Daily Health Policy Report

Thursday, July 31, 2014

Last updated: Thu, Jul 31

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace


State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Report Touches Off Fight Over Future Of Doctor Training Program

Kaiser Health News staff writer Julie Rovner reports: “A high-level report recommending sweeping changes in how the government distributes $15 billion annually to subsidize the training of doctors has brought out the sharp scalpels of those who would be most immediately affected. The reaction also raises questions about the sensitive politics involved in redistributing a large pot of money that now goes disproportionately to teaching hospitals in the Northeast U.S. All of the changes recommended would have to be made by Congress” (Rovner, 7/30). Read the story.

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Capsules: 6 States, D.C. Extending Medicaid Pay Raise Next Year To Primary Care Doctors

Now on Kaiser Health News’ blog, Phil Galewitz reports: “Just six states and the District of Columbia will use their own money in 2015 to sustain the federal Medicaid pay raise to primary care doctors, which was a key provision of the Affordable Care Act intended to make sure millions of low-income people enrolling in the expanding insurance program have access to a physician” (Galewitz, 7/31). Check out what else is on the blog.

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Consumers Asked To Verify Income, Other Information — Or Risk Losing Government Subsidies For Health Insurance

The Miami Herald's Daniel Chang and Nick Madigan, working in partnership with Kaiser Health News, report: "About eight million people signed up for a health plan through the ACA exchanges. According to the Kaiser Family Foundation, 85 percent of them were eligible for financial aid, and the government is expected to deliver about $10 billion in subsidies during the first year. Healthcare analysts say some consumers will end up paying higher monthly premiums as a result of the verification process, while others may have to repay some or all of their subsidies if they are found to be ineligible. But for some, like Martinez, the verification process has become a maze of red tap" (Chang and Madigan, 7/31). Read the story.

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Political Cartoon: 'Teething Pains?'

Kaiser Health News provides a fresh take on health policy developments with "Teething Pains?" by Roy Delgado.

Meanwhile, here's today's haiku:


Employer mandate
delay? The prez went too far...
We're gonna sue him!

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

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Capitol Hill Watch

House Authorizes Boehner To Proceed With Lawsuit Against President Obama

The House voted mostly along party lines to proceed with the lawsuit against President Barack Obama. The legal challenge, which focuses on last year's White House decision to delay the employer mandate, alleges that the president's use of executive power is unconstitutional.  

Los Angeles Times: GOP-Led House Votes To Sue Obama In First-Of-Its-Kind Lawsuit
The House vote to sue President Obama is the first such legal challenge by a chamber of Congress against a president and a historic foray in the fight over constitutional checks and balances. Wednesday’s nearly party-line vote followed a feisty floor debate and offered a fresh example of how the capital’s hyper-partisanship has led both parties into unprecedented territory, going to new and greater lengths to confront one another (Memoli, 7/30).

The Washington Post: House Clears Way For Lawsuit Against Obama
House Republicans voted to proceed with a lawsuit against President Obama on Wednesday, saying that his executive actions are so extreme that they violate the Constitution. The nearly party-line vote — all Democrats voted against it, and all but five Republicans voted for it — further agitated an already polarized climate on Capitol Hill as both parties used the pending suit to try to rally support ahead of the November elections (Kane and Goldfarb, 7/30).

The Wall Street Journal: House Votes To Authorize Boehner To Sue Obama
In a 225-201 vote, the House told Mr. Boehner (R., Ohio) to move ahead with the suit. House GOP leaders have said they would focus the suit on the White House's decision last year to give employers a one-year reprieve on enforcing a requirement under the Affordable Care Act that they offer health coverage or pay a penalty. The requirement was delayed until 2015, and the White House then revised the health law further by saying employers with between 50 and 99 full-time workers wouldn't have to comply or pay a fee until 2016 (Crittenden and McCain Nelson, 7/30).

The Associated Press: Suing Obama: GOP-Led House Gives The Go-Ahead
Just a day before lawmakers were to begin a five-week summer recess, debate over the proposed lawsuit underscored the harshly partisan tone that has dominated the current Congress almost from its start in January 2013. The vote to sue Obama was 225 to 201. Five conservative Republicans voted with Democrats in opposing the lawsuit. No Democrats voted for it. Republicans said the legal action, focusing on Obama’s implementation of his prized health care overhaul, was designed to prevent a further presidential power grab and his deciding unilaterally how to enforce laws (7/30).

Politico: House Votes To Sue Obama
The House voted along party lines Wednesday to move forward with a lawsuit against President Barack Obama, escalating tension between the executive and legislative branches months before the pivotal midterm elections. The 225-201 vote authorizes Speaker John Boehner to take Obama to court on behalf of the House for delaying a provision in the health care overhaul that requires that most employers provide insurance to their workers. Republicans see the delay as a clear example of Obama overstepping his executive authority (French, 7/30).

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House Approves Sweeping Overhaul Of Vets' Health Care System

The chamber passed the $16.3 billion measure 420 to 5, and it is expected to clear the Senate by the end of the day Thursday.   

