Daily Health Policy Report

Tuesday, July 31, 2012

Last updated: Tue, Jul 31

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Capitol Hill Watch

Administration News

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insuring Your Health: Transportation Law Encourages Stricter Teen Driving Regs

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "In most states today, such a novice driver would not be allowed to drive with a car full of friends and would have other driving restrictions, thanks to regulations implemented over the past decade. But safe-driving advocates say more needs to be done" (Andrews, 7/30). Read the column.

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Mass. Aims To Set First-In-Nation Health Care Spending Target

WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, reports: "Massachusetts leads the nation once again, this time with Phase II of health reform. A 350-page bill expected to be voted on Tuesday sets the first statewide target for health care spending in the U.S. Massachusetts would aim to hold health care cost increases to same rate as the state's economy through 2017" (Bebinger, 7/31). Read the story.

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Hospital Debt Collector Settles Minnesota Case For $2.5 Million

Minnesota Public Radio News' Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "Accretive Health, the former bill collector for Fairview Health Service in Minnesota, has agreed to pay a $2.5 million fine and leave the state as part of a settlement of a federal lawsuit brought by state Attorney General Lori Swanson" (Stawicki, 7/31). Read the story.

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Capsules: Medicaid Expansion Favored In General, Less So Near Home, Survey Finds; Blogwatch: The CBO's New Medicaid Numbers And The Cost Of Saving Lives

Now on Kaiser Health News' blog, Jordan Rau reports on the latest Kaiser Family Foundation tracking poll: "Americans are broadly supportive of the health care law's expansion of Medicaid to cover millions of uninsured people, according to a new poll.  But they are less enthusiastic about expanding it in their own states after they realize state taxpayers will pick up some of the cost" (Rau, 7/31).

Also on Capsules, Andrew Villegas surveys what the blogosphere is saying about the recent Congressional Budget Office health law estimates: "This week, the Congressional Budget Office updated its numbers on the cost of the health law, the Affordable Care Act. The verdict? Now that the Supreme Court has overturned part of the Medicaid expansion – thereby allowing states to opt out of this portion of the overhaul without penalty, the law's cost will likely be around $84 billion lower over 11 years than previously estimated" (Villegas, 7/30). Check out what else is on the blog.

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Political Cartoon: 'Next!'

Kaiser Health News provides a fresh take on health policy developments with "Next!" by Lisa Benson.

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


When U.S. next hosts
Olympics, will it feature
Obamacare show?

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

How The Republicans Might Reshape Medicaid If They Win The White House And Congress

The Los Angeles Times reports on how the GOP is readying a push to scale back the health insurance program for the poor if it takes control of the White House and Congress next year. Meanwhile, the insurance industry is paying $1.1 billion in rebates to consumers under the health care law and eyeing congressional efforts to overhaul the tax code next year as its best chance to roll back a new health insurance tax.

Los Angeles Times: Medicaid Could Be Scaled Back Sharply Under GOP Plans
Nearly half a century after President Lyndon Johnson signed Medicaid into law, conservative critics of the massive government health insurance program for the poor are readying a new push to dramatically scale it back if Republicans control the White House and Congress next year (Levey, 7/30).

Reuters: Obama Administration States Will Join Medicaid Expansion
The Obama administration on Monday said it expects that U.S. states will eventually join its planned expansion of the Medicaid healthcare program as they evaluate the benefits of providing health coverage to more low-income people. U.S. Medicaid director Cindy Mann said states will likely spend the next several months analyzing the plan, which under President Barack Obama's healthcare law, would extend health coverage to about 16 million uninsured people based on new criteria that broadens eligibility to people with incomes of up to 133 percent of the federal poverty line (Morgan, 7/30).

The New York Times: Insurance Rebates Seen As Selling Point For Health Law
The law requires insurers to give out annual rebates by Aug. 1, starting this year, if less than 80 percent of the premium dollars they collect go toward medical care. For insurers covering large employers, the threshold is 85 percent. As a result, insurers will pay out $1.1 billion this year, according to the Department of Health and Human Services, although most of it will not go to individuals. The average rebate will be $151 per household, with the highest in Vermont ($807 per family), Alaska ($622) and Alabama ($518). No rebates will be issued in New Mexico or Rhode Island, because insurers there met the 80/20 requirement (Goodnough, 7/30).

