Daily Health Policy Report

Friday, July 6, 2012

Last updated: Fri, Jul 6

KHN Original Reporting & Guest Opinion

Campaign 2012

Health Reform

State Watch

Health Care Marketplace

Public Health & Education

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Kentucky Public Health Expert Says Diabetes Epidemic ‘Really Requires Community Action And Support’

Writing for Kaiser Health News, Frank Browning interviews Dr. Gilbert Friedell who says: "We know what we have to do to prevent Type II diabetes and how to maintain a reasonable level of personal performance.  We know these things.  But, if we’re so smart, how come we haven’t fixed the diabetes problem?  The answer is we’re still relying on individual approaches where it really requires community action and support” (Browning, 7/7). Read the story.

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Capsules: Study: High CEO Pay Doesn’t Boost Hospital Quality; How Many Will Remain Uninsured If States Don’t Expand Medicaid?; Medicaid Expansion Already An Issue In Some Gubernatorial Races

Now on KHN's health blog, Jay Hancock examines a New Hampshire study that finds "'virtually no correlation between hospital [CEO] pay and either quality or cost' at nonprofit health systems (Hancock, 7/6). 

Also Marilyn Werber Serafini writes, "Since the Supreme Court ruled that states won’t be required under the health law to expand Medicaid, Washington has been buzzing with estimates about the numbers of poor people who could be left uninsured. ... Today, the Urban Institute released a more detailed estimate with state breakdowns that looks only at those likely to be left uninsured if a state chooses not to expand Medicaid" (Werber Serafini, 7/5).  Phil Galewitz reports that "experts say the health law – and specifically, whether states should opt into an expansion of Medicaid to cover more low-income people – is expected to come up" in gubernatorial races this year (Galewitz, 7/5).  See what else is on the blog.

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Political Cartoon: "Rocket's Red Glare"

Kaiser Health News provides a fresh take on health policy developments with "Rocket's Red Glare" By Steve Kelley, New Orleans Times-Picayune.

And here's today's health policy haiku:

THIS IS VERY TAXING

No, it's not a tax.
Excuse me for one moment.
Yes, it is a tax.
-Anonymous

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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Campaign 2012

Obama, On Campaign Swing, Says Health Law 'Here To Stay'

On a bus tour in Ohio, the president touts his health overhaul, adding he was willing to work with critics to improve the legislation that requires most Americans to purchase health care.

Los Angeles Times: Obama Takes The Offensive On His Healthcare Law
A week after the Supreme Court upheld most of President Obama's signature domestic policy achievement, the politics of healthcare held center stage in the presidential campaign, shoving aside the economic debate that has dominated most of the last several months. In a notable shift of tactics after months of talking only minimally about healthcare in public, Obama went on the offensive Thursday and emphasized the law during a campaign bus trip through the crucial swing state of Ohio. As he did so, his Republican challenger, former Massachusetts Gov. Mitt Romney, was on the defensive, under attack from leading conservatives for purported failures in handling the issue (Parsons and Landsberg, 7/5).

The Washington Post: Obama On Health Care: 'The Law I Passed Is Here To Stay'
President Obama declared victory Thursday in the two-year fight over his health care reform bill, declaring at a campaign rally that "the law I passed is here to stay." Obama told a crowd of about 500 supporters in this town just south of Toledo that he was willing to work with critics to improve the legislation that requires all Americans to purchase health care. But he vowed that there was no turning back on the law (Nakamura, 7/5).

Politico: Obama: Health Care Law 'Is Here To Stay'
President Obama said that repealing his signature health care law is not an option. ... In the aftermath of the Supreme Court decision last week upholding the law, Republicans have vowed to renew their efforts to get rid of the law. But Obama defended the provisions in his law as benefiting Americans — and keeping insurance companies from abusing their power (Epstein, 7/5).

The Hill (Video): Obama: Health Law 'Here To Stay'
It's the first time Obama has mentioned the ruling on the campaign trail. Later, at a campaign stop in Sandusky, Ohio, Obama told a crowd of about 350 people that with the Supreme Court's ruling to uphold the bulk of the law, it was time for Republicans to move on. "We fought so hard to make that happen and now the Supreme Court has ruled, it's time for us to move forward," Obama said. "We don't have to re-litigate the last two years. I don't want us to keep having political arguments that are based on politics and not on facts" (Cohn, 7/5).

Modern Healthcare: Reform Law 'Here To Stay,' Obama Says
President Barack Obama blasted both efforts to repeal his healthcare law and to replace it with Republican-backed alternatives. "I'll work with anybody who wants to work with me to continue to improve our healthcare system and our healthcare laws," Obama said at a Maumee, Ohio, campaign rally Thursday. "But the law I passed is here to stay." He criticized repeal efforts because of the anticipated effects, including reduced insurance coverage and the return of certain insurance underwriting practices (Daly, 7/5).

The Washington Post: Obama Meets Natoma Canfield, Ohio Woman Whose Letter Inspired Him On Health Care
After the Supreme Court upheld his health care law last week, President Obama thanked Natoma Canfield in a televised address to the nation. On Thursday, he thanked her in person. Canfield, a cancer survivor, wrote a plaintive letter to Obama in December 2009 after losing her health insurance, a note the president hung on the wall of the Oval Office. "I carried Natoma's story with me every day of the fight to pass this law," Obama said last week (Nakamura, 7/5).

