000 MNsure Applicants Without Insurance
About 16,000 Minnesotans who applied for Medical Assistance through MNsure are still without health insurance, some caught in limbo for as long as six months. State officials said Wednesday that letters notifying consumers of problems with their original insurance applications never got sent out. That mistake meant consumers didn’t realize they still had to provide crucial information before they could get coverage. “It was a serious error on our part of not being more on top of understanding that process, and having the oversight in place,” said Deputy Commissioner Chuck Johnson of the Minnesota Department of Human Services (Crosby, 7/2).

Minnesota Public Radio: Human Error Cited In State Health Insurance Delay
Minnesota's Department of Human Services failed to send 16,000 notices to Minnesotans whose Medical Assistance applications are pending through MNsure, the state's online insurance marketplace. The letters would have notified applicants that they needed to provide proof of key information the federal government couldn't verify automatically -- information such as income, citizenship, tribal membership, or Social Security numbers. The notices were supposed to go out beginning in February. Until MNsure receives the information, these Medical Assistance applications are on hold (Stawicki, 7/2).

In California, a big fight is brewing on rate regulation --

Los Angeles Times: Los Angeles Times: Need For Ballot Measure On Health Insurance Rate Regulation Debated
Kicking off a major ballot fight this year, California lawmakers pressed the state's insurance commissioner to defend a proposal that would grant his agency sweeping new authority over health insurance rates. At a legislative hearing Wednesday, backers and opponents of the statewide ballot measure on health insurance rate regulation called Proposition 45 squared off for the first time in a public debate. Before the hearing, supporters of Proposition 45 rallied in Sacramento and accused health insurers of putting profits ahead of patient care (Terhune, 7/2).

Reuters: Californians Spent $250 Million On Excessive Health Premiums, Group Says
Californians paid a quarter of a billion dollars in health insurance premiums during a 15-month period ended last year that were deemed excessive by state regulators, a consumer group said Wednesday. Santa Monica-based Consumer Watchdog, which released the figures on Wednesday, is pushing Proposition 45, a ballot initiative that would give regulators the power to reject rate increases determined to be excessive (Bernstein, 7/2).

And one insurer is seeing a wave of new patients in Colorado --

Health News Colorado: Wave Of New Patients Means All Hands On Deck At Kaiser Permanente
Kaiser Permanente is grappling with double the number of new customers that the nonprofit health provider projected it would attract through Colorado’s exchange this year. To handle the surge in patients, Kaiser managers have opened new clinics, are offering some evening hours and are hiring the equivalent of about 70 new providers and support staff. Kaiser enrolled about 58,000 people -- or nearly half of the customers who bought private insurance through the exchange, Connect for Health Colorado. Kaiser spokeswoman Amy Whited said the nonprofit was expecting about 25,000 sign-ups through the exchange and has seen an overall jump in customers this year of 15 percent to about 615,000 members (McCrimmon, 7/2).

Meanwhile, in state Medicaid news --

Los Angeles Times: Obamacare: Legal Aid Groups Demand Answers On Medi-Cal Backlog
With low-income Californians continuing to face months-long delays in getting state healthcare coverage, health advocates are calling on the state to explain within 10 days how it will address lingering Obamacare application delays. In a letter to Gov. Jerry Brown and other officials Wednesday afternoon, the advocates demanded that California's healthcare agency lay out specific plans for eliminating a huge backlog in applications for Medi-Cal, the state healthcare program for the poor (Brown, 7/2).

Milwaukee Journal Sentinal: Scott Walker's Staff Scoffs At Report Pushing Health Care Expansion
In a new national report, advisers to President Barack Obama criticized state officials such as Scott Walker for not using federal money to expand a state health program, drawing a sharp rebuke from Wisconsin's governor. Obama's Council of Economic Advisers on Wednesday issued a report that said 120,000 uninsured state residents could gain coverage if Wisconsin fully expands its BadgerCare Plus health program. But one health care expert in Wisconsin said that number was inflated. He cautioned that the report, while useful for its findings at the national level, didn't account for Wisconsin's unusual approach to implementing the federal Affordable Care Act, also known as Obamacare (Stein, 7/2).

Tampa Bay Times:  White House: Blocking Medicaid Expansion Would Cost Florida 63,000 Jobs
The White House has a Medicaid expansion argument for Gov. Rick Scott and Florida Republicans: It creates jobs. A state-by-state report released Wednesday estimates that Florida will lose out on 63,000 new jobs, mainly in health care, from 2014-2017. That’s the three years that the federal government would have paid the entire cost of providing health care to 848,000 people. The study by the Council of Economic Advisers -- titled “Missed Opportunities” -- is part of an ongoing push by the Obama Administration on a central part of the Affordable Care Act (Leary, 7/2).

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Government Has Yet To Resolve Subsidy Inconsistencies

The inspector general report details that the government isn't quite sure how to fix the problem. In the meantime, a new health startup looks to cash in on helping companies enroll low-wage earners in Medicaid instead of company plans.

The Fiscal Times: Government Struggling To Fix Obamacare Errors
Obamacare’s technological nightmare might not be over yet. Due to problems with the backend of the website, the Department of Health and Human Services reported last month that nearly 3 million of the applications for health insurance had inconsistencies with who was receiving federal subsidies. At the time, officials assured the public they were aggressively working to solve the problem. But now, a new inspector general report reveals that nearly nine out of 10 erroneous applications have yet to be resolved, and the government isn’t really sure how to fix the problem (Ehley, 7/2).