Los Angeles Times: In-Store Clinics Look To Be A Remedy For Healthcare Law Influx
If you thought it was hard getting a doctor's appointment now, just wait until 30 million more Americans join the line. Nearly 3 in 4 California counties already lack a sufficient number of family physicians, and by 2020 the U.S. faces an estimated shortage of 40,000 primary-care doctors with no way to remedy that in just a few years (Terhune, 7/30).

Politico: Insurers Eye Tax Reform To Nix Fees
With GOP repeal efforts stalled out this year, health insurers are eyeing an expected effort to overhaul the nation's Tax Code next year as their best shot to get rid of a tax they'll have to pay under President Barack Obama's health care law. Lobbyists for the health insurance industry are calling on lawmakers to make repeal of the "health insurance tax" a priority during those discussions, arguing that a rewrite of the Tax Code is the best time to re-examine the tax that is expected to help pay for health care reform (DoBias, 7/30).

CQ HealthBeat: Hash Elaborates On Exchange Effort At Bipartisan Policy Center
Michael Hash, the top Centers for Medicare and Medicaid Services official in charge of implementing health insurance exchanges, elaborated on that effort Monday, telling a Washington, D.C., forum that within a few weeks virtually all states will be getting money to set up the new marketplaces. Hash addressed a meeting sponsored by the Bipartisan Policy Center on the health care law; the center also announced a new effort to control health care costs. Former Senate Majority Leader Democrat Tom Daschle, who co-chairs the Center along with former Senate Majority Leader Republican Bill Frist, called the new project "an urgent and absolutely essential endeavor" (Reichard, 7/30).

Also in the news -

CQ HealthBeat: Health Law Birth Control Coverage To Launch Wednesday As Legal Battle Continues
New attention was focused Monday on a federal rule requiring employers to provide free coverage for birth control in their employee health insurance policies following a federal court ruling that temporarily barred enforcement of the rule for a business in Colorado. Religious leaders who back the rule warned that a preliminary injunction that a federal district judge granted on Friday may be applied to other pending lawsuits and the leaders said that women’s rights to use contraceptives should not be restricted (Norman, 7/30).

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Poll: 2 Out Of 3 Voters Favor Medicaid Expansion 'In General'; 1 In 5 Expect To Pay Penalty

A new Kaiser Family Foundation poll finds views generally reflect partisan affiliations, and, overall, the public remains split in its view of the 2010 health law. A slim majority (54 percent) says they are tired of hearing lawmakers fight over the law and would like the debate to move on to other topics.

Reuters: Poll Shows Most Americans Favor Medicaid Expansion
In a survey released on Tuesday by the nonpartisan Kaiser Family Foundation, 67 percent of respondents gave a favorable view of President Barack Obama's healthcare reform provision to "expand the existing Medicaid program to cover more low‐income, uninsured adults.” ... Support dropped to 49 percent when poll participants were asked whether they would like to see Medicaid expanded in their home states, and a slight majority of 52 percent preferred maintaining the status quo when pollsters suggested an expansion could cost their states more money (Morgan, 7/31).

Kaiser Health News: Capsules: Medicaid Expansion Favored In General, Less So Near Home, Survey Finds
Americans are broadly supportive of the health care law's expansion of Medicaid to cover millions of uninsured people, according to a new poll.  But they are less enthusiastic about expanding it in their own states after they realize state taxpayers will pick up some of the cost (Rau, 7/31).

Politico Pro: Poll: 1 In 5 Think They'll Get Hit By Penalty
One in five Americans expects to pay the individual mandate penalty imposed by the Affordable Care Act, according to a new poll by Kaiser Family Foundation, despite assurances by the Obama administration that far fewer will be asked to pony up. The poll found that 19 percent believe they'll be subject to the health law's penalty on Americans who fail to obtain health insurance by 2014. For those keeping score, that's 10 to 20 times as many as President Barack Obama predicted would actually face the fine (Cheney, 7/31).