Politico: Sobbing Woman Thanks Obama For Health Care Law
An emotional Ohio voter personally thanked President Obama for passing a health care overhaul, relating the story of her late sister's battle with cancer. After Obama's speech in Sandusky, he encountered a sobbing Stephanie Miller, who later told reporters about her encounter with Obama. "I thanked him for the getting the Affordable Health Act passed," Miller said (Tau and Epstein, 7/5).

Meanwhile, a new poll finds concerns about the law's effect on the economy.

The Hill: Poll: Health Law Will Hurt Economy More Than Help
A plurality of Americans believe the healthcare law will do more harm than good to the economy, according to a new poll. The finding comes one week after the Supreme Court upheld the law and as fallout from the decision begins to overtake the presidential race. According to Gallup, 46 percent said the law will hurt the economy, while 37 percent said it would help. Seventeen percent expressed no opinion. The full breakdown paralleled the opinions expressed by independent voters, 47 percent of whom said the law would harm the economy and 34 percent of whom said it would help (Viebeck, 7/5).

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Obama Assails Romney For Shift On Mandate

President Barack Obama questions whether Republican Mitt Romney's view that the mandate is a tax is "abandoning a principle" because of pressure from critics. Romney's campaign says he hasn't changed his views, and that the mandate is different on a federal level.

Associated Press: Obama Accuses Romney Of Caving On Taxes
President Barack Obama is accusing Republican Mitt Romney of caving under pressure from Rush Limbaugh for saying that requiring all Americans to buy health insurance amounts to a tax. Obama says in an interview with NBC affiliate WLWT in Cincinnati that Romney supported the individual mandate as Massachusetts governor but "has suddenly reversed himself." Obama says it raises questions over whether Romney is abandoning a principle after "getting pressure for two days from Rush Limbaugh" or other critics (7/6).

ABC: Obama Hits Romney On Health Care Flip Flops
He also questioned Romney’s change of heart on whether the punishment for those who can afford insurance but don't buy it is a "tax" or a "penalty." "The fact that a whole bunch of Republicans in Washington suddenly said this is a tax — for six years, he said it wasn't, and now he suddenly reversed himself. And so, the question becomes 'Are you doing that because of politics? Are you abandoning a principle that you fought for for six years simply because you’re getting pressure for two days?'" Obama said (Tapper, 7/6).

Politico: Obama: Romney 'Abandoning ... Principle' On Health Care
In an email, Romney spokeswoman Andrea Saul reiterated the argument the former Massachusetts governor made in a July 4 CBS interview: that he hasn't changed his views, but that a mandate is legally different on the federal level than on the state level. "Governor Romney has always said that he did not raise taxes and that his Massachusetts reforms were designed to penalize those who were free-riding on others," she said. "States have that power but the federal government does not" (Burns, 7/6).

The New York Times: In Defending His Health Care Plan, Romney Often Called Its Mandate A Tax
As the Massachusetts governor and then as a presidential candidate, Mr. Romney spent the next six years describing in a variety of different ways the possible punishments for ignoring the Massachusetts mandate: as "free-rider surcharges," "tax penalties," "tax incentives" and sometimes just as "penalties." But regardless of the terms he used, his intentions were clear: Massachusetts residents who chose not to buy health insurance would see their state income taxes go up. ... Both his plan and Mr. Obama's use the threat of higher taxes to motivate people to buy insurance. But Mr. Romney is seeking to draw a sharp distinction between the two, criticizing the president's approach with the same language that he once happily applied to his own achievement (Shear and Parker, 7/5).

Slate: Tax Dodger: Mitt Romney's Evolving Positions On Whether Mandatory Health Insurance Is A Tax
Does Mitt Romney think that penalizing people who don’t buy health insurance is a tax? The answer depends on when you ask him and whether he’s the guy who imposed the penalty.  Here’s how his position has evolved over the years (Saletan, 7/5). 

Bloomberg: Romney Declaration On Health Mandate Tax May Boomerang
Mitt Romney's assertion that President Barack Obama's mandate to buy health insurance amounts to a tax increase may boomerang by opening the presumptive Republican nominee to the same charge.  As governor of Massachusetts, Romney championed a state health-care plan with a similar mandate to buy insurance -- one he says today should be described as a penalty not a tax boost (Lerer, 7/6).

NPR: 'Obamneycare' Revisited: Tax Penalties Most Similar Part, Expert Says
When Mitt Romney was still battling last fall to become the GOP candidate for president, we compared the health care plan he implemented as governor of Massachusetts to the one President Obama signed into law in 2010. ... (Following the Supreme Court ruling) we came up with five ways the two plans are similar — and five ways they are different. The analysis post-Supreme Court decision stands largely unaffected, with one notable change in the ability of the federal government to impose on the states an expansion of Medicaid (Halloran, 7/5).

Anti-tax advocate Grover Norquist says the health law increases taxes.

The Hill: Norquist: 'ObamaCare Is ObamaTax'
Washington's leading anti-tax activist has laid out Republicans' election-year argument against the healthcare law — and it all comes down to taxes. "A vote for Mr. Obama is a vote for more than $5.5 trillion in higher taxes over the next 10 years," Grover Norquist wrote in the Washington Times. "A vote for Mitt Romney and a Republican Congress will repeal all 20 of ObamaCare’s taxes and extend all the lapsing tax hikes so Congress can reform the tax code without a tax increase," he wrote (Viebeck, 7/5).