The Washington Post: House Easily Approves VA Overhaul
House lawmakers easily passed a sweeping overhaul of the troubled Department of Veterans Affairs that will make it easier for the nation's military veterans to seek medical care outside the government-run system. On a vote of 420 to 5, the House sent the legislation to the Senate, where it is expected to be easily approved by the end of Thursday. Five conservative Republicans voted against the legislation: Reps. Rick Crawford (Ark.), Walter Jones (N.C.), Jack Kingston (Ga.), Mark Sanford (S.C.) and Steve Stockman (Tex.). It was not immediately clear why they did so (O’Keefe, 7/30).

The Associated Press: House Approves VA Health Care Overhaul
The House overwhelmingly approved a landmark bill Wednesday to help veterans avoid long waits for health care that have plagued the Veterans Affairs Department for years. The $16.3 billion measure also would allow the VA to hire thousands of doctors and nurses and rewrite employment rules to make it easier to fire senior executives judged to be negligent or performing poorly (7/30).

The Wall Street Journal: House Passes $17 Billion Overhaul Of Department Of Veterans Affairs
The legislation, if approved by the Senate and signed by President Barack Obama, would provide the VA with $10 billion to allow veterans experiencing long appointment wait times, or who live far from VA hospitals, to see non-VA doctors to get health care. It would also provide $5 billion to hire new doctors, nurses and other staff, as well as make infrastructure improvements. The bill includes other provisions, including allowing the VA secretary more power to fire underperforming executives, expanding health care for rural veterans and leasing more than two-dozen facilities, bringing the total cost of the bill to $17 billion (Kesling, 7/30).

Politico: House Approves VA Reform Bill
The agency has been widely criticized in the wake of reports that it manipulated data on its wait times, hiding delays that in some cases contributed to the deaths of veterans. There has been overwhelming support in Congress to overhaul the agency after the White House found a “corrosive culture” of corruption within the department - a report that prompted former VA Secretary Eric Shinseki to resign (French, 7/30).

The Associated Press: What’s In Bill To Overhaul VA
Congress is set to adopt a landmark bill to help veterans avoid long waits for health care, hire more doctors and nurses to treat them and make it easier to fire senior executives at the Veterans Affairs Department. The House approved the bill Wednesday, with a Senate vote expected Thursday. Congressional budget analysts estimate the bill will cost about $16.3 billion over three years and add $10 billion to the federal deficit over 10 years after cost savings are included, such as changes in a veterans’ retirement program and reimbursements by insurance companies (7/31).

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Hospital 'Observation Stays' Scrutinized By Senate Aging Committee

Meanwhile, on the House side, the Energy and Commerce Committee approved legislation that would allow people with group health insurance to keep policies that don’t conform to the health law's standards.

CQ Healtbeat: Three-Day Rule, Observation Stays Under Fire at Senate Hearing
A Senate panel Wednesday highlighted instances in which Medicare patients got stuck with thousands of dollars in bills because their hospital stays were less than three days, the standard for Medicare to pay for subsequent care in a skilled nursing facility. The leaders of the Senate Aging Committee sought to build support for legislation (S 569) that would count all days spent in the hospital toward the requirement. “Most people, after spending the night in a hospital would say that they have been ‘admitted’ to the hospital – that they are an inpatient of that hospital,” said Bill Nelson, D-Fla., chairman of the Aging Committee (Reichard, 7/30).

The Hill: Panel Approves Bill Letting People Keep Old Health Insurance Plans
The House Energy and Commerce Committee approved a bill Wednesday that would let people on group health insurance plans keep policies that don’t conform to ObamaCare’s standards. The legislation, approved almost down a party-line 27-20 vote, is meant to respond to those who said their health plans were cancelled because of the new healthcare law, which required plans to meet minimum coverage standards. (Al-Faruque, 7/30).

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Health Reform

GAO Report: Poor Planning And Oversight Led To Website Woes

The government watchdog organization also found that more problems could emerge in the upcoming enrollment season. Investigators suggested implementation of a cost-control plan and improved oversight procedures, among other steps.

The New York Times: Investigators Warn of Possible Perils In Fall With Health Site
The federal health insurance marketplace, a centerpiece of President Obama’s health care overhaul, still suffers from serious problems, raising questions about whether it will be ready to enroll millions more people this fall, federal investigators said Wednesday (Pear, 7/30).

The Washington Post: Poor Planning And Oversight Led To Healthcare.gov Flaws, GAO Finds
Federal health officials were responsible for the problem-pocked start of healthcare.gov last year because of poor planning and lax oversight of outside contractors, according to government investigators who warned that “significant risks remain” that some Americans could again have trouble buying coverage in the federal health insurance marketplace this fall. Such management failures are the central conclusion of the first report issued by the Government Accountability Office as part of a wide-ranging appraisal of the reasons the computer system was not ready when the marketplace opened in October (Goldstein, 7/30).

The Wall Street Journal: Poorly Managed Healthcare.gov Construction Cost $840 Million, Watchdog Finds
The problems of healthcare.gov have been extensively reported since the federal government opened the website in October to sell insurance plans under the Affordable Care Act. Still, the official conclusions are likely to further fuel debate ahead of November's midterm elections, and as the Obama administration scrambles to finish and revamp the site in time for the next enrollment season. "CMS incurred significant cost increases, schedule slips, and delayed system functionality for the [site] and data hub systems due primarily to changing requirements that were exacerbated by inconsistent oversight," according to the testimony (Radnofsky, 7/30).