Modern Healthcare: Views Closely Divided On Medicaid Expansion
Public support for Medicaid expansion is closely divided in a monthly poll that asked respondents about broadening the safety net in their home states. Forty-nine percent said they would prefer their own state to expand Medicaid and 43% said they would not change eligibility, the latest Kaiser Health Tracking Poll found. The Patient Protection and Affordable Care Act allows states to expand Medicaid coverage, but June's U.S. Supreme Court decision on the healthcare reform law stuck down a hefty threat—the potential loss of all Medicaid funds—if states did not widen access to Medicaid (Evans, 7/31).

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Health Care Marketplace

Cost Of Future Post Office Retirees' Health Benefits Driving Possible Default

The Associated Press: Post Office Nears Historic Default On $5B Payment
The U.S. Postal Service is bracing for a first-ever default on billions in payments due to the Treasury, adding to widening uncertainty about the mail agency's solvency as first-class letters plummet and Congress deadlocks on ways to stem the red ink. With cash running perilously low, two legally required payments for future postal retirees' health benefits — $5.5 billion due Wednesday, and another $5.6 billion due in September — will be left unpaid, the mail agency said Monday. Postal officials said they also are studying whether they may need to delay other obligations. In the coming months, a $1.5 billion payment is due to the Labor Department for workers compensation, which for now it expects to make, as well as millions in interest payments to the Treasury (Yen, 7/30).

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In Response To Increasing Medicare Costs, Humana Reduces 2012 Forecast

Bloomberg: Humana Reduces 2012 Forecast As Medicare Costs Increase
Humana Inc., the second-biggest provider of Medicare benefits, cut its 2012 profit forecast as enrollees in the U.S. health insurance program visited the doctor in higher numbers than the company expected….The company generated three-quarters of its sales last year from Medicare, the U.S.-backed program for the elderly and disabled, and Chief Executive Officer Michael B. McCallister said in the statement that new members were proving more expensive. Humana's report contrasted with that of Minnetonka, Minnesota-based UnitedHealth Group Inc., the top Medicare insurer, which raised its profit forecast two weeks ago (Nussbaum, 7/31).

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Study: 5 Percent Of Americans Responsible For Half Of Health Care Spending

The Fiscal Times: 5% Of Americans Spend 50% Of Health Care Dollars
A new issue brief from the National Institute of Health Care Management adds grist to the mill of those who rebelled against the universal insurance mandate. The study showed that in 2009 half the population – fully 150 million people – spent an average of just $236 per person on health care. That was a paltry $36 billion for the entire group out of $1.3 trillion in personal health care expenditures.  On the other side of the use spectrum, however, just five percent of the population – about 15 million people – spent a whopping $623 billion or about half of all personal health care expenditures. That came to nearly $41,000 per patient (Goozner, 7/31).

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Capitol Hill Watch

House To Vote On D.C. Abortion Measure

The House is scheduled to vote Tuesday under suspension of the rules on legislation that would limit abortions in D.C. Specifically, the measure would ban abortions after 20 weeks of pregnancy, except when the pregnancy is a danger to the life of the mother.   

CQ HealthBeat: District Of Columbia Abortion Bill Placed On Right To Life Vote List
Anti-abortion groups are closely watching a House floor vote on a bill this week to limit abortions in the District of Columbia, but a high voting threshold may jeopardize passage. The House on Tuesday is scheduled to take up, under suspension of the rules, a bill to ban abortions in D.C. after 20 weeks of pregnancy except when the pregnancy would endanger the woman's life. The measure is a priority for the National Right to Life Committee (NRLC) and other anti-abortion groups, which have been lobbying for a floor vote for months. The NRLC says it will "score" the vote to record where lawmakers stand on the issue (Ethridge, 7/30).