And in his interview with CBS, Romney also talked about Chief Justice John Roberts' decision on the health law.

The New York Times: Romney Sees 'Political Consideration' In Chief Justice's Health Care Vote
Mitt Romney seemed to challenge the motivation behind the decisive vote by Chief Justice John G. Roberts Jr. to uphold the Affordable Care Act, saying reports that the justice switched his vote suggested that the ruling was based on a "political consideration" rather than a legal judgment. "It gives the impression that the decision was made not based upon constitutional foundation, but instead political consideration about the relationship between the branches of government," Mr. Romney said in an interview with CBS that was broadcast on Thursday morning (Barbaro, 7/5).

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Health Reform

Congressional GOP Planning Rollback Of Individual Health Law Provisions

As the House Rules Committee schedules a hearing on the bill to repeal the full 2010 health law, Republican members and staff examine how to target individual provisions through budget reconciliation.

Politico Pro: Gaming Out Repeal By Reconciliation
If Mitt Romney wins the White House and Republicans take back total control of Congress in November, their combined forces can take a pretty big legislative wrecking ball to the Democrats' health care law. What's left in the rubble could cause some pretty serious policy headaches. GOP Hill aides are still working through the details of what they can rip out from the Affordable Care Act through budget reconciliation — the same complex process used to usher through final passage of the health law more than two years ago. There's broad agreement Republicans could use the legislative maneuver to go after the law's individual mandate — and it doesn't matter whether it's a "tax" or a "penalty," either is fair game under reconciliation (Millman and DoBias, 7/6).

Louisville Courier-Journal: Mitch McConnell Vows To Repeal Healthcare Reform Law
Senate Minority Leader Mitch McConnell on Thursday continued his election-year call to repeal the health care overhaul law recently upheld by the U.S. Supreme Court, telling a Louisville audience that it will be first on the agenda if Republicans win control in November. ... The speech came several days after McConnell suggested to Hardin Memorial Hospital workers that repealing the law could be a tough battle, saying "it's a lot harder to undo something than it is to stop it in the first place" (Kenning, 7/6)

National Journal: Rules Committee To Hold 'Emergency' Meeting Monday On Health Care Repeal
The House Rules Committee will convene in an expedited meeting on Monday to consider a measure to repeal President Obama's signature health care reform law, according to a statement from the panel's spokesman. Under committee rules, Monday's business is considered an "emergency" meeting because a  hardcopy of the introduced measure must be available to members of the panel at least 24 hours before a meeting. While the text is available online now, the bill is not expected to be introduced until Monday, said committee spokesman Doug Andres (Catalini, 7/5).

Meanwhile, Hill Democrats say donors are showing support for the law.

Roll Call: DSCC Raised $2.5 Million After Supreme Court Ruling
The Democratic Senatorial Campaign Committee had a big two days after the Supreme Court upheld the president’s health care reform law. From last Thursday through Saturday, the DSCC raised  $2.5 million. According to a DSCC statement, "On the Thursday of the ruling, the committee shattered the previous record for number of online contributions in one day." The group's House counterpart, the Democratic Congressional Campaign Committee, experienced a similar burst after the ruling (Livingston, 7/5).

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Hospitals Concerned About States' Interest In Opting Out Of Medicaid Expansion

As Republican-led states mull the possibility of not expanding their programs under the health law, news outlets look at who would be affected.

Marketplace:  Hospital Lobbyists Gear Up After Healthcare Ruling
Following last week's big Supreme Court ruling on healthcare, states have a choice about whether to expand their Medicaid programs, which provide healthcare to the poor. And a number of them -- including Florida, Louisiana, and South Carolina -- say they won't.  That's worrying for hospitals, as Dan Gorenstein reports from New Hampshire Public Radio.

Politico: Rick Scott: Jobs, Not Medicaid Growth
Florida Gov. Rick Scott justified his decision to opt out of the Medicaid expansion Thursday, saying that the massive health care program was growing at a pace that outstrips general revenue and that he was focused on helping his state get jobs. ... "That’s what I'm focused on, getting our citizens jobs to afford insurance. This expansion will cost the federal government, which is our tax money, and the state a lot of money. We can't afford it," he explained  (Mak, 7/5).

NPR: Medicaid Expansion: Who's In? Who's Out?
In the week since the Supreme Court upheld almost all of President Obama's health care law, some of the biggest action has been on the Medicaid front, where the administration definitely lost. ... The Affordable Care Act, as written, would have required states to provide Medicaid coverage to adults, whether they have children or not, with incomes up to 133 percent of the federal poverty level. Now that expansion is optional, and it's unclear how many uninsured people will ultimately gain coverage under the law (Hensley, 7/5).

NewsHour (Video): Arguments Brew At State Level Over Medicaid Expansion
Health correspondent Betty Ann Bowser takes a closer look at the arguments over Medicaid expansion and the states that want to opt out rather than take federal money (7/5).

Kaiser Health News: How Many Will Remain Uninsured if States Don’t Expand Medicaid?
Since the Supreme Court ruled that states won’t be required under the health law to expand Medicaid, Washington has been buzzing with estimates about the numbers of poor people who could be left uninsured. ... According to the (Urban Institute), 11.5 million of 15.1 million adults who are potentially eligible for Medicaid under the health law wouldn’t qualify either for that coverage or for federal subsidies to purchase private insurance through state online insurance marketplaces without an expansion (Werber Serafini, 7/5).