The Associated Press: Probe Exposes Flaws Behind Healthcare.gov Rollout
Spokesman Aaron Albright said the administration takes its responsibility for contract oversight seriously and has already started carrying out improvements that go beyond GAO’s recommendations. The congressional investigators recommended a cost-control plan and other changes to establish clear procedures and improve oversight (7/30).

USA Today: Probe Faults Oversight Of Healthcare.gov
The Department of Health and Human Services "needs a mitigation plan to address these issues," wrote the report author, William Woods, director of acquisitions and sourcing management for the Government Accountability Office. Unless the government "improves contract management and adheres to a structured governance process, significant risks remain that upcoming enrollment periods could encounter challenges." A new contract went to Accenture Federal Services to take over the site in January after the original contractor, CGI Federal, was essentially dropped after the poor launch. But Accenture's original contract for $91 million has increased to more than $175 million, and some of the back-end issues on the site are still not working, according to the report, which will be presented in a House hearing Thursday (Kennedy, 7/30).

Politico: Probe Exposes Flaws Behind Healthcare.gov Rollout
Major flaws in managing healthcare.gov contractors led to tens of millions of dollars in extra costs and contributed to the botched rollout of the federal Obamacare website last fall, according to a review by a nonpartisan government investigator released Wednesday. The report also identifies ongoing challenges for the contractor hired to get healthcare.gov into better shape after CGI, the original contractor, was replaced. Enough improvements were made to allow millions of people to sign up, but aspects of the website are still unfinished, especially the financial management tools insurers need to help balance their books. Health and Human Services Secretary Kathleen Sebelius resigned in April, and Sylvia Mathews Burwell replaced her (Haberkorn and Norman, 7/30).

Reuters: Federal Obamacare Market Still Faces Cost Overruns, Delays, Watchdog Says
Ten months after the botched rollout of healthcare.gov, Obamacare's federal health insurance exchange is still dogged by cost overruns and technology delays that could hamper enrollment when it resumes in November, a U.S. watchdog said. The total cost of healthcare.gov and its supporting systems hit $840 million in March, according to a forthcoming report by the nonpartisan Government Accountability Office (GAO). Excerpts of the report were released on Wednesday by a U.S. House of Representatives oversight committee. Part of the cost stems from the federal government's work with Accenture Plc, the lead contractor for the healthcare.gov website. The value of that contract soared more than 92 percent in less than six months, from $91 million in January to more than $175 million by early June, a GAO investigation found (Morgan, 7/30).

The Fiscal Times: Healthcare.Gov Costs Climb To Nearly $1 Billion
The federal government has doled out more than $840 million to build and then fix the tech--troubled Obamacare website, Healthcare.gov. Though many have speculated about the climbing costs of the federal Obamacare exchange website that suffered a nightmarish rollout plagued with technical glitches last fall, a new investigation from the Government Accountability Office reveals its official price tag and details why the costs have soared so high. In prepared testimony posted ahead of a House Energy and Commerce Committee hearing scheduled for Thursday, GAO official William T. Woods blasts the Centers for Medicare and Medicaid Services (CMS) for serious management issues and lack of oversight over contractors, which led to the disastrous website problems and expensive repair efforts (Ehley, 7/30).

NBC News: Rushed HHS Let Contractors Fumble Obamacare Website, GAO Says
A rushed team at the Department of Health and Human Services failed to plan properly or watch over contractors hired to set up and run the online health insurance exchange, setting it up for its spectacular blowout when it rolled out last October, according to a report to be released Thursday. And unless HHS acts, more problems could happen this year, the report warns (Fox and Seidman, 7/30).

CBS News: HealthCare.Gov Has Already Cost $840 Million
Healthcare.gov, the federal health-exchange website plagued with glitches at its launch, has already cost $840 million to build, according to a Government Accountability Office (GAO) review of two task orders and one contract related to building the system. The cost overruns were incurred through a combination of inconsistent oversight and constantly changing requirements, according to testimony prepared by GAO's Director of Acquisition and Sourcing Management, William Woods, who is scheduled to testify before a House Energy and Commerce Committee subcommittee Thursday. (Kaplan, 7/30).

Fox News: Failures in Management Led to Obamacare Website Woes, Investigation Finds
A failure of management by the Obama administration led to the disastrous rollout of the Obamacare website and has caused the government to incur tens of millions in additional costs, according to a congressional watchdog report released Wednesday. The Government Accountability Office (GAO) concluded after a months-long investigation into the rocky rollout of Healthcare.gov that the Centers for Medicare & Medicaid Services’ failure to establish “effective planning or oversight practices” was to blame for website’s myriad problems after it was launched (7/30).

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Minn. Exchange Will Add $3.16 Million For Repairs; Cover Oregon's Problems Lead To Political Casualties

News outlets report on developments regarding state online insurance marketplaces.

Pioneer Press:  MNsure To Pay Deloitte $3M More For Health Exchange Repairs
MNsure plans to spend another $3.16 million for help from a New York-based consultant with fixes to its troubled information technology system. The state's health insurance exchange agreed this spring to spend $4.95 million for assistance from Deloitte in assessing problems with the MNsure system plus help managing the project. Now, with the additional funds, Deloitte would help implement a plan to improve the MNsure website and related systems before most consumers start using it again on Nov. 15. The MNsure board voted Wednesday to authorize negotiations on the expanded contract, but Republicans criticized the decision because information on the proposed amendment wasn't made public prior to the board's meeting in St. Paul (Snowbeck, 7/30).