The Hill: Planned Parenthood, NARAL To Score House Abortion Vote
Groups that support abortion rights say they will score Tuesday's scheduled vote in the House on legislation that would ban abortions after 20 weeks in the District of Columbia. Planned Parenthood Federation of America and NARAL Pro-Choice America said they would inform their members and the public as to which lawmakers vote in favor of the District of Columbia Pain-Capable Unborn Child Protection Act. Introduced by Rep. Trent Franks (R-Ariz.) in January, the bill proposes prohibiting abortions past the 20-week gestation period solely in the District (Siegelbaum, 7/30).

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Administration News

Tales Of Two Doctors, At FDA And Federal Health Services, Who Saw Themselves As Whistleblowers

The New York Times reports on how the Food and Drug Administration created an elaborate surveillance operation in response to the complaints of a particularly "caustic" agency scientist. In a separate story, the paper examines how the federal health service reassigned a psychologist who told his superiors that a North Dakota Indian tribe was ignoring an "epidemic" of child abuse.

The New York Times: Caustic Crusader At Center Of FDA Scandal
This month, F.D.A. officials came under fire from Congress after disclosures that they had begun a surveillance operation monitoring the e-mail of Dr. Smith and four other employees as they wrote to their lawyers, lawmakers and even President Obama. Dr. Smith's scorched-earth tactics had so unnerved managers that they, too, resorted to extreme measures, and the monitors ended up producing a sort of enemies list of 21 agency critics, including Congressional officials, academics and journalists (Lichtblau and Shane, 7/30).

The New York Times: Psychologist Who Wrote Of Abuse Is Punished
A federal health services psychologist who told superiors that an American Indian tribe was ignoring widespread child abuse on a North Dakota reservation has been reprimanded and reassigned, according to federal officials and documents.The psychologist, Michael R. Tilus, director of behavioral health at the Spirit Lake Health Center on the Spirit Lake Indian reservation, describes himself as a whistle-blower. He wrote in an e-mail to state and federal health officials this spring about an "epidemic" of child abuse on Spirit Lake, which is in a remote area of northeastern North Dakota. ... The Spirit Lake reservation has been buffeted by accusations of child abuse and neglect during the past 15 months (Williams, 7/30).

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State Watch

Mass. Lawmakers Unveil Bill To Cut Health Costs

Legislature expected to vote on compromise today.

The Wall Street Journal: Massachusetts Set For Health-Care Vote
Massachusetts lawmakers are expected to vote Tuesday on long-awaited legislation to rein in health care costs. The effort, which would put the state again at the forefront of health policy, will be watched by other states looking to control spiraling costs. After months of debate, House and Senate leaders filed a bipartisan compromise bill of more than 350 pages Monday night that would seek to contain health-care costs by setting a target at which overall state health spending should rise (Levitz, 7/30).

Kaiser Health News: Mass. Aims To Set First-In-Nation Health Care Spending Target
Massachusetts leads the nation once again, this time with Phase II of health reform. A 350-page bill expected to be voted on Tuesday sets the first statewide target for health care spending in the U.S. Massachusetts would aim to hold health care cost increases to same rate as the state's economy through 2017. Specifically, health care costs could not rise faster than the Gross State Product from 2013 to 2017 (Bebinger, 7/30).

Boston Globe: Bill Aims To Curb Health Spending In Massachusetts
Supporters believe the bill will help moderate increases in insurance premiums for consumers and businesses. While the measure does not spell out specific cuts, health providers are expect­ed to expand efforts already under­way to slow the proliferation of some medical procedures, better coordinate care to keep patients healthier and out of the hospital, and steer patients to lower-cost care­givers. Providers and insurers that do not meet the spending targets would have to submit "performance improvement plans" to a new state commission. Failure to implement their plans could lead to a fine of up to $500,000 (Kowalczyk, 7/31).

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Medical Debt Collection Company Accretive Settles Suit With Minnesota

Chicago-based Accretive Health agrees to pay $2.5 million and end operations in the state for at least two years to settle charges that it violated federal law requiring hospitals to provide emergency care even if people cannot afford to pay.

The New York Times: Medical Debt Collector To Settle Suit For $2.5 Million
Accretive Health, one of the nation's largest collectors of medical debt, has agreed to pay $2.5 million to the Minnesota state attorney general's office to settle accusations that it violated a federal law requiring hospitals to provide emergency care, even if patients cannot afford to pay (Silver-Greenberg, 7/30).