Modern Healthcare: Estimates Say 22 Million Could Gain Coverage If All States Go Along With Reform-Law Expansions
An additional 22 million people could gain coverage under the federal healthcare overhaul if all states implement its enrollment expansions, according to estimates from the Urban Institute (PDF). The expansion projections, drawn from estimates of the 2010 American Community Survey, stem from the law's provision that expanded Medicaid eligibility to all people with incomes of up to 138% of the federal poverty level. The extent to which the projected expansion will occur, however, is in doubt after the U.S. Supreme Court decided that the federal government cannot coerce states into expanding their program (Daly, 7/5).

Kaiser Health News: Medicaid Expansion Already An Issue In Some Gubernatorial Races
There are 11 gubernatorial campaigns this year, including six like Missouri that have incumbents running for re-election. And experts say the health law – and specifically, whether states should opt into an expansion of Medicaid to cover more low-income people – is expected to come up in many of those (Galewitz, 7/5). 

St. Louis Beacon:  McCaskill:  Missouri Making 'A Mistake' If It Fails To Expand Medicaid, Create Insurance Exchange
U.S. Sen. Claire McCaskill, D-Mo., lamented Thursday that state officials in Jefferson City may avoid setting up a health insurance exchange or expanding the Medicaid rolls, as called for in the federal Affordable Care Act.  While emphasizing that "it’s not a decision I can or should make," McCaskill told reporters during a campaign stop in St. Charles that "it would be unfortunate for federal tax dollars to go to help states around the country, but not Missourians" (Mannies, 7/6).

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State Officials Pursue Divergent Paths On Health Law

Missouri Republicans aim to bar the Democratic governor, or the federal goverment, from setting up an insurance exchange without approval of voters or state legislators, while in Massachusetts, which implemented the prototype of the federal law, 44,000 residents pay fines for not carrying insurance.

St. Louis Beacon: Kinder, Lager Disagree On How To Block Implementation Of Insurance Exchange In Missouri
Missouri Lt. Gov. Peter Kinder says he plans to raise private money -- and won’t use any public funds -- to pay the legal expenses for his planned lawsuit challenging the ballot wording for a measure on a proposed state insurance exchange. The measure would not allow the creation of a health-insurance exchange in Missouri unless it had been approved by the General Assembly or by voters. It aims to bar Gov. Jay Nixon's administration, or the federal government, from setting up an exchange without approval of voters or legislators (Mannies, 7/5).

CT Mirror: Impact Of Health Care Act On Connecticut Residents Will Vary Widely
The Supreme Court's decision last week to uphold most of the Affordable Care Act has renewed political debate over the health care overhaul. But its full impact may not be felt for years. While some reforms have already been enacted, the very heart of the Affordable Care Act won't be implemented until 2014, with the debut of state insurance exchanges that aim to give individuals and companies more -- and better -- coverage choices. … Here is how it is already affecting -- or likely to affect -- some Connecticut residents (Radelat/Masroor, 7/5).

In the meantime, thousands in Massachusetts paid a fine in 2010 for not having health insurance, also a key part of the national health law --

Boston Globe: 44,000 Uninsured Massachusetts Residents Paid Penalty In 2010
Massachusetts had the nation's highest rate of health coverage even before passage of a pioneering 2006 law requiring most residents to have insurance. Yet tens of thousands of people … go uncovered each year and pay a fine. Starting in 2014, when much of the national ­Affordable Care Act kicks in, millions of other Americans could face a similar fine, putting Massachusetts in the spotlight as a possible indicator of what lies ahead for the country. The federal plan mimics the state’s law in its basic approach to expanding coverage: Make health insurance more affordable through new subsidies and a state-run insurance market. Then compel most people to buy plans and penalize those who do not. Policy advocates say the Massachusetts law lays out a finan­cial and moral incentive to get coverage. But it is not clear that this approach can be effectively replicated nationally (Conaboy, 7/6).

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State Watch

Roundup: Feds Rank Texas Last In Health Care Delivery

Houston Chronicle: Feds Rank Texas Worst Health Care Provider
Texas ranked dead last in the federal government's latest report card on the delivery of health services, falling short in areas ranging from acute hospital care to home treatment of the chronically ill. Texas scored 31.61 -- less than half of top-ranked Minnesota's 67.31 -- out of a possible 100 points in the Agency for Healthcare Research and Quality annual rankings. Rated "weak" or "very weak" in nine of 12 health delivery categories, Texas dropped from 47th place in 2010 to 51st in 2011, behind all other states and Washington, D.C. (Ackerman and Walczak, 7/5).

Associated Press/The Dallas Morning News: Federal Agency Ranks Texas At Bottom For Health Care
Texas ranks worst in the nation in health care services and delivery, according to an annual scorecard issued by the federal Agency for Health Care Research and Quality…. The agency identified 155 areas where it could compare the quality of health services across the country, such as infant mortality and obesity rates. Researchers used that data to generate both national and regional averages for each area, and they then compared each state to the national and regional averages to generate a score (7/5).

Boston Globe: Health Care, Education Consume 63 Percent Of Planned State Budget
With the Medicaid program, subsidized insurance under the 2006 health care access reform law, and investments in state employee health insurance and public health programs, health care spending this fiscal year is on pace to rise to 43 percent of the overall state budget, according to an analysis of the spending bill being reviewed by Governor Deval Patrick. One in five Massachusetts residents will have their health care largely covered through the budget, and taxpayer-supported health care costs next year will gobble up most of new discretionary state revenue, hitting $15.14 billion, up from $14.65 billion (Norton, 7/6).