The Oregonian: As Feds Probe Cover Oregon, State Has Approved Criminal Defense Costs For Five Former Employees
Five former state officials have taken steps toward hiring criminal defense lawyers at state expense as federal investigators probe the Cover Oregon health insurance exchange fiasco. Triz delaRosa, Bruce Goldberg, Aaron Karjala, Rocky King and Carolyn Lawson have applied for legal coverage under a new state policy adopted as a result of the ongoing FBI investigation, according to documents obtained by The Oregonian. The policy pays up to $35,000 for the legal defense of a current or former state employee accused of a crime (Budnick, 7/30).

The Oregonian: Among Political Casualties Of Cover Oregon Health Exchange Fiasco, Some Fared Better Than Others
Six state officials involved with the failed Cover Oregon health insurance exchange have resigned since December. But over the last seven months it's become clear that some of the departed employees received a softer landing than others (Budnick, 7/30).

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Health Care Marketplace

Cigna's Quarterly Earnings Up

Gains driven largely by global benefits operation after Cigna reported earlier that its business on the health law marketplaces was soft. News outlets also examine Humana and WellPoint's earnings.

The Wall Street Journal: Premiums, Fees Boost Cigna's Profit
Cigna again boosted its per-share adjusted earnings expectations for the year, to a range of $7.20 to $7.40. In May, the company had projected earnings of $7.05 to $7.35 a share. The health insurer said in February that it expected to lose money on health-care exchanges this year as enrollment numbers looked soft in the early going, particularly after a series of technical glitches in the federal HealthCare.gov site that slowed registration. In the most recent quarter, gains were driven in large part by the company's global supplemental benefits operations (Prior, 7/31).

The Wall Street Journal: Benefit Costs Pare Humana's Profit
The closely watched health insurer said its profit declined, as expected, because of its investments in health-care exchanges and state-based contracts, while higher costs associated with specialty hepatitis C treatments also weighed on results. Humana saw a large flow of consumers into its individual plans, including those sold through the health law's government marketplaces. It had 1.12 million enrollees in individual plans at the end of June, more than double the 478,000 it had a year earlier. Humana said it is requesting rate increases for health-law marketplace plans next year, a move it said wasn't unexpected because it previously warned that the enrollees' demographics could be worse—and thus costlier—than it originally projected when it set 2014 prices. Early drug claims signal that its later exchange enrollees were younger and healthier than those who signed up in the first quarter, the insurer said (Calia and Wilde Mathews, 7/30).

The Associated Press: WellPoint 2Q Tops Wall Street Expectations
WellPoint’s second-quarter profit fell 8.6 percent as expenses tied to changes in the nation’s health care laws climbed. It still beat Wall Street expectations, and the nation’s second-biggest health insurer raised its profit expectations for the year. Its shares fell in morning trading after initially rising (Chapman, 7/30).

The Wall Street Journal: WellPoint Lifts View Despite Profit Drop
WellPoint said it enrolled 769,000 people through the health-law marketplaces through the end of the second quarter, more than the approximately 600,000 it had projected. The demographics of the enrollees, including age, "continue to track well versus our expectations," with a "balanced risk pool," and the trends so far in the claims paid are "encouraging," said Joseph Swedish, the insurer's chief executive. However, WellPoint pointed to a drop in the small-group business that was steeper than it expected, reflecting faster-than-projected moves by employers to put workers into exchanges (Prior and Wilde Mathews, 7/30).

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IOM Report Calling For Medical Education Reform Could Set Up Major Battle Over Funding

The report, which says the $15 billion spent annually to train doctors is failing, could lead to congressional battles and rivalries among doctors' groups.

The Fiscal Times: Gov't Spends $15 Billion To Train Incompetent Doctors
The government spends about $15 billion every year on physician training programs that a panel of highly respected medical experts says may not actually be producing quality doctors. The Institute of Medicine (IOM) issued a report this week concluding that the current system is failing and must be reformed. "A variety of surveys indicate that recently trained physicians in some specialties cannot perform simple procedures often required in office-based practice and lack sufficient training and experience in care coordination, team-based care and quality improvement,” the report said (Ehley, 7/31).

Kaiser Health News: Report Touches Off Fight Over Future Of Doctor Training Program
A high-level report recommending sweeping changes in how the government distributes $15 billion annually to subsidize the training of doctors has brought out the sharp scalpels of those who would be most immediately affected. The reaction also raises questions about the sensitive politics involved in redistributing a large pot of money that now goes disproportionately to teaching hospitals in the Northeast U.S. All of the changes recommended would have to be made by Congress (Rovner, 7/30).

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Few States Plan To Extend Medicaid Pay Raise For Primary Care Docs

Also in the news, the Government Accountability Office examines Medicaid's supplemental payments to hospitals and health care providers.   