Kaiser Health News: Hospital Debt Collector Settles Minnesota Case For $2.5 Million
 Accretive Health, the former bill collector for Fairview Health Service in Minnesota, has agreed to pay a $2.5 million fine and leave the state as part of a settlement of a federal lawsuit brought by state Attorney General Lori Swanson. A federal judge approved the settlement late Monday. The case against Chicago-based Accretive attracted national attention with allegations of repeated privacy breaches and abusive collection tactics, such as approaching patients in emergency room for payment (Stawicki, 7/31).

(St. Paul) Pioneer Press: Accretive Settles With Minnesota Over Hospital Debt-Collection Practices
Filed in federal court in January, Swanson's lawsuit alleged violations of state and federal health privacy laws by the Chicago-based health care consulting firm, which worked under contracts at hospitals operated by Minneapolis-based Fairview Health Services and Robbinsdale-based North Memorial Health Care. Swanson claimed Accretive Health also broke state debt collection and consumer protection laws -- points she underscored in April with the release of a report that alleged overly aggressive collection techniques in emergency rooms and maternity wards by Accretive Health and Fairview (Snowbeck, 7/30).

Minneapolis Star Tribune: Accretive Is Banned From Minnesota
Accretive Health will be barred from operating in Minnesota for two to six years under a settlement agreement announced Monday by Minnesota Attorney General Lori Swanson. ... Accretive, one of the country's largest health care consulting firms, has consistently denied any wrongdoing. In a statement Monday, the company said there were "no findings of fault," and that it agreed to the settlement "in order to prevent this matter from being a continued distraction" (Kennedy and Lerner, 7/31).

Modern Healthcare: Accretive Health To Pay $2.5 Million Settlement
The company agreed to destroy or return health and financial information of its Minnesota clients within 60 days of closing down its Minnesota operations, the agreement said. Accretive will also pay for an independent consultant to verify it did so. Minnesota's attorney general will have the power to oversee Accretive's return to Minnesota's market for four years after the company's two-year exile ends. The company must provide 120 days notice of plans to do business in Minnesota and enter into a consent decree with the attorney general (Evans, 7/30).

MarketWatch: Accretive To Halt Minnesota Operations, Pay $2.5 M
Accretive Health Inc. has agreed to cease its operations in Minnesota and pay $2.5 million to settle a case brought by the state’s attorney general, according a Securities and Exchange Commission filing posted Monday. Accretive promises to stay out of Minnesota for two years after Attorney General Lori Swanson leveled charges against Accretive — a health-care billing consultant — alleging that it employed overly aggressive collection tactics in the emergency rooms, cancer wards and delivery rooms of its clients Fairview Health Services, based in Minneapolis (Britt, 7/30).

Reuters: Accretive Health To Exit Minnesota Under Settlement
Medical billing services provider Accretive Health Inc said it would wind down its Minnesota operations to settle a 6-month-old lawsuit by the state that has led to the loss of a contract for the company…. Accretive must pay $2.5 million and stop all business operations in Minnesota within the next 90 days under the settlement. The money will partly be used to compensate patients, with the rest going to the state treasury. Accretive said in a statement that it has not yet determined when it will complete the wind down process (Siddiqui, 7/30).

The Associated Press: Minn. Settles Suit Over Hospital Debt Collections
Attorney General Lori Swanson announced a legal settlement Monday that will bar a Chicago medical revenue company from doing business in Minnesota for six years after she accused Accretive Health Inc. of intrusive efforts to collect money from patients in several hospitals. The settlement requires Accretive to stop operations in Minnesota by November. Accretive will be banned for two years outright and another four years after that unless the attorney general approves. Accretive also will pay $2.5 million to set up a restitution fund for patients and return patient data to its client hospitals in the state, which include Fairview Health Systems hospitals, North Memorial Health Care and Maple Grove Hospital. Fairview terminated its contract with Accretive in April (Lohn, 7/30).