Detroit Free Press: Labor Activists Say They’ve Collected Enough Signatures To Put Home Health Workers Measure On The Ballot
A labor-backed coalition of advocates for home health care for elderly and disabled people said Thursday it has collected more than a half million signatures on petitions to amend the state Constitution to regulate safety and training for home care workers and guarantee those workers' collective-bargaining rights. Representatives of Citizens for Affordable Quality Home Care said at a news conference that they expect to submit about 550,000 signatures to the Secretary of State within the next few days. To qualify for the Nov. 6 general election, state elections officials need to certify that the petitions contain at least 322,609 signatures from registered voters (Bell, 7/6).

St. Louis Beacon: Missouri Consumers To Get $60 Million In Rebates On Insurance Premiums Under the ACA
Many consumers will get rebates on their health insurance premiums now that the Affordable Care Act has been upheld by the Supreme Court. The law says consumers must get any rebates by Aug. 1 of each year in cases where insurers failed to spend at least 80 percent of premiums on medical services (Joiner, 7/5).

Denver Post: The New Chief Of Denver Health Was Ousted In San Diego Clash
The newly appointed chief of Denver Health was ousted from a community hospital near San Diego in 2009 amid deteriorating finances, though supporters of Arthur Gonzalez say the move was political and that his past was fully vetted by Denver and others (Booth, 7/6).

Minneapolis Star Tribune: Health Beat: Minn. Aims To Refocus Its Aid For Most Frail
State planners are seeking public reaction to a sweeping proposal they say would better target human services spending for frail and aged Minnesotans at a time of tight government budgets. The 144-page report, "Reform 2020: Pathways to Independence," by the Department of Human Services (DHS), follows the Legislature's directive early this year to seek federal permission to better target home- and community-based programs. The state-federal Medicaid program will spend $8.5 billion this year on about 733,000 Minnesotans, many of them elderly or disabled; federal approval is required for many of the changes (Wolfe, 7/5).

California Watch: Rebuffed In California’s High Desert, Prime Healthcare Expands Out Of State
In recent months, Southern California-based Prime Healthcare Services has bought financially troubled hospitals in Nevada, Texas and Pennsylvania. But the rapidly expanding hospital chain hit a speed bump on its home turf in San Bernardino County, where a bankruptcy judge bypassed Prime's nonprofit foundation and steered the sale of 101-bed Victor Valley Community Hospital to a local investment group. Judge Catherine Bauer’s decision, reached last week, was a setback in Prime’s long-running legal fight to acquire the bankrupt nonprofit hospital in Victorville, east of Los Angeles -- and, perhaps, to continue its expansion in the Golden State (Williams, 7/6).

California Healthline: Committee Moves Stop-Loss Bill Forward
Stop-loss health insurance is a way for small-business employers to offer a form of health care insurance to employees while limiting risk. The trouble with that, according to Senate member Kevin De León (D-Los Angeles), is that the low risk incurred by stop-loss insurers could mean higher rates for the rest of California. … Basically, stop-loss coverage allows insurers to cherry-pick or adversely select the youngest and healthiest consumers with low rates, which makes rates rise for everyone else, De León said. De León has introduced SB 1431, which would place some limits on stop-loss insurance. California Insurance Commissioner Dave Jones, speaking at the committee hearing, said stop-loss insurance threatens the success of the state's benefit exchange (Gorn, 7/6).

California Healthline: Targeting Technology To Treat Senior Population
California faces a challenge as the number of seniors in the state and the costs to provide medical care for them continue to rise. With 6.4 million seniors -- including about 1.1 million who are eligible for both Medicaid and Medicare -- health officials are scrambling to provide care more effectively so existing money can be stretched to accommodate more heavy users of health care. One way to deliver more efficient health care is wider use of better technology, according to Scott Peifer, executive director of AgeTech California, a new, tech-minded organization designed to do just that (Gorn, 7/5).

Health News Florida: Doctors' Names Hijacked In Ads
Without their knowledge, Florida's largest insurer and scores of doctors, dentists and lawyers in the state were listed as advertisers on a controversial website promoted by an alleged scam artist who is now behind bars. The use of their names not only brought the promoter revenue but also made him look legitimate. The incident offers a cautionary tale about how today's Internet advertising practices can place professionals and corporations at risk of appearing to promote companies or causes that are controversial or even criminal (Gentry and Watts, 7/6).

The Lund Report: Regence Seeks Rate Hikes In Washington And Oregon In The Individual Market
Regence BlueCross BlueShield is after rate hikes in both Oregon and Washington for people who purchase their own coverage. A public hearing on a rate request impacting close to 53,000 Oregonians is scheduled for 3 p.m., July 30 in Salem. If approved, that 9.6 average increase would take effect in December. Nearly 90,000 people in Washington could also end up seeing their costs increase by 14.7 percent on October 1 (Lund-Muzikant, 7/6).

The Lund Report: Oregon Insurers Increase Their Net Income Despite Membership Losses
For the second consecutive year, Oregon's seven domestic health insurers saw a decrease in their overall net income, but still found themselves on pace to achieve financial prosperity in 2012. At the end of March, there were 1,544,560 Oregonians insured through individual or group policies, down 24,399 -- by 1.6 percent -- compared to the same time last year, according to financial data released by the Oregon Insurance Division (Thomas, 7/5).