Kaiser Health News: Capsules: 6 States, D.C. Extending Medicaid Pay Raise Next Year To Primary Care Doctors
Just six states and the District of Columbia will use their own money in 2015 to sustain the federal Medicaid pay raise to primary care doctors, which was a key provision of the Affordable Care Act intended to make sure millions of low-income people enrolling in the expanding insurance program have access to a physician (Galewitz, 7/31). 

CQ Healthbeat: Extra Medicaid Payments Rise by $20 Billion Amid Oversight Questions
Extra payments made through the Medicaid program to hospitals and health care providers totaled at least $43 billion in fiscal 2011, up from an estimated $23 billion in fiscal 2006, according to a report from the investigative arm of Congress. The supplemental payments often are intended to address a gap between what Medicare pays for a service and the reimbursement from Medicaid, the Government Accountability Office said in a report released Tuesday. The GAO noted that it has previously raised questions about oversight of the supplemental payments. In 2012, for example, GAO reported that 39 states had made supplemental payments to 505 hospitals that, when combined with their regular Medicaid payments, topped these hospitals’ total costs of serving Medicaid patients by $2.7 billion (Young, 7/30).

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State Watch

State Highlights: Maryland's Top Health Official Leaving For Johns Hopkins

A selection of health policy stories from New York, Massachusetts, Illinois, North Carolina and Kansas.

The Washington Post: Top Maryland Health Official Joshua Sharfstein To Step Down In January
Maryland’s top health official, Joshua M. Sharfstein, announced Wednesday that he will leave at the end of Gov. Martin O’Malley’s term in January to become an associate dean at the Johns Hopkins Bloomberg School of Public Health (Johnson, 7/30).

The Baltimore Sun: Health Secretary Shafstein To Join Hopkins
Dr. Joshua M. Sharfstein said Wednesday he plans to leave his post as secretary of the state Department of Health and Mental Hygiene, where he drew criticism for the botched rollout of the state's health insurance exchange website. Sharfstein, a trained pediatrician who has spent his career in public service, will join the Johns Hopkins Bloomberg School of Public Health as an associate dean in January as the O'Malley administration ends (Cohn, Walker and Dresser, 7/30).

The Associated Press: NY To Appeal Federal Medicaid Claim For $1.25B
The New York Health Department says it will appeal a federal claim for the return of more than $1.25 billion in Medicaid funds, saying federal authorities previously approved that funding and the claw back could hurt the state's health care system (7/30).

Pioneer Press: Minnesota Legislature To Propose Requiring Insurers To Pay For Contraception
Spurred by a recent Supreme Court ruling, DFLers in the state House say they will introduce legislation next year to require insurance coverage for contraceptives by certain employer health plans in Minnesota. House Majority Leader Erin Murphy, DFL-St. Paul, says the legislation is needed because of a U.S. Supreme Court ruling that upheld a challenge by crafts retailer Hobby Lobby to mandated contraceptive coverage in the federal Affordable Care Act. Hobby Lobby argued the contraceptive mandate infringed on the religious views of the closely held company's owners. A majority of court justices agreed and said the ruling should have a limited impact on employer health plans because it was focused on closely held companies (Snowbeck, 7/30).

Politico: Testing Boundaries Of Abortion Clinic Buffer Zones
The court’s ruling in McCullen v. Coakley has invigorated groups opposed to abortion and frustrated those that support abortion rights. The Alliance Defending Freedom, which argued the Massachusetts case, has sued New Hampshire over its new law with a 25-foot buffer zone and filed a court brief opposing a Madison, Wis., measure banning protesters from approaching people without permission within 100 feet of a medical center (Winfield Cunningham, 7/30). 

The Associated Press: Illinois Medicaid Restricts Use of Hepatitis Drug
Facing ballooning costs for a $1,000 pill to treat hepatitis C, Illinois' Medicaid program is putting tight restrictions in place, including requiring patients to meet 25 criteria and get prior approval before the government program will pay for the new drug. After spending an estimated $16 million this fiscal year on Sovaldi, which holds promise for a cure for the liver-damaging disease, the state agency headed by Julie Hamos approved the restrictions July 10 (Johnson, 7/30).

Winston Salem Journal: N.C. House Rejects Senate's Medicaid Reform Bill
The state House, in a rare show of bipartisan support, rejected a Senate proposal Wednesday for Medicaid reform that includes privatizing portions of the program and creating a new department to run it. The House voted 106-0 not to accept the Senate version of House Bill 1181, which is aimed at modernizing how the state operates and pays for Medicaid coverage for nearly 17 million North Carolinians. Gov. Pat McCrory opposes the Senate proposal, as do a wide variety of health care providers and advocacy groups (Craver, 7/31).

Kansas Health Institute News Service: Company Seeking To Buy Kansas-Area hospitals Draws Condemnation, Admiration
Prime Healthcare Services, the for-profit California health care company that has agreed to acquire two nonprofit Kansas City area hospitals, is no stranger to controversy. Among other things, it has faced fierce opposition from the nation’s largest health care labor organization - the Service Employees International Union (SEIU) - and has been accused of billing fraud. Ascension, a Catholic health system based in St. Louis, announced Monday that its affiliate in Kansas City, Mo., Carondelet Health, has agreed to sell St. Joseph Medical Center in south Kansas City and St. Mary’s Medical Center in Blue Springs to Prime. Terms of the deal were not disclosed, and Prime spokesman Edward Barrera on Tuesday declined to comment on the transaction or on questions that have arisen about its operations (Sherry and Margolies, 7/30).