Crain's New York Business:  Health Startup Cashes In On Obamacare Loophole 
Another New York startup is looking to make money filling a hole in the Affordable Care Act, and once again investors are intrigued. Manhattan-based BeneStream announced Tuesday that it has raised $1.58 million from angel investors looking to capitalize on the expected surge in business when Obamacare's employer mandate takes effect on Jan. 1. The mandate, which requires businesses with more than 50 full-time equivalent employees to provide health insurance or pay a monthly penalty, is the driving force behind BeneStream's business plan: it wants to help companies enroll eligible low-wage workers in Medicaid (McEnery, 7/2).

And closer looks at figures detailing just how many have signed up for health coverage under the health law --

The Washington Post: Sebelius’s Claim That Obamacare Has Brought 'Affordable Coverage' To 22 Million People
This number -- 22 million -- is an interesting figure from the recently departed HHS secretary, given that she had once famously defined "success" for the Affordable Care Act as having signed up 7 million people by the end of March. How did the number suddenly balloon to 22 million? Brad Kemp, an aide to Sebelius, provided the following breakdown: "8 million in market; 3 million young adults; 5 million in ACA-compliant off-market plans, and 6 million (and counting) additional Medicaid folks." That adds up to 22 million, but he did not respond to follow-up e-mails or provide any sources for the numbers. So let's dissect these figures ourselves (Kessler, 7/2).

Marketplace: Five Million Stick To Private Health Insurance
We all know people have signed up for insurance through the healthcare exchanges, or enrolled in Medicaid. But a new report in the New England Journal of Medicine shows about five million people bought coverage straight from an insurance company. There’s nothing new about people buying insurance policies directly from insurers; it’s been happening forever. But Harvard’s Ben Sommers says not for everybody (Gorenstein, 7/3).

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Administration News

VA's Medical Inspector Steps Down

Dr. John Pierce, the director of the VA's medical inspector office, had served in that role since 2004 and is the fifth senior official at the VA to step down during the past six weeks. Also, stories look at how lawmakers are trying to reform the VA and just why the VA was developed 100 years ago.

The New York Times: After Criticism, Investigator Steps Down From The V.A.
The head of the Department of Veterans Affairs’ medical investigation unit has stepped down, the department announced Wednesday, just days after a federal watchdog sharply criticized the department for failing to adequately investigate allegations of poor care within its sprawling hospital system. The official, Dr. John R. Pierce, who had been director of the department’s office of medical inspector, is the fifth senior V.A. official to depart in the past six weeks (Oppel, 7/2).

Associated Press:  VA Medical Inspector Retires After Scathing Report 
The chief medical inspector for the Department of Veterans Affairs has retired, following a report that his office downplayed whistleblower complaints outlining serious problems at VA facilities across the country, acting VA Secretary Sloan Gibson said Wednesday. Dr. John R. Pierce had served as medical inspector since 2004 and was deputy medical inspector for two years before that. Pierce's office came under scrutiny last week, after the independent Office of Special Counsel issued a scathing report that identified "a troubling pattern of deficient patient care" at VA facilities around the country. The problems were pointed out by whistleblowers but downplayed by the medical inspector and other top officials, the report said (Daly, 7/2).  

Politico: Reforming The VA One Step At A Time
Congress is poised to pass the most significant reforms to the Department of Veterans Affairs in nearly two decades -- but don't expect quick fixes to the layers of rot at the agency. The House and Senate have passed bills responding to revelations that veterans died after the VA delayed providing medical care. But the measures don't change the VA employees' habit of gaming the system, covering up problems and punishing whistleblowers who try to sound the alarm — the "corrosive culture" that White House deputy chief of staff Rob Nabors warned about in a report to President Barack Obama last week (Nather, 7/2).

The Arizona Republic: Why Was The VA Created 100 Years Ago, Anyway?
The VA's health-care system has never been perfect. But it has had its benefits. When veterans returning from America's wars threatened to overwhelm the civilian health-care system, the VA was seen as a savior. Veterans, meanwhile, found themselves in hospitals recuperating among their own. As recently as 15 years ago, it also was heralded as a leading and innovative health-care provider after Kenneth Kizer, then-undersecretary for health, imposed sweeping reforms that decentralized care into clinics and improved coordination of VA services. But its reputation has since crumbled (Lee, 7/2). 

And a host of wounded, young veterans are pushing military medicine to accommodate their desire for an active life --

Associated Press:  Young, Active War Wounded Pushing Medical Science 
The blood is not the most jarring part of the photograph taken shortly after the bomb blew off Marine Gunnery Sgt. Brian Meyer's leg and hand. It's his smile. The bomb technician had asked a team member to take the picture. He knew his defiance in the face of death would keep his comrades going and ease the torment caused by what they had witnessed. His attitude set the tone for the long journey the double amputee is taking along with nearly 2,000 troops who lost one or more limbs from combat injuries in Iraq and Afghanistan.  It's also pushing military medicine to find better ways to accommodate such a large population of young, severely disabled combat veterans who want to maintain an active lifestyle. Many wear out their prosthetic limbs in a matter of months doing everything from mountain climbing to running marathons (Watson, 7/3).  