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Health Care Marketplace

Proposed Rules Would Bar Aggressive Medical Debt Collection Tactics From Nonprofit Hospitals

New proposed rules from the IRS would require nonprofit hospitals to avoid the most aggressive debt collection methods against lower-income patients.

Fox News: IRS To Tax-Exempt Hospitals: Go Easier On Medical Debt Collection
A little-noticed provision of the health care reform law could help millions of people avoid staggering medical bills, liens on their homes and debt collection calls. In passing the Affordable Care Act (ACA), Congress directed the Internal Revenue Service to draft rules to flesh out a portion of law, spelling out the consumer protections for those receiving charitable care at nonprofit hospitals. ... The proposed rules, issued June 22 by the IRS, would apply to the nearly six in 10 U.S. hospitals that operate as tax-exempt, nonprofit charitable hospitals. They would be required to provide additional consumer protections and services to patients who qualify for charity care and medical financial aid. If finalized, the rules would bar the hospitals from using the most aggressive debt collection tactics against low-income patients who don't pay their medical bills (Prater, 7/5).

And a new study says high CEO pay doesn't correlate to hospital quality --

Kaiser Health News: Study: High CEO Pay Doesn't Boost Hospital Quality
Everybody agrees the health system needs to improve patient results even as it becomes more efficient. So shouldn't we reward hospital managers who make progress in both areas? That doesn't seem to be the case in New Hampshire, according to a new study from the New Hampshire Center for Public Policy Studies (Hancock, 7/6).

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Public Health & Education

New HIV Test Results Are 'Preliminary' And Need Doctors' Confirmation

In reports on two major public health issues, experts seek to remind people that the new HIV test offer only a preliminary result, so a confirmation from a physician is necessary, and a Kentucky health veteran works to stem the diabetes epidemic there.

KQED:  New In-Home HIV Test Raises Follow-Up Concerns
The Food and Drug Administration approved the test earlier this week, but it warned the test's results are a "preliminary" diagnosis, so check-ups are still necessary. Some Bay Area researchers said a key challenge will be ensuring that people actually seek out a confirmation test and additional services from their doctors, regardless of testing positive or negative for the virus (Tran, 6/5).

Kaiser Health News: Kentucky Public Health Expert Says Diabetes Epidemic 'Really Requires Community Action And Support'
An epidemic more deadly than coal dust is sweeping through the dogwood-dappled hollows of eastern Kentucky. The new threat: diabetes.  In Kentucky and across the broad Appalachian region, a third of the population is estimated by health officials to have diabetes, double the rate for the country as a whole. Ads for diabetes counseling and testing clinics have replaced those for supermarkets as a major revenue source in local newspapers, and billboards urging middle-aged people to get tested appear almost everywhere there’s a straight stretch of highway (Browning, 7/7).



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Health Policy Research

Research Roundup: Crowded Emergency Departments, Expensive HIV Drugs

Each week KHN reporter Christian Torres compiles a selection of recently released health policy studies and briefs.

RAND: Skin In The Game: How Consumer-Directed Plans Affect The Cost And Use Of Health Care -- Consumer-directed health plans, which feature lower premiums and higher deductibles than traditional plans, are designed to reduce costs by discouraging unnecessary care. This brief describes a study of more than 800,000 households that switched from a traditional employer-based plan to a consumer-based plan. Within the first year, families spent 21 percent less on care; about a third of the reduction was attributed to less spending per care episode, while two-thirds was attributed to fewer episodes total. Families also, however, sought less preventive care -- including childhood vaccinations, mammograms and blood tests. The authors caution that if "patients skimp on highly valuable services that can prevent more costly problems later, the savings [from consumer-directed plans] may be short-lived" (Haviland et al, 6/28).

Journal of the American Medical Association: Duplicate Federal Payments For Dual Enrollees In Medicare Advantage Plans And The Veterans Affairs Health Care System -- The Veterans Affairs system is allowed to bill private health plans for the care it provides to enrollees, but it is not allowed to bill privately run Medicare Advantage plans. This sets up the potential for redundant federal spending as elderly veterans enrolled in an MA plan also visit a VA facility. Researchers in this study found that, from the beginning of 2004 until the end of 2009, more than 1.2 million veterans were enrolled for at least a month in both the VA and a Medicare Advantage plan, and VA spending for the dual enrollees totaled $13 billion. The authors encourage policymakers to "monitor the use of VA services among MA-enrolled veterans and modify payments to MA plans accordingly" (Trevidi et al, 6/26).

RAND: Negotiation Strategies For Antiretroviral Drug Purchasers In The United States -- Antiretroviral drugs continue to be inaccessible and unaffordable for many low-income individuals, and despite the government's leverage through Medicaid and other programs, new strategies are needed for price negotiation with manufacturers. This report looks at several options, including improved price transparency and switching people dually eligible for Medicare Part D and Medicaid to the latter program, which pays less for these antiretroviral drugs. The authors also propose pooling individual states and groups to increase their drug purchasing power. With "greater consolidation of public programs and increased demand for drugs through universal coverage," they note, "public programs might be in a better position to negotiate drug prices" in the future (Linnemayr et al, 6/29).