North Carolina Health News: Community Homeless Clinic Connects Dots
An entire, 360 degree approach. That’s how the health care practitioners at Lincoln Community Health Center’s Health Care for the Homeless Clinic say they want to treat every homeless person who comes through its doors. The homeless clinic, located on the campus of Durham’s Urban Ministries, focuses on treating physical and psychological ailments and coordinating social services for people living on the streets or in shelters. The clinic also serves those who might be sleeping on a couch in an already crowded dwelling. At a minimum, each patient sees a nurse, a medical provider and a social worker. From there, referrals for specialty care may be added (Porter-Rockwell, 7/31).

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Weekend Reading

Longer Looks: Pittsburgh's 'Frayed Safety Net'; Curing Cancer

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

Pittsburgh Post-Gazette: Poor Health: A Frayed Safety Net
More than a quarter of the hospitals in the Pittsburgh area closed in the first decade of the 21s century, drastically reducing the amount of charitable care available to the poor. The failure of the remaining hospitals to provide adequate care to low-income patients and the inability of free and government-funded clinics to fill the gap has left the region's health safety net badly frayed. ... "Everyone knows you go broke providing health care to broke people," said Braddock Mayor John Fetterman, whose community lost its hospital in 2010. Broke people usually have no insurance or they are on Medicaid. Hospitals and doctors lose money serving such patients. ... In Pittsburgh, St. Francis Central, St. Francis Medical Center and Mercy Providence — all Catholic institutions now closed — once were routinely among the largest providers of uncompensated care in the region. ... "The problem as always was money," said Sister Ann Carville, who was vice chair of St. Francis Health System when UPMC bought and then tore down St. Francis Medical Center in Lawrenceville. "We really lived by the principle that we wouldn't turn anyone away, and we didn't" (Sean D. Hamill, July 2014).

PBS NewsHour: Why Summer Is The Hungriest Season For Some U.S. Kids
Now that Isaac Mejia has graduated first grade, he knows a little something about the grading scale. And he's developed his own set of evaluations for the summer camp he attends here in D.C. For example, watching movies: super fun. Swim time: pretty good. Eating broccoli at lunch: worst "by far." "Sometimes I just spit it out in the trash can," he said. "But sometimes I’ll swallow it." That's better than never, his camp counselors at Park View Recreation Center say. Even Isaac's small bites of healthy food are more than many of his neighbors eat in the summertime. Because when school ends each year, so do the free and reduced-price meals that most low-income D.C. families rely upon for basic nutrition (Jason Kane, 7/16).

JAMA Internal Medicine: The Many Stories Of My Mother’s Death
I knew immediately on hearing the details of the accident that my mother could not, would not, survive her injuries. ... My mother had severe osteoporosis. The seat belt crushed her ribs, and the air bag shattered her neck. ... I knew she would die. I just wondered when, and how. ... Each day at work as a palliative medicine physician I advocate vigorously for patients near the end of life. Yet even when my mother entered the recognizable death spiral known as the "Weissman triad" (feeding tube, restraints, pulse oximeter), I could not summon up the courage to challenge her physicians' authority. I wanted to cry out: "Do you not recognize that your best medical technology cannot rescue her tired and broken body?" Instead, I said nothing. Why did I remain silent? The lesson I have gleaned from my own mother's death is this: our standard approach to end-of-life decision-making places an enormous and unfair burden on patients and families. The standard approach is to first elicit from patients and families their preferences, finding out what they want. But my mother was frequently delirious. My father was so grief-stricken he could barely speak. And I was not about to say, "My preference is that my mother dies." Nor was I willing to ask my mother, "Do you want to die?" (Dr. Paul B. Bascom, 7/28).

WBUR: My Right Breast: One Man's Tale Of Lump And Mammogram
It began with an itch I just had to scratch. Doesn't every adventure begin that way? I was lying in bed reading on a Saturday evening, and without even looking I idly scratched a spot on the right side of my chest –- at that point I had a chest, not breasts. As I did, my fingers rode over a small something, a little like a speed bump about an inch below and two inches to the left of my right nipple. I stopped reading and started poking. And prodding. And pushing. And feeling. And manipulating. And panicking (B.D. Colen, 7/25).

The Atlantic: What If The Path To Curing Cancer Has Been Part Of The Body All Along?
For generations the three pillars of cancer treatment have been surgery, radiation, and chemotherapy. But both chemotherapy and radiation are crude weapons with significant collateral damage to healthy tissue, and surgery can leave cancerous cells behind. Scientists have long tried to understand how to get the immune system—the body’s natural defense mechanism—to recognize cancer cells as the enemy and destroy them. And now we may finally be turning the corner: Doctors are finding that clinical regimens known as immunotherapies can empower a patients immune system to fight the disease like it might an infection, while sparing a person's normal cells (Jacoba Urist, 7/28).