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Women's Health

Mass. To Weigh Options On Abortion Safeguards; Mo. Gov. Vetoes Bill

Mass. Gov. Deval Patrick says he wants new legislation by the end of the month to strengthen security around clinics. Missouri Gov. Jay Nixon vetoes a bill that would require women to wait 72 hours for the procedure.

Associated Press:  Massachusetts Working On Abortion Clinic Bill To Strengthen Security Measures
Gov. Deval Patrick said Wednesday he expects to have a bill on his desk by the end of the month that would strengthen security around abortion clinics in Massachusetts. The legislation is a response to the U.S. Supreme Court’s unanimous decision last week striking down the state’s 35-foot buffer zone law, deeming it an unconstitutional restraint on the free-speech rights of protesters (LeBlanc, 7/2).

Politico: Massachusetts Readies New Abortion Clinic Protections
Massachusetts leaders, still smarting from a unanimous Supreme Court rebuke, are preparing to take another shot at keeping protesters away from women entering abortion clinics in the state. The high court last week ruled that Massachusetts' 35-foot "buffer zone" outside the facilities is unconstitutional. A majority of justices said such a large area is overly restrictive of free speech (Cheney, 7/2).

Los Angeles Times: Abortion Foes Get Up Close And Personal After Court Erases Buffer Zones 
Though the Supreme Court decision applied only to the Massachusetts law, advocates on both sides of the debate say it eventually could apply to a variety of ordinances across the country that are aimed at minimizing conflicts in some of the nation's most contentious terrains. New Hampshire last month approved a 25-foot buffer zone around its clinics, and cities including Sacramento, San Francisco, Santa Barbara and Portland, Maine, also have fixed-distance buffer zone laws in place. Many other municipalities, including Los Angeles, require protesters to stay 8 feet away from patients who are within 100 feet of a clinic. Those laws also could be the next targeted by the antiabortion movement after last week's decision (Semuels, 7/2).

The Associated Press: Missouri Governor Vetoes 72-Hour Abortion Wait
Missouri Gov. Jay Nixon vetoed legislation Wednesday that would have required a 72-hour wait for women seeking abortions, asserting that legislators showed a "callous disregard for women" by granting no exception for rape and incest victims. Republican legislators quickly vowed to override the Democratic governor's decision, and they may have the numbers to do so (Lieb, 7/2).

St. Louis Post-Dispatch:  Nixon Vetoes 72-hour Waiting Period For Abortions In Missouri
Setting up an election-year showdown with the Legislature, Gov. Jay Nixon vetoed on Wednesday a bill that would have required a 72-hour waiting period for abortions in Missouri. Nixon said the bill’s lack of an exception for victims of rape and incest was a "glaring omission" that was "wholly insensitive to women who find themselves in horrific circumstances." But even if the bill had contained such an exception, he would have vetoed it, Nixon said in unusually sharp criticism of an abortion bill (Young, 7/3).

Minnesota Public Radio: Minn. Abortions Drop To Lowest Number Since 1970s
A Minnesota Department of Health report finds the number of abortions performed in Minnesota dropped seven percent last year to 9,903. The annual assessment marks the first time since the mid-1970s that that the number of abortions has been below 10,000. Advocates on both sides of the abortion debate said the lower number reflects their efforts to help women (Zdechlik, 7/2).

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Medicare Proposes To Slightly Raise Kidney Care Payments

Modern Healthcare: CMS Proposing Slight Uptick In Kidney Care Payments In 2015
The CMS is proposing changes to payment policies for the treatment of end-stage renal disease that the agency estimates would increase payments by about 0.3 percent, or $30 million, in 2015.  The payment policies were detailed in a proposed rule issued by the agency on Wednesday. Medicare disburses roughly $8.5 billion per year to facilities that provide dialysis services to individuals with the chronic kidney disease (Demko, 7/2).

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Health Care Marketplace

NIH Expands Effort To Diagnose Misunderstood Disorders

The agency announces $43 million for its Undiagnosed Disease Network, which by the summer of 2017 is expected to enroll at least 300 new patients with mysterious and intractable conditions per year. Meanwhile, online ER booking in California is the latest example of how hospitals are attempting to compete with one another.

Los Angeles Times: Medical Sleuths Seek Patients With Mystery Diseases, Offer New Tools
Everyone loves a medical mystery, except the afflicted patient and his or her family who shuffle from doctor to doctor in search of an explanation for a disorder whose name, origin, prognosis and cure are all unknown. Now, the National Institutes of Health have underwritten a nationwide "whodunnit" campaign, with a $43 million-initiative to fund the diagnosis and exploration of undiagnosed, unrecognized and misunderstood diseases (Healy, 7/2).

Kaiser Health News: The Latest In Medical Convenience: ER Appointments
Scott Paul knew he needed to head to the emergency room on a recent Sunday after his foot became so painful he couldn't walk. The one thing that gave him pause was the thought of having to wait several hours next to a bunch of sick people. But his wife, Jeannette, remembered she'd seen Dignity Health television commercials featuring a woman sitting in a hospital waiting room and then cutting to the same woman sitting on her living room couch as words come up on the screen: "Wait for the ER from home" (Gorman and Colliver, 7/3).

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Public Health & Education

Digital Mammograms May Not Be Better At Diagnosing Older Women: Study

The Yale review adds to the mixed report card on digital mammography, reports NPR. Meanwhile, big increases in vaccination prices are straining public health budgets and creating dilemmas for some doctors, finds The New York Times.