Annals of Emergency Medicine: National Trends In Emergency Department Occupancy, 2001 to 2008: Effect Of Inpatient Admissions Versus Emergency Department Practice Intensity -- Emergency department crowding can lead to lower patient satisfaction and adverse outcomes. In this study, researchers used federal survey data from 2001 to 2008 and estimated that the number of ED visits increased nearly 2 percent each year, and average occupancy increased more than 3 percent each year. One of the main drivers of crowding was intensity of care, with patients receiving more imaging tests and services, which significantly extended their stays. The data also showed Medicare beneficiaries had increasingly frequent visits, which could be attributed to poor access to primary care. Overall, the authors write, "ED crowding is probably getting worse, not better" (Pitts et al, 6/22).

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

Modern Healthcare: Researchers Find Higher Costs For Medical Homes
Healthcare payment reform is needed for the patient-centered medical-home model to be sustainable, according to a report published online by the Journal of the American Medical Association. The model leads to higher operating costs, and most of the savings generated though reduced hospital admissions and emergency-department visits benefit payers rather than providers, researchers concluded (Robeznieks, 7/2). 

Medscape: Dental Care Disparity Narrows For Black Children
Black children now receive basic dental care at nearly the same rates as white children of the same age, although other racial disparities in oral health status, such as untreated cavities, persist, a new study reports. Inyang A. Isong, MD, MPH, from Massachusetts General Hospital Center for Child and Adolescent Health Research and Policy and Harvard Medical School in Boston, and coauthors report their findings in an article published online July 2 in Pediatrics (Henderson, 7/2).

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Editorials and Opinions

Viewpoints: Romney's Mandate Problem; Rage At Roberts; Should Feds Take Over Medicaid?

The New York Times: Mr. Romney Changes His Mind, Again
Massachusetts residents who file a state tax return have to provide proof that they have health insurance. If they can afford insurance but don’t have it, they must “pay a penalty through their tax returns,” according to the state Department of Revenue’s Web site. This is all thanks to former Gov. Mitt Romney, who set up the system -- the best of its kind in the country -- and is now trying to pretend he doesn’t remember how it works (7/5).

The New York Times Taking Note blog: Flip Flopping Away
Last week, the Romney campaign didn’t want to call the fine a “tax,” probably because Mr. Romney himself imposed such a penalty as part of the health care reform he got enacted in Massachusetts. (That reform, of course, is the template for President Obama’s program.) That caused a lot of bother among what’s left of the Republicans to his right. So on Wednesday, Mr. Romney celebrated the nation’s independence by abandoning his (Andrew Rosenthal, 7/5).

The Washington Post: Mitt Romney’s Problem On The Health-Care Mandate Question
Romney has tried to talk his way past his health-care dilemma for more than a year. Faced with the choice between calling his support for an Obama-like health-care plan in Massachusetts a mistake or sticking with it while trying to draw distinctions between the two, Romney chose the latter. Labeling it a mistake would have opened him up to a new charge of flip-flopping for political convenience. But neither course was ideal (Dan Balz, 7/5).

Chicago Tribune: Mr. Romney, Own It
Mr. Romney, just own it. You signed a health care mandate. It looks very much like Obamacare on a state scale. The state and federal laws are built on the same principles. They share many benefits and requirements. Please stop trying to talk your way around that. ... Romney took a political risk to reach a deal with Democrats in Massachusetts to extend health care to thousands of uninsured people. He can't dance around that. He would sound a lot more believable if he spoke about the future of health care from experience. Instead, he's all about political advantage, and that has him twisting (7/5).

Baltimore Sun: Romney Foolishly Flip-Flopped On Health Mandate
Remember in March, when former senator Rick Santorum got a lot of grief for saying that Mitt Romney was the "worst Republican" in the country to challenge President Barack Obama on health care reform? Well, turns out he was right. That was evident Wednesday when former governor Romney decided he couldn't leave well enough alone and, in a CBS television interview, declared Mr. Obama's individual health care insurance mandate was a tax. That directly contradicted what his campaign had been saying on the subject for two days and left the Republican in the uncomfortable position of having to explain why his own version of health care reform in Massachusetts, which also carried a mandate and a similar penalty, was somehow not a tax (7/5).

Baltimore Sun: Romney Courts Confusion
Poor Mitt Romney. Even when he is handed the football with a clear path to the goal line, he seems almost unable not to fumble it along the way. In his majority opinion ruling the Affordable Care Act constitutional, Supreme Court Justice John G. Roberts Jr. surprisingly said the law's mandate was a tax and therefore within Congress' revenue-raising power. In doing so, he presented Mr. Romney a prime argument for accusing President Barack Obama of heaping more billions of dollars in taxes on the middle class. But the likely Republican nominee, instead of instantly seizing the decision to make that case against Mr. Obama, contradicted one of his own political aides who tried to do so. A Romney campaign release contended that mandating the citizenry to shell out to the feds in lieu of buying health insurance was not a tax, just "an unconstitutional penalty" (Jules Witcover, 7/6).

The Des Moines Register: A Tax Or Not A Tax. That Is The Question
We are now in summer silly season for politics. Citizens are jumping into lakes and pools and staying cool in basement rec rooms, door stoops, and under shade trees in parks and back yards. Still the political classes keep churning away. This week we found out that “Romney Now Says Health Mandate by Obama Is a Tax” according to JEREMY W. PETERS of the New York Times. “Days after his spokesman [his top aide Eric Fehrnstrom] said the requirement that people have insurance was not a tax, [he said Romney believed it’s is “an unconstitutional penalty” instead] Mitt Romney said it was [a tax], aligning himself with the conservative voices in his party” (Steffen Schmidt, 7/6).