Mashable: Big Data's Effect On Organ Transplant Wait Lists
Of 28,594 organs transplanted in 2013, you haven't heard about most. The stories of a few might go viral thanks to social media, but the vast majority of donated organs are harvested from deceased donors or taken from living donors in relative obscurity. While the total number of organs transplanted seems like an impressive amount, nearly 18 people still die each day waiting for a new organ, according to the United Network for Organ Sharing, the private, non-profit organization that manages the U.S.’s organ transplant system under a contract with the federal government. Faced with more than 120,000 people who need a life-saving organ and a constant shortage of donors, economists, doctors and mathematicians are teaming up with data to save lives (Eli Epstein, 7/23). 

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Editorials and Opinions

Viewpoints: GOP Lawsuit Against Obama On Health Law Is Not A 'Stunt'; 'Wisdom' Lacking In The House; The Danger Of Cyberattacks On Hospitals

The Wall Street Journal: The Case For Suing The President
"So sue me" is President Obama's message to Congress. And on Wednesday the House of Representatives took up his taunt, authorizing a lawsuit to challenge the president's failure to faithfully execute provisions of the Affordable Care Act as passed by Congress. The House lawsuit is no "stunt," as Mr. Obama has characterized it. The lawsuit is necessary to protect the Constitution's separation of powers, a core means of protecting individual liberty. Without a judicial check on unbounded executive power to suspend the law, this president and all who follow him will have a powerful new weapon to destroy political accountability and democracy itself (David B. Rivkin Jr. and Elizabeth Price Foley, 7/30). 

The Wall Street Journal: So Sue Him
The House challenge involves crucial questions about the architecture of American government and the separation of powers -- questions that haven't been joined in this kind of challenge at the courts. Mr. Boehner contends that Mr. Obama's habit of amending or suspending (not enforcing) statutes that conflict with his political goals have usurped "all legislative powers herein granted" by Article I to Congress (7/30).

The Washington Post: In House, Priorities -- Like Wisdom And Understanding -- In Short Supply
The people's representatives were hurrying to depart Thursday for their five-week summer vacation, but first they had some important business to complete. Emergency legislation to ease the crisis at the border? Funding to keep highway repairs going? Afraid not. House Republicans were instead taking up their not-quite-impeachment legislation: a bill that would authorize the House to sue President Obama for allegedly violating the Constitution, which, by definition, is an impeachable offense (Dana Milbank, 7/30). 

Politico: A Constitutional Crisis For Fun And Profit
The reality is that House Speaker John Boehner's lawsuit that [Democrats] say is part of the nefarious impeachment plot will, even if successful, have little practical effect beyond establishing the precedent of Congress suing the president (a precedent Democrats may welcome if they lose the White House in 2016) (Rich Lowry, 7/30).

The Wall Street Journal: Democrats Try the Impeachment Ploy
So why are Democrats -- led by the Obama White House -- incessantly raising impeachment? First, it fattens Democratic bank accounts. ... Finally, talk of impeachment diverts attention from everything else. Every moment spent discussing impeachment is a moment not spent discussing issues that hurt Democrats, such as ObamaCare, the weak recovery, the border crisis, the nation's growing debt and the world's increasingly dangerous condition (Karl Rove, 7/30). 

Bloomberg: Why Shouldn't Democrats Fan The Impeachment Flames?
Republicans such as Speaker John Boehner and Bob Corker dismiss the issue, and possibility, as frivolous. The problem is these political wardens can't control some of the inmates. Palin earlier this month called on Congress to impeach Obama for a variety of offenses, the top being failing to control the border with Mexico. "If after all this he's not impeachable," she argued, "then no one is." ... Although serious scholars dismiss as silly any notion there are "high crimes or misdemeanors" -- the grounds for impeachment --there are no shortage of charges cited by right-wing Republicans. ... The Democrats' response: Bring it on and we'll take it all the way to the bank (Albert R. Hunt, 7/30).

The Wall Street Journal: Amid Tensions, Legal Immigrants Fear Signing Up For Obamacare
The wave of unaccompanied undocumented minors entering the U.S. has captured national attention. But a new Kaiser Family Foundation survey reveals a very different immigration issue. In California, legal immigrants entitled to health coverage under the Affordable Care Act (ACA) are afraid to enroll because they worry that doing so would expose an undocumented relative to investigation and deportation. That's despite assurances from the government that any information gathered about immigrant families from ACA coverage applications will not be used toward immigration enforcement (Drew Altman, 7/30). 

The New York Times' The Conscience Of A Liberal: Stealth Single Payer
The Kaiser Family Foundation has a new survey on Obamacare in California, and it's full of remarkably good news. For those who haven't been following this, CA -- with its now-dominant Democratic Party -- is where Obamacare was implemented the way it was supposed to be implemented: the website worked pretty well from the beginning, Medicaid expansion was implemented, and the state worked hard on outreach. It was also a place that really needed reform: the uninsured were a high percentage of the population, and an individual market without community rating meant that the mere hint of a preexisting condition was enough to prevent coverage (Paul Krugman, 7/30).

The New York Times: The F.D.A.'s Blatant Failure On Food
Every year, antibiotic-resistant infections kill at least 23,000 Americans and make another two million sick, according to the Centers for Disease Control and Prevention. That's why a recent ruling by the United States Second Circuit Court of Appeals is so appalling. It allows the federal Food and Drug Administration to leave an antibiotic used in animal feed on the market even if the agency openly states that the drug’s use is not safe and increases the risk of antibiotic resistance in people (Ruth Reichl, 7/30). 