NPR: Costlier Digital Mammograms May Not Be Better For Older Women
According to the Yale review of the data, the use of digital mammograms and of computer-aided detection increased nationally from around two percent to 30 percent between 2000 and 2010. As a result, the cost per screening mammogram rose from $75 to $101 during this period. They estimated that for each Medicare recipient, the average cost of all screening-related tests, including follow-up biopsies, MRIs, and ultrasounds, increased from $76 to $112 during the time period. Almost all of that increase in cost came from digital mammography and computer-aided detection. But switching to the more expensive technology didn't seem to help doctors spot cancer (Manke, 7/2).

The New York Times: The Price Of Prevention: Vaccine Costs Are Soaring
Vaccination prices have gone from single digits to sometimes triple digits in the last two decades, creating dilemmas for doctors and their patients as well as straining public health budgets. Here in San Antonio and elsewhere, some doctors have stopped offering immunizations because they say they cannot afford to buy these potentially lifesaving preventive treatments that insurers often reimburse poorly, sometimes even at a loss (Rosenthal, 7/2).

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State Watch

State Highlights: N.C. Lawmakers Reach Medicaid Agreement; Idaho Asks SCOTUS To Take Up Medicaid Case

North Carolina Health News: NC House, Senate Begin To Come Together On Medicaid
For the past few weeks, two big issues have kept the two chambers of the General Assembly from reaching an agreement on next year’s state budget: teacher salaries and Medicaid. But on Wednesday, the Senate and the House of Representatives finally moved closer to agreement on their Medicaid forecasts, loosening a logjam that’s kept legislators in Raleigh past July 1, the beginning of the fiscal year (Hoban, 7/3).

The Associated Press: NC Budget Negotiators Find Agreement On Medicaid
House and Senate Republicans made a key breakthrough in the stalled North Carolina government budget talks Wednesday by agreeing to earmark another $323 million for possible Medicaid cost overruns. The Senate's budget negotiators accepted the House's offer -- the midpoint of best- and worst-case scenarios presented by fiscal analysts -- for pending Medicaid provider claims and potential expenses for the coming year. The amounts are closer to what the Senate originally proposed in its budget (Robertson, 7/2).

Associated Press:  Idaho Asks Supreme Court To Take Up Medicaid Reimbursement Challenge 
The U.S. Supreme Court should consider an appeal by Idaho of a lawsuit challenging increased Medicaid reimbursement rates, according to a petition filed Wednesday. The state’s appeal requests that the justices decide on a 2009 case where five providers say Idaho’s Medicaid rates were too low because they were kept at 2006 reimbursement levels. The Idaho private agencies that sued the state include Inclusion Inc.; Exceptional Child Center Inc.; Living Independently for Everyone Inc.; Tomorrow’s Hope Satellite Services Inc.; and WDB Inc. In 2011, a federal judge ruled against Idaho and ordered the department to raise the payments. The increased reimbursements cost the state $12 million in 2013 (Krusei, 7/3).

The Boston Globe: State Panel Deals Challenge To Another Partners Hospital Merger
A key state board on Wednesday dealt another challenge to the quest of the state’s biggest health system to become even bigger. The Health Policy Commission found that Partners HealthCare’s proposed takeover of Hallmark Health System, which runs two hospitals north of Boston, would reinforce Partners’ market power, raise spending on medical care by $15.5 million to $23 million per year, and increase premiums for employers and consumers. Partners operates Brigham and Women’s and Massachusetts General hospitals, as well as several community hospitals, health centers, and a health plan. It wants to absorb Hallmark’s Lawrence Memorial Hospital in Medford and Melrose-Wakefield Hospital in Melrose. It plans to convert the Medford hospital to a short-stay facility, while renovating the Melrose facility (McCluskey, 7/2).

The Washington Post: City Officials: Fewer New HIV Cases In D.C. In 2012, But Infection Rate Still 'Epidemic'
New HIV/AIDS data released by the D.C. government Wednesday show fewer new cases and fewer deaths in 2012 than years prior, but infection levels remain at epidemic rates in the District, officials said. According to data compiled by the District’s health department, 680 new HIV cases were reported, down from 722 new cases in 2011 and 1,180 in 2008. And 221 HIV-positive city residents died in 2012, down from 345 in 2008 and 229 in 2011, with fewer of those 2012 deaths due to causes related to the infection (DeBonis, 7/2).

McClatchy: U.S. Court Doesn’t Change NC Contraception Law
The Supreme Court ruling this week that certain business owners don’t have to provide their employees with no-cost access to contraceptives under federal law doesn’t affect North Carolina’s state law on contraceptives. The state law, which went into effect in 2000, requires that insurers that provide plans that cover prescription drugs or devices also cover contraceptives. The Supreme Court, in the case brought by Hobby Lobby and Conestoga Wood Specialties, ruled that closely held corporations can be exempt from the Affordable Care Act’s mandate to provide employees with no-cost birth control coverage if the company’s owner objected on the basis of religion (Schoof, 7/3).