The Denver Post: Editorial: On Health Care, Tax Vs. Penalty Is The Wrong Debate
Mitt Romney — or at least his campaign — had it right the first time. Just because the Supreme Court has said the Affordable Care Act's individual mandate to buy health insurance is a tax doesn't mean he should adopt the thesis as a campaign theme. Before last week's court ruling, Romney didn't believe the mandate was a tax. Why pretend he believes it now? (7/5)

Boston Globe: For Mitt Romney, Avoiding Risk Means Obscuring His Own Positions
Mitt Romney responded to the Supreme Court’s upholding the health care law last Thursday with a short, blunt declaration: “What the court did not do on its last day in session, I will do on my first day,” he said. “I will act to repeal Obamacare.” Like many other Republicans, Romney has said he wants to “repeal and replace” the health care law. But however much he’s pressed, he offers few specifics about what he would replace it with. On Thursday, he skipped over the issue altogether. This has become a familiar pattern: a ringing affirmation of some major policy difference with President Obama, followed by a lot of vagueness about what he would do instead (Joshua Gree, 7/6).

Chicago Sun-Times: Rage At Roberts Won’t End Soon
Admittedly, it was not standard fare for a Fourth of July party, but time and again the conversation under a sweltering sun drifted back to the U.S. Supreme Court’s health care ruling. This being a mostly conservative crowd, much perplexity and dissatisfaction were expressed about Chief Justice John Roberts finding a way to save the Affordable Care Act from a constitutional challenge. It was another bit of evidence that the firestorm ignited by the controversial ruling won’t go away, likely making ObamaCare a major issue, albeit far behind the economy, for the fall election (Steve Huntley, 7/5).

Kansas City Star: Ruling Put Constitution Before Political Ideology
Conservatives’ fury over Chief Justice John Roberts’ surprising ruling in support of President Barack Obama’s health care law has crystallized into a shocking accusation. He changed his mind. How dare he? Only a week after the court announced its long-awaited decision on the constitutionality of the Affordable Care Act, a scenario first based on speculation has been confirmed by “sources” and emerged as a meme (Barbara Shelley, 7/5).

Philadelphia Inquirer: How The Supreme Court’s Health Care Decision Affects Pharma
The Supreme Court's decision last week to let the Affordable Care Act (ACA) stand will not appreciably affect the escalation of costs or the other fundamental dynamics of health care. While the decision clearly provides fodder for politicians and other blowhards, its effect on most of health care's business sectors appears unlikely to alter the course of events. … The manufacturing sectors such as pharma and devices will sustain both gains and losses, but nothing appears likely to alter industry fundamentals (Dr. Daniel R. Hoffman, 7/5).

The Fiscal Times:  Small Businesses:  Big Losers In Obamacare Decision
Why are small businesses so opposed to the Patient Protection and Affordable Care Act? Sam Graves, chairman of the House Committee on Small Business, who held hearings on the matter, recently sent a letter to President Obama highlighting companies’ concerns. He quoted one restaurant owner who said, "The real irony here is that in the name of expanding health care coverage, Congress and the administration are making it more difficult for workers to enter and eventually be promoted in the workforce at a time when we need job growth" (Liz Peek, 7/6).

The Fiscal Times:  Should The Federal Government Take Over Medicaid?
With over a dozen conservative states leaning against expanding Medicaid to cover poor workers without health insurance, perhaps it is time to resuscitate an idea embraced by President Ronald Reagan. Let the federal government take over Medicaid lock, stock and barrel. In 1982 the president who ushered in the modern conservative era offered to assume federal responsibility for the program that now consumes over 22 percent of state government budgets in exchange for states taking over welfare. His offer built on a series of recommendations going back to 1969 by the U.S. Advisory Commission on Intergovernmental Relations, which called for a federal takeover of all public assistance programs (Merrill Goozner, 7/6).

The New York Times: When It’s the Nurse Who Needs Looking After
Trusted more than almost any other professional, nurses exert a wide-ranging influence on how health care is delivered and defined. But nurses’ work is not easy, particularly in the hospital setting, where they must deal with intense intellectual and significant physical demands over three or more grueling 12-hour shifts each week. Not surprisingly, nursing ranks among the worst occupations in terms of work-related injuries, and studies have shown that in a given year, nearly half of all nurses will have struggled with lower back pain (Dr. Pauline W. Chen, 7/5).

The Arizona Republic:  Arizona Has Hard Choice To Make
Now that the U.S. Supreme Court has made it voluntary, should Arizona participate in "Obamacare's" Medicaid expansion to 133 percent of the federal poverty level?  Well, as the movie title puts it, it's complicated.  In the first place, Arizona is in an awkward position to consider the question. The state is already in violation of an initiative approved by voters to cover everyone up to 100 percent of the poverty level. And it's broke (Robert Robb, 7/6).

Milwaukee Journal Sentinel: Cuts Hurt Care For Disabled
These aren't people needing nursing homes or hospitals. They are individuals who simply can't live on their own, who need assistance at various levels to live normal lives. … But cutting funding for these people will not make them more independent. It will only increase risks (Thomas Zachek, 7/5).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.