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Judge Allows Ariz. Late-Term Abortion Ban To Take Effect

A federal judge ruled Monday that Arizona's ban on most abortions after 20 weeks of pregnancy can stand. The judge said the law doesn't stop women from getting abortions, but that it may make some women consider the procedure earlier in their pregnancies.

The Associated Press: Judge Says Arizona's Abortion Ban Can Take Effect
Arizona's ban on abortions starting at 20 weeks of pregnancy is poised to take effect this week after a federal judge ruled Monday that the new law is constitutional. U.S. District Judge James Teilborg says the statute may prompt a few pregnant women who are considering abortion to make the decision earlier. But he says the law is constitutional because it doesn't prohibit any women from making the decision to end their pregnancies (Billeaud and Davenport, 7/30).

Reuters: Judge Clears Arizona Late-Term Abortion Ban
A federal judge refused on Monday to block an Arizona law banning most abortions after 20 weeks of pregnancy, saying it does not impose a "substantial obstacle" to the procedure, and cleared the way for the statute to take effect on Thursday. The ruling marked a stinging legal defeat for abortion-rights advocates who cited the Arizona law as the most extreme example of late-term abortion prohibitions enacted in more than half a dozen states, and they vowed to immediately appeal the decision. U.S. District Judge James Teilborg ruled that the measure, passed by the Republican-controlled state legislature and signed into law in April by Republican Governor Jan Brewer, was consistent with the standards that federal courts have set on limits to late-term abortions (Schwartz, 7/30).

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State Roundup: High-Ranking Iowa Gov't Employees To Pay More In Health Costs

A selection of health policy stories from New Jersey, Iowa, Florida, Texas, Kansas, Wisconsin, Oregon, California and Pennsylvania.

The Wall Street Journal: Judge Benefit Fight Moves To Ballot Box
The [New Jersey] state Legislature endorsed a constitutional amendment Monday requiring judges to contribute more to their government benefits, sending to voters an issue that some consider a linchpin of judicial independence. In a rare midsummer voting session, lawmakers responded quickly and almost unanimously to a state Supreme Court decision last week that said judges can't be forced to pay more for pension and health benefits, as other government workers were in a historic 2011 law (Haddon, 7/30).

Des Moines Register: Majority Of Top State Employees Enroll In Health Plan
The majority of Iowa's top-ranking state government employees enrolled in a new health care plan and will pay 20 percent of their premiums -- a plan advocated earlier this month by Gov. Terry Branstad. A review of public records by The Des Moines Register shows that 32 of Iowa's 54 department directors or division heads enrolled in the new health insurance plan. Two declined coverage by the state and 20 others were not enrolled. Branstad has been critical of state employees receiving premium-free health care coverage, saying he believes the contributions will help the state reduce costs. But on Monday, Branstad and his staff gave little indication whether he was satisfied with the participation numbers (Clayworth, 7/30).

The Associated Press/ABC: Fla. Appeals Ruling Voiding 'Docs Vs. Glocks' Law
Florida officials are appealing a federal judge's ruling striking down a Florida law that restricted doctors from talking with patients about gun ownership. Gov. Rick Scott announced the appeal Monday. U.S. District Judge Marcia Cooke ruled earlier this month in the case known as "Docs vs. Glocks." Cooke agreed with physicians who contended the law violates free speech rights. The state will take its case to the Atlanta-based 11th U.S. Circuit Court of Appeals. Scott says he believes the law is constitutional and will continue to defend it (7/30).

Medpage Today: Florida Appeals Ruling On Gun Gag Law
The state of Florida is appealing a federal judge's ruling that halts implementation of a law preventing doctors from asking patients and families about guns in the home. "This law was carefully crafted to respect the First Amendment while ensuring a patient's constitutional right to own or possess a firearm without discrimination," Florida governor Rick Scott (R) said in a Monday press release announcing the appeal, which was filed by the state Department of Health. ... Scott signed the measure, known as the Firearms Owners' Privacy Act, on June 2, 2011. The law made it illegal for physicians to ask patients about guns in their homes; violators faced $500 fines and loss of their medical licenses. A few days after Scott signed the bill into law, medical groups filed suit to overturn it (Frieden, 7/30).