WBUR: Mass. Receives Mixed Marks On Painkiller Prescription Report
Massachusetts ranks in the top 10 of all states for prescribing OxyContin and other long-acting painkillers, but in the bottom 10 for overall prescribing of opioids. That’s according to a report from the Centers for Disease Control and Prevention. The report, based on 2012 data, says Massachusetts ranks eighth in long-acting painkiller prescription rates and ninth in the use of the sedative benzodiazepine.“ State variation in prescribing shows us that the overprescribing of opioids can be reduced safely and feasibly,” said Daniel Sosin, acting director of CDC’s National Center for Injury Prevention and Control, in a statement. “Improving how opioids are prescribed will help us prevent the 46 prescription painkiller overdose deaths that occur each day in the United States” (7/2).

Stateline: Without Federal Action, States Move on Long-Term Care
Three years after the demise of the long-term care piece of the Affordable Care Act, some states are retooling their Medicaid programs to maximize the number of people who can get care at home and minimize the number who have to become poor to receive help. They also are trying to save state dollars. Medicaid is a joint state-federal program, and long-term care for the elderly is putting an ever greater burden on state budgets: Total Medicaid spending for long-term services rose from $113 billion in 2007 to nearly $140 billion in 2012. Two recent reports have focused attention on the issue (Ollove, 7/3).

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Weekend Reading

Longer Looks: Rethinking Involuntary Commitment; Awaiting A Transplant

Each week KHN staff find interesting reads from around the Web. 

The Washington Post: Behind The Yellow Door, A Man’s Mental Illness Worsens 
Everyone is worried about the man in the house. His ex-wife, his mother, his father, his neighbors, the psychiatrists he has seen and no longer sees, they are all concerned because he has been alone in the house in suburban Maryland for two years. ... Once, the man’s family might have handled the situation by having him involuntarily committed to a psychiatric institution. For decades, it was a routine and simple procedure: If a doctor agreed that the patient had a mental illness, he could be institutionalized even against his will. The problem was that it was a process with few safeguards, and during much of the 20th century, all kinds of people who didn’t belong — from free-thinking women to gay people, minorities and rebellious children — wound up locked in hospitals where abuse was common and conditions were often bleak. So the system changed .... But 40 years after that standard was established, some people are asking whether society’s concern for the constitutional rights of people with mental illness has led to their abandonment (Stephanie McCrummen, 6/28).

The Boston Globe: Learning The Difference Between Medicine And The Medical Industry
Last month, I was standing in an intensive care unit, wearing my white coat and trying to look like I knew what I was doing. My third year of medical school had just begun. It was my first day on a clinical rotation, my first time actually taking care of patients. My assigned team had started morning rounds, discussing the patients on the unit and making decisions about their care. While the dialogue bounced among residents, nurses, and attending physicians, I struggled to keep up with the conversation (Nathaniel P. Morris, 6/30).

The Cincinnati Enquirer: How An Organ Transplant Changed My Life 
This is an organ transplant support group, and everybody here knows sickness intimately and speaks of it openly. They talk about constipation and catheters like most people talk about the weather. I look around to see if anyone else is about to hyperventilate. Two of us are waiting for transplants, and we say almost nothing. Everyone else has already received one, and they don't stop. I don't want to know about hard times and doubt. I have no interest in drug protocols and risk factors. I want to stop being a diabetic. I want to take control of my health. I want to grow old and read books and take walks with my wife. I want to see our little girl, Lucy, now 7, walk down the aisle. I want to be well. I have no interest in the truth (John Faherty, 6/29).

The New York Times: I Couldn't Turn My Abortion Into Art
Yet as I looked around the room, my expectations began to shift. This wasn’t the liberating environment I’d expected to enter. The uncomplicated message of those protests led me to think that legal abortion would be light. Lite. I wasn’t prepared for the saturnine cloudiness of the room, all those sad-looking women burying their faces in tabloid magazines. ... Fifteen years later, happily coupled with a wonderful man, I gave birth to my first daughter; I now have two. I don't wish I had a 20-year-old. I didn’t want that baby, with that man. Abortion rights, yes, I’ll always support them, but even all these years later, I wish the motto wasn't "Never again," but "Avoid this if there’s any way you possibly can, even if it’s legal, because it’s awful." I wish that someone had alerted me to the harshness of the experience, acknowledged the layers of regret that built and fell away as the months and years passed. I want my daughters to have the option of safe and legal abortion, of course. I just don’t want them to have to use it (Lisa Selin Davis, 7/2).

The Wall Street Journal: Gary Mendell Is New Voice In The Fight Against Addiction 
Mr. Mendell says, Brian is the only thing that matters. His son's drug addiction and ultimate suicide in October 2011 at the age of 25—after a year of sobriety—set Mr. Mendell on a new path. In 2012, he left his career to dedicate himself full-time to the launch of a organization called Shatterproof, which he hopes will become the first national umbrella group dedicated to addiction—a goal that has ruffled a few feathers among existing nonprofits. Mr. Mendell put in $5 million of his own money to start the group, and has raised another $3 million (Melanie West, 6/27). 

WBUR: For Rwandan Man In Boston, New Arms Replace Those A Father Destroyed
At United Prosthetics in Dorchester, Greig Martino, grandson of the company’s founder, pounds the final rivet into a new right forearm for Patrick as he waits downstairs. The prosthetic is a brown tube that ends in tong-like, curved hooks. "Ooo," Patrick says after sliding the soft flesh below his elbow into the socket. He stretches the arm out several times before raising it toward his face. "Now I can scratch. This is incredibly amazing." ... The arms will change his life, Patrick says, although he’s surprisingly adept without them (Martha Bebinger, 6/30).