USA Today: VA Deal Shows Congress Can Work: Our View
Something unusual is happening this week in the otherwise gridlocked and dysfunctional Congress: Lawmakers are coming together to pass a law to address a significant national problem. The problem is veterans' health care. With the August recess approaching, political opportunity high and midterm elections looming, the system is responding in the way it is supposed to but too rarely does (7/30). 

USA Today: Sen. Coburn: Don't Reward VA For Failing
The bad news for veterans is that little at the VA will change if the House-Senate conference agreement becomes law. In typical Washington fashion, instead of making the agency more transparent and accountable, Congress is rewarding the department for its failures with a $16 billion bonus. The problems plaguing the VA, which boasts the second largest budget in the federal government and ends every year with billions of unspent dollars, are not the result of a lack of funds (Sen. Tom Coburn, R-Okla., 7/30). 

The CT Mirror: Federal Insurance And Obamacare: Why This Birthday Matters
Imagine parents having twins and each year celebrating the birthday of only one. Rough, huh? But that is exactly what America has done every July 30 since 1964, the day Medicare and Medicaid were born. These vital programs are now 49 years old… and one, Medicare, has received far more policymaker love than Medicaid. Medicare provides health care coverage mostly to senior citizens; Medicaid to the poor and underprivileged. By 2020 there are expected to be more people enrolled in Medicaid than Medicare. Therefore it is a serious problem that on average across all 50 states, Medicaid in 2012 paid providers about two thirds of what Medicare reimbursed for comparable services (Doug Olson, 7/30).

The Sacramento Bee: Improve Health Care By Building On Medicare’s Success
I’m appreciative of the expansion in coverage that the ACA has allowed, but we still have a ways to go. There are still 13 percent of Americans without health insurance. Many of my patients who just enrolled in Medi-Cal are having trouble getting specialty care because their plans have not negotiated contracts with specialists in their areas. ... The answer to health care costs that are 2.5 times higher than the industrial nation average (and yet fail to produce higher-quality care and more favorable morbidity and mortality indicators) is Medicare for All (Dr. Erica Heiman, 7/31).

The New England Journal Of Medicine: Reforming The Financing And Governance Of GME
After reviewing the relevant literature, the committee reached several important conclusions that helped shape its recommendations: forecasts of future physician shortages are variable and have been historically unreliable; increasing the number of physicians is unlikely to resolve specialty and geographic maldistribution; increasing Medicare funding is not essential for increasing the physician workforce. ... Despite the potential for disruption, the committee firmly believes that Medicare funding of GME can and should be better leveraged than it has been to date for achieving national health care objectives and meeting the needs of the American people (Gail R. Wilensky and Dr. Donald M. Berwick, 7/30).

The New England Journal Of Medicine: Innovation In Medical Education
Our nation's lack of research in medical education contrasts starkly with the large and essential commitment to biomedical research funded by industry, philanthropic organizations, and the public. No one questions the need for sustained support for research in cancer, heart disease, or dementia. But despite medical education's central role in creating a workforce capable of delivering the resulting biomedical advances -- and despite the $15 billion in annual public investment in the medical education enterprise -- funding for medical education research is conspicuously absent (Drs. David A. Asch and Debra F. Weinstein, 7/30).

The New England Journal Of Medicine: Subsidies And the Survival Of The ACA -- Divided Decisions On Premium Tax Credits
In rapid succession on July 22, two federal courts of appeal reached opposite conclusions on the single most important outstanding legal issue affecting the Affordable Care Act (ACA): whether the federally facilitated insurance exchanges that serve two thirds of the states can grant premium tax credits to individuals purchasing health insurance plans. ... It is obvious that the premium-tax-credit provision is awkwardly worded. The purpose of the statute is clear, however, and there is no evidence, other than the four words on which these cases turn, that Congress meant to deny millions of Americans health insurance simply because their states elected not to operate exchanges (Timothy Stoltzfus Jost, 7/30).

The New England Journal Of Medicine: When 'Hacktivists' Target Your Hospital
Earlier this year, Boston Children's Hospital was targeted in a sustained cyberattack purportedly instigated by the hacker group known as Anonymous. With cybersecurity becoming an increasingly important focus for both corporations and individuals, and with electronic systems now central to most operational functions in health care organizations, it is important to learn whatever lessons we can from this event. ... Fortunately, no patient was harmed, and no patient data or other data were lost or compromised during the weeks that the hospital was under assault. Advance planning, well-trained and dedicated staff, the support of a multidisciplinary team, and the resources and expertise of the ISP and third-party partners were all critical to managing the response (Dr. Daniel J. Nigrin, 7/31).

The New England Journal Of Medicine:  Cybersecurity In Health Care
In a recent study, a whopping 94 percent of health care institutions reported having been victims of cyberattacks. To date, cybercrime against health care has manifested as four specific threats: data loss, monetary theft, attacks on medical devices, and attacks on infrastructure. ... The threats of cyberattack are clear and present in health care. It is time to organize, convene, and focus in a way that that truly protects our patients, providers, and institutions. Technology has unquestionably improved health care. Let's be sure that its promised benefits continue to be delivered safely (Eric D. Perakslis, 7/31).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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