The Dallas Morning News: Parkland Memorial Hospital To Temporarily Close Psych ER
Parkland Memorial is temporarily shuttering its troubled psychiatric ER for renovation while suspending longer-term care for the mentally ill, according to an internal bulletin sent to employees this morning. The hospital is remodeling the existing psych ER, the scene of numerous cases of abuse and neglect during recent years, beginning Thursday to boost capacity and improve care, the newsletter said (Moffeit, 7/30).

Kansas Health Institute News: KanCare Information Forums Begin
Representatives of hospitals, doctor practices and other Medicaid providers turned out in relatively large numbers today for the beginning of a series of meetings aimed at answering questions about KanCare, Gov. Sam Brownback's plan to remake the state Medicaid program. State officials said they still hadn't resubmitted their application for the federal waivers needed to launch the administration's Medicaid makeover plan but intend to refile that paperwork "very soon" and meanwhile are moving forward with their desired Jan. 1 start date for the new program. Federal approval is necessary for the administration to advance its plan of moving virtually all of the state's 383,000 Medicaid beneficiaries into fixed-cost managed care plans run by insurance companies (Shields, 7/30).

Milwaukee Journal Sentinel: State To Create Coordinated Care Program For Foster Children
The Department of Health Services has received federal approval to create a foster care "medical home" program in southeastern Wisconsin, Gov. Scott Walker announced Monday. The program, scheduled to begin this fall, is designed to break down the barriers that too often delay, sometimes even prevent, important medical information from being shared when a child who has suffered abuse or neglect is removed from his or her home and placed in protective services, said Fredi-Ellen Bove, administrator of the Division of Safety and Permanence for the Department of Children and Families. It will also improve the quality of the care that these children receive by requiring timely health screenings, full medical, dental and behavior exams, she said (Boulton and Stephenson, 7/30).

The Oregonian: Regence BlueCross BlueShield Defends Proposed Rate Hike At Salem Hearing
Escalating medical and prescription drug costs have given Regence BlueCross BlueShield executives little choice but to raise rates an average 9.6 percent for people who buy their own insurance, an executive told Oregon insurance regulators Monday. "We are simply putting our finger in the dam and hoping that the water stops flowing," said Don Antonucci, Regence's Oregon president, adding that the insurer is spending down reserves to limit increases. The rate hike and a new, more limited provider network for about 20,000 Portland-area members were discussed at a sparsely attended public hearing in Salem (Budnick, 7/30).

California Healthline: DHCS Director Douglas Rejects Another Judicial Decision
Toby Douglas, director of the Department of Health Care Services, has rejected another proposed decision by an administrative law judge over an appeal of eligibility for the Community Based Adult Services program. According to stakeholders, it is the first rejection based on eligibility criteria. Douglas earlier had rejected -- or "alternated" as it's known in the appeals system -- two other proposed decisions based on the legal question of whether the department had the right to reverse face-to-face assessments of eligibility by nurses. After a Department of Social Services administrative law judge issued a proposed decision that DHCS did not have that right, Douglas disagreed, and rejected those proposed decisions (Gorn, 7/31).

California Healthline: Reform Talk Moving From Rhetoric To Bottom Line In Business Community
With legal and political wrangling over health care reform waning, California small business owners -- many uninformed and some misinformed -- seem eager to learn more and get on with the process, according to a new report. The report -- based on a statewide "listening tour" orchestrated by Small Business Majority and chambers of commerce around the state -- indicates many business owners had "little or no interest in an ideological or partisan discussion of the law, but instead wanted a fact-based explanation of it and how its provisions will apply to their businesses" (Lauer, 7/30).

Medpage Today: [Pennsylvania] State Offers Incentives To Get Docs Online
Pennsylvania is hoping an offer of free software and a new customer reward will get smaller health care providers to turn off their fax machines and to switch to secure, encrypted email to share patient information. It's part of a national program designed to provide a halfway point for providers that can't afford the infrastructure to connect with a health care information exchange. The state's eHealth Collaborative is providing free implementation of Direct Messaging for small healthcare providers for 1 year if they register by Aug. 15. Also, it is paying $250 to health care information service providers for each provider they register for the Direct Messaging program (Baum, 7/30).