PBS NewsHour: Pediatric Cancer Survivors Face Lifetime Of Health Challenges
Thanks to better treatments, more people are surviving cancer. But those treatments come with a downside: Survivors, especially those who got sick as children, are at greater risk for other significant health issues later. The NewsHour's Cat Wise profiles a clinic at the University of California, San Francisco that specializes in caring for survivors of pediatric cancer and studying their long-term health (Wise, 6/30).

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Health Policy Research

Research Roundup: 20M Gain Insurance, Coverage's Effect On Surgery Choices; Opioid Use

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

The New England Journal of Medicine: Health Care Coverage Under The Affordable Care Act — A Progress Report
This report aims to help readers understand recently announced enrollment numbers, as well as other numbers that have received less attention, and assess their importance for the future of the ACA and our health care system. ... Taking all existing coverage expansions together, we estimate that 20 million Americans have gained coverage as of May 1 under the ACA. We do not know yet exactly how many of these people were previously uninsured, but it seems certain that many were. Recent national surveys seem to confirm this presumption. The CBO projects that the law will decrease the number of uninsured people by 12 million this year and by 26 million by 2017. Early polling data from Gallup, RAND, and the Urban Institute indicate that the number of uninsured people may have already declined by 5 million to 9 million and that the proportion of U.S. adults lacking insurance has fallen from 18% in the third quarter of 2013 to 13.4% in May 2014 (David Blumenthal, M.D., M.P.P., and Sara R. Collins, 7/2).

JAMA Surgery: Effect Of Insurance Expansion On Utilization Of Inpatient Surgery 
[This study sought to] estimate the differential effect of insurance expansion on utilization of discretionary vs nondiscretionary inpatient surgery with Massachusetts health care reform . ... We identified a total of 836 311 surgical procedures during the study period. Insurance expansion was associated with a 9.3% increase in the use of discretionary surgery in Massachusetts. Conversely, the rate of nondiscretionary surgery decreased by 4.5%. ... Insurance expansion in Massachusetts led to greater use of discretionary inpatient surgical procedures. Not surprisingly, this effect was greatest for populations at highest risk for being uninsured in Massachusetts before reform. By translating the Massachusetts experience to the national level, we estimated that insurance expansion will result in almost half a million new discretionary surgical procedures (ie, knee and hip replacements, back surgery, inguinal hernia repair, and transurethral resection of the prostate) by 2017. ... for inpatient surgical care, the effect of policies aimed at increasing coverage is not uniform. Instead, patients in need of imperative or nondiscretionary inpatient surgery appear to get this care whether or not they have insurance (Ellimoottil, 7/2).

JAMA Internal Medicine: Chronic Pain And Opioid Use In US Soldiers After Combat Deployment
Opioid medications are prescribed for chronic pain, but recently, rates of opioid use and misuse have ballooned, leading to significant numbers of overdose-related hospitalizations and deaths. The prevalence of chronic pain and opioid use associated with deployment is not well known, despite large numbers of wounded service members. ... Chronic pain was reported by 44.0% [of a sample of 2597 members of an infantry brigade three months after returning from Afghanistan]. Of these, 48.3% reported duration 1 year or longer, 55.6% reported nearly daily or constant frequency, and 51.2% reported severity of moderate to severe; 23.2% reported past-month opioid use, and 57.9% of those reported few or several days use. ... The prevalence of chronic pain (44.0%) and opioid use (15.1%) in this non–treatment-seeking infantry sample were higher than estimates in the general civilian population of 26.0% and 4.0%, respectively. ... These findings suggest a large unmet need for assessment, management, and treatment of chronic pain and related opioid use and misuse in military personnel after combat deployments (Toblin et al., 6/30).

Pew Charitable Trusts: Expanding The Dental Team
More states are looking to midlevel dental providers—such as dental therapists or dental hygienists who can provide routine preventive and limited restorative care—to help address critical problems accessing dental care. Pew undertook a series of case studies to enrich the understanding of how such providers perform in practice settings and how they affect practice economics. This report focused on midlevel dental providers employed in three public health programs [in Minnesota, Alaska and California] with the mission of increasing access by the underserved. ... The findings show promise that midlevel providers are an effective and cost-efficient means for addressing the significant unmet need for care (Gehshan et al., 6/30)

Urban Institute/Robert Wood Johnson Foundation/Ford Foundation: Increase In Medicaid Under The ACA Reduces Uninsurance, According To Early Estimates
[S]imple enrollment counts do not fully answer important questions for those tracking how health insurance coverage has been changing under the ACA: How much of the increase in Medicaid coverage is a net gain in insurance coverage rather than a shift to Medicaid from other coverage? Are there differences in the patterns of Medicaid changes across states and among different population subgroups? ... We use the March 2014 [Health Reform Monitoring Survey] to examine recent changes in coverage in Medicaid and other state health insurance programs. ... This early HRMS evidence suggests that significant gains in Medicaid/state coverage occurred following the first Marketplace open enrollment period, especially in the Medicaid-expansion states. Further, the gains in Medicaid/state coverage were a major component of the reduction in uninsurance (Clemans-Cope et al., 6/25).