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Editorials and Opinions

Viewpoints: States May Not Be Up To The Challenge Of Setting Up Exchanges; Post Office's 'Default Day'

The Wall Street Journal: 'Exchange' For The Worst 
On the ever-lengthening fiasco list, the "exchange" problem is one of the worst. Congress told states to build these bureaucracies that will dispense health insurance subsidies and regulate coverage, but by and large the states aren't doing so. ... The exchanges do not merely subsidize but must verify who is eligible by income and residency, police compliance with the individual mandate and report scofflaws to the Internal Revenue Service; regulate insurers and enforce price controls; and penalize businesses that don't insure their employees. All this is a vast, complex, extremely technical and expensive undertaking that the states can barely handle, even if they wanted to (7/30).

The New York Times: It's D-Day For The Post Office
Welcome to the week the United States Postal Service defaults on a major obligation. D-Day is Wednesday, Aug. 1, when the Postal Service is obligated, by statute, to make a $5.5 billion payment, money that is supposed to be put aside to "prefund" health benefits for future retirees. But, with less than $1 billion in the bank, the Postal Service announced on Monday that it would not be making the payment. It has a second payment, for $5.6 billion, due in September. Unless lightning strikes, it won't be making that one either (Joe Nocera, 7/30). 

The Washington Post: Social Security Disability Insurance's Incentive Not To Work
Social Security Disability Insurance, however, pays people who can show that they are too mentally or physically impaired to remain in the labor force. In short, for many workers, SSDI creates a quasi-right not to work. This paradox is getting expensive. SSDI spending has doubled as a percentage of gross domestic product in the last 25 years, according to the Congressional Budget Office (Charles Lane, 7/30).

Fox News: Obama Administration Chooses Planned Parenthood Over Women's Health
The Obama administration’s decision this month to award $3.1 million in federal funds to Planned Parenthood affiliates and other family planning groups in New Jersey comes as no surprise. Despite the $15 trillion national debt, the administration seems willing to keep borrowing to support the nation’s largest abortion provider. And this isn't the first time the Obama administration has stepped in to ensure that taxpayer dollars continue to flow to its favorite abortion provider even at the expense of women’s health care (Kellie Fiedorek, 7/30).

The Washington Post: House Late-Term Abortion Bill Exploits The District
Legislation that would ban late-term abortions in the District is set for a vote this week on the House floor under a procedure that is normally used for non-controversial things like naming post offices or honoring folks back home. That the Republican leadership is suspending its rules for this bill suggests it's more interested in putting on a show to placate special interests than actually passing the measure. Or it thinks infringing on the authority of a local government to limit women's constitutional rights is no big deal. Either way, it's a misuse of Congress’s time and another cynical exploitation of the District to advance others' political agendas (7/30). 

Minneapolis Star Tribune: Worst Possible Time To Cut Research
Minnesota's congressional delegation must more prominently wield its clout to prevent harmful cuts to medical research funding -- an economic engine vital to the state and the nation. Major federal budget decisions aren't likely until after this fall's election. But disturbing recent moves in Washington, D.C., suggest that policymakers are willing to potentially delay medical advances and risk the country's leadership position in global research by inadequately funding the National Institutes of Health (NIH) and other critical initiatives (7/30).

The New York Times: A Battle For Florida's Courts
Under Florida's system of choosing Supreme Court justices, the governor makes the initial appointments, then voters get to decide every six years whether to keep them. This system of "retention elections" was intended to avoid the politicization of the courts associated with regular, multicandidate judicial elections. It is not working out that way this time. Some conservatives are trying to purge three moderate justices facing a retention vote in November: R. Fred Lewis, Barbara Pariente and Peggy Quince. The only Democratic appointees on the state's seven-member court, they are being singled out for various rulings, including a decision in 2010 that blocked from the ballot a misleadingly worded constitutional amendment designed to permit the state to opt out of national health care reform (7/30). 

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Andrew Villegas

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The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.