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

Reuters:  Videoconferencing Linked To Reduced Stress For Some Hospitalized Kids 
The ability to videochat with family and friends might help relieve stress among some hospitalized kids, according to a new study. The "virtual visits" seemed to help kids who lived closest to the hospital and were hospitalized for the shortest amount of time, an average of five days. The videochat program has been used at the University of California Davis Children’s Hospital in Sacramento for the past several years, said lead author Nikki H. Yang, who works at the hospital (Doyle, 6/30). 

The Wall Street Journal: New Weapon In Fight Against 'Superbugs'
A soil sample from a national park in eastern Canada has produced a compound that appears to reverse antibiotic resistance in dangerous bacteria. Scientists at McMaster University in Ontario discovered that the compound almost instantly turned off a gene in several harmful bacteria that makes them highly resistant to treatment with a class of antibiotics used to fight so-called superbug infections. The compound, called aspergillomarasmine A, or AMA, was extracted from a common fungus found in soil and mold (Lukits, 6/30).

MinnPost:  Working Parents Use ER Visits To Get Doctor’s Note For Sick Child, Study Finds
A young doctor who is doing his medical residency in the emergency room of a large, urban hospital recently told me about one of his frustrations regarding patients: Too many of them, he said, sought late-night care in the ER for minor ailments that could have been diagnosed and treated by the patient’s own doctor the following day. A study published earlier this week helps explain why one group of patients — parents of babies and preschoolers — take their child with a mild illness to the emergency room or to an urgent care clinic rather than to the child’s pediatrician. They are in immediate need of a doctor’s note that will permit their sick child to return to child care the following day — or that will permit the parent to stay home with the child (Perry, 6/27).

Los Angeles Times: Vaccines Are Safe And Problems Are 'Extremely Rare,' Study Says
Public health experts have taken a fresh look at the safety records of childhood vaccines and once again pronounced them safe. A systematic review published Tuesday by the journal Pediatrics notes some evidence of "adverse effects" from 11 vaccines. But the authors of the 13-page report emphasize that such problems are "extremely rare" and that the benefits of routine childhood immunizations far outweigh the risks (Kaplan, 7/1).

The New York Times: Common Back and Leg Pain Treatment May Not Help Much, Study Says
A widely used method of treating a common cause of back and leg pain — steroid injections for spinal stenosis — may provide little benefit for many patients, according to a new study that experts said should make doctors and patients think twice about the treatment. Hundreds of thousands of injections are given for stenosis each year in the United States, experts say, costing hundreds of millions of dollars (Belluck, 7/2).

news@JAMA:  Only 10% With Chronic Hepatitis C Complete Successful Treatment
Fewer than 10% of US residents with chronic hepatitis C virus (HCV) infection know of their illness, have access to health care, and have been treated successfully with antiviral therapy, according to a new study. The finding comes two years after the Centers for Disease Control and Prevention recommended one-time testing for the baby boom generation born between 1945 and 1965, which accounts for about 75% of all HCV infections in the United States. The study’s lead author, Baligh Yehia, MD, MPP, MSHP, of the University of Pennsylvania Perelman School of Medicine in Philadelphia, said the new data provide a baseline of hepatitis C care that health experts can use to monitor the effect and success of screening such a large population (Voelker, 7/2).

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Editorials and Opinions

Viewpoints: Expanding Hobby Lobby Decision; The Faux War On Women; Dispute Over Pelvic Exams

Los Angeles Times: Danger Sign: The Supreme Court Has Already Expanded Hobby Lobby Decision
The Supreme Court wasted no time in delivering a message to anyone who thought its Hobby Lobby ruling was limited to religious objections to coverage of purported abortion methods: You're wrong. The day after handing down the Hobby Lobby decision on Monday, the court issued orders pertaining to six pending cases in which employers claimed religious objections to all contraceptive services required under the Affordable Care Act. The court either ordered appeals courts to reconsider their rejection of the employers' claims in light of the Hobby Lobby decision, or let stand lower courts' endorsement of those claims (Michael Hiltzik, 7/2).

The New York Times: Hobby Lobby, Or When Corporations Get Things Both Ways
The notion that a corporation is a distinct entity with its own rights and obligations separate from those of its shareholders is the foundational principle of corporate law. It means that people can invest in a company without risking personal assets beyond their investment. If a corporation fails to observe proper safety precautions in manufacturing a product, for example, the victim can only sue the corporation — not the individual shareholders. ... Under the new decision, religious owners of closely-held, for-profit companies get to have it both ways. They get to assert their personal religious identity to exclude legally mandated birth-control benefits from their company’s health insurance plan. Yet they will still enjoy the insulation against economic liability that comes from doing business as a corporation (Dorothy J. Samuels, 7/2).

The Wall Street Journal: Hooray! The War On Women Is Back
Do Democrats seem livelier than usual this week—more spring in their step, maybe, their cheeks rosier, extra gleam in the eye? Verily, the Supreme Court has liberated them to unleash their gender and other identity-politics grievances in an election year. Democrats claim to be distraught over the Court's Hobby Lobby decision, but really they can barely suppress their glee. Allowing some religious objectors in business to opt out of the contraception mandate lends them a campaign theme that isn't the economy, the Middle East in flames or incompetent governance. No agenda, no problem. Patriarchs and Republicans—if that's not redundant—are coming for your womb, ladies (7/2).

The Washington Post: Supreme Court Reveals Its Class Bias
It’s not often that social and corporate conservatives come together, but the five right-of-center justices on the Supreme Court fashioned exactly this synthesis in their Hobby Lobby decision this week. In a religious freedom case related to birth control, the majority focused on the liberties of the company’s owners, not of those who work for them (E.J. Dionne Jr., 7/2).

The Washington Post: The High Court Highlights The Problem Of The Middleman
Conservatives are hailing the Supreme Court’s 5 to 4 rulings in Burwell v. Hobby Lobby and Harris v. Quinn as victories for liberty, religious in the former case and associational in the latter. Liberals say what the decisions have in common is the obliteration of worker rights. I agree that the cases teach a similar lesson but would summarize it differently: Oh, what a tangled web we weave when first we channel government-subsidized social benefits through corporations and unions (Charles Lane, 7/2).

New England Journal of Medicine: When Religious Freedom Clashes With Access To Care
At the tail end of this year's Supreme Court term, religious freedom came into sharp conflict with the government's interest in providing affordable access to health care. In a consolidated opinion in Burwell v. Hobby Lobby Stores and Conestoga Wood Specialties Corp. v. Burwell (collectively known as Hobby Lobby) delivered on June 30, the Court sided with religious freedom, highlighting the limitations of our employment-based health insurance system (I. Glenn Cohen, Holly Fernandez Lynch and Gregory D. Curfman, 7/2).

Bloomberg: Answers To All Your Hobby Lobby Questions
But Hobby Lobby invests in companies that make birth control! They don't have a problem with IUDs when they can turn a profit, apparently! I don't blame you for saying this, because everyone else who read that somewhat overwrought Mother Jones article seems to have gotten the same impression. However.What Hobby Lobby does is outsource its 401(k) to a company that provides mutual funds; those mutual funds invest in companies that make birth control. There are all manner of reasonable distinctions here (Megan McArdle, 7/2).

The Chicago Sun-Times: Illinois Can Fight Court's Bad Health Care Ruling
The Supreme Court majority got it wrong. No one — not a boss and not a stranger on the street — should prevent a woman from exercising her constitutional right to make a private medical decision. The decision to use birth control is an individual one. And a prescription for birth-control bills can be written for a host of health care reasons, from acne to pre-menstrual cramps or endometriosis migraines. These health care decisions should be based on the individual’s personal religious beliefs and what is best for her health and her family (Sheila Simon, 7/2).

And on other health issues -

The Wall Street Journal: How Automatic Renewal Could Cost Obamacare Enrollees
The administration no doubt views auto-enrollment as a way to minimize what even a supporter of the health-care law called the "massive technological challenge" associated with redetermining eligibility. But as The Wall Street Journal reported two weeks ago, the lowest-cost plans for 2014 have recorded some of the highest enrollments this year—and have proposed large increases for 2015. Unless millions of individuals switch plans, they could be in for some nasty spikes in their out-of-pocket premium costs come Jan. 1 (Chris Jacobs, 7/2). 

The New York Times: The Dispute Over Annual Pelvic Exams
Two major medical groups have taken opposing positions on whether healthy, low-risk women with no symptoms should have an annual pelvic exam. The American College of Physicians, the largest organization of physicians who practice internal medicine, strongly advised against the exams, which many women find distasteful or painful. The American College of Obstetricians and Gynecologists, the leading group of specialists providing health care for women, immediately reiterated its support for yearly pelvic exams for asymptomatic adult women. The exams at issue are not the Pap smears used to detect cervical cancers. ... Oddly enough, both professional groups agree there is no credible scientific evidence that the annual pelvic examinations save lives. They simply disagree over whether that lack of evidence matters much (7/2).

The New York Times: Jay Nixon Vetoes A Terrible Abortion Bill
Gov. Jay Nixon of Missouri vetoed an extreme measure on Wednesday that would have tripled his state’s existing mandatory waiting period for women seeking an abortion, to 72-hours. In so doing he provided an example of principled leadership in defense of women’s reproductive rights — currently under unprecedented assault — and bolstered supporters of those rights in his state and across the country (Dorothy J. Samuels, 7/2).

Los Angeles Times: Beware The Rush To Help People Die
The Medical Society of New Jersey, the state's largest physicians group, opposed a recently tabled bill for physician-assisted suicide. But it is pushing an alternative that may be just as bad: the Practitioner's Orders for Life-Sustaining Treatment, or POLST. POLST is a legally binding form with medical instructions that other healthcare providers, such as paramedics and nursing home staff, must follow if the patient is unable to speak because of illness. It gives more specific instructions than a living will or advance directive, and is said to be more effective because it comes from — and is signed by — a medical authority, such as the patient's doctor (Ben Mattlin, 7/2).

WBUR: Time To Lift The Black Box Warning On Antidepressants
In 2004, the Food and Drug Administration made the difficult decision to apply a “black box” warning to virtually all antidepressant medications. A few months earlier, British health officials had issued a similar warning for paroxetine, or Paxil, a frequently used antidepressant. Both the United States and the United Kingdom were worried about the possibility of antidepressant use in some people causing an increase in agitated, and even suicidal, behavior. The warnings, still in effect, apply particularly to adolescents. But recent research suggests that perhaps the black box warning should itself have a black box warning (Steve Schlozman and Gene Beresin, 7/2). 

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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.