Daily Health Policy Report

Monday, July 7, 2014

Last updated: Mon, Jul 7

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicare

Health Information Technology

Coverage & Access

Public Health & Education

Medicaid

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Florida Shifts Medicaid Mental Health Strategy

Kaiser Health News staff writer Phil Galewitz reports: "Mental illness is a big driver of Medicaid costs because it is twice as prevalent among beneficiaries of the public insurance program for the poor as it is among the general population. Studies show that enrollees with mental illness, who also have chronic physical conditions, account for a large share of Medicaid spending. Yet many Medicaid programs, including Florida’s, have traditionally contracted with separate companies to provide coverage for mental health services, making coordination more difficult" (Galewitz, 7/7). Read the story, which also appeared in USA Today.

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Capsules: Advocates Say California Is Rejecting ‘Free Money’ To Renew Poor People’s Insurance

Now on Kaiser Health News’ blog, Anna Gorman reports: “Consumer advocates and some legislators were surprised and frustrated when California health officials recently refused a $6 million donation to help people re-up their Medi-Cal health coverage. Now two senators have proposed an unusual solution: a bill to force the state to accept the offer from The California Endowment” (Gorman, 7/4). Check out what else is on the blog.

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Political Cartoon: 'Hole-istic Health Care?'

Kaiser Health News provides a fresh take on health policy developments with "Hole-istic Health Care?" by Mike Peters.

Meanwhile, here's today's haiku:

BACK TO BUSINESS!

The fireworks are
over -- it's time to catch up
on health care headlines.
-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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Health Reform

Health Law Backers Brace For New Battles Over 2015 Insurance Rates

Politico reports that this round of messaging will be critical because rates are expected to increase and could add to Democrats' midterm election challenges. Also in the headlines, reports about how the employer mandate is getting increasingly unpopular -- even among liberals, and other news related to the overhaul's implementation.    

Politico: Obamacare’s Next Threat: A September Surprise
Obamacare open enrollment closed March 31. The White House’s Obamacare war room did not. Most state health insurance rates for 2015 are scheduled to be approved by early fall, and most are likely to rise, timing that couldn’t be worse for Democrats already on defense in the midterms. The White House and its allies know they’ve been beaten in every previous round of Obamacare messaging, never more devastatingly than in 2010. And they know the results this November could hinge in large part on whether that happens again (Dovere, 7/7).

Politico: Why Liberals Are Abandoning The Obamacare Employer Mandate
More and more liberal activists and policy experts who help shape Democratic thinking on health care have concluded that penalizing businesses if they don’t offer health insurance is an unnecessary element of the Affordable Care Act that may do more harm than good. Among them are experts at the Urban Institute and the Commonwealth Fund and prominent academics like legal scholar Tim Jost. ... Leading Democrats in Congress aren’t bolting from the employer mandate, at least not before the November election (Winfield Cunningham and Cheney, 7/6).

USA Today: Rise In Part-Time Workers Worries Some Experts
Among the few worrisome signs in Friday's generally encouraging employment report was a sharp rise in the number of part-time workers who prefer full-time jobs. The total jumped by 275,000 to 7.5 million, the Labor Department said. ... The Affordable Care Act, which requires firms with at least 50 employees to provide health insurance to those working at least 30 hours, also could be prompting some businesses to hire more part-time workers, [said Jim O'Sullivan, chief U.S. economist of High Frequency Economics] (Davidson, 7/6).

The Washington Post: What Obamacare Means For Your Investment Portfolio
[The Affordable Care Act is] overhauling the business of health care — for hospitals and insurers, doctors and patients. For investors, that means tracking a new roster of winners and losers across the industry. The nearly $3 trillion industry, long considered a recession-proof holding for investors looking to play it safe, now also exhibits the kind of growth that appeals to investors looking for a hot new stock. Health-care spending in the U.S. accounts for a whopping 18 percent of GDP (Marte, 7/4).

USA Today/The Tennessean: Couple Splits Up To Stay Insured
The day Linda Drain put baby's breath in her hair and said "I do," she had no idea that government policies would tear her apart from her husband. But 33 years later, she and her husband, Larry Drain, separated so she could keep her health insurance. Six months into the full implementation of the Affordable Care Act, the Drains are among 162,000 Tennesseans who got caught in a coverage gap. Their household income is too little to qualify for a government subsidy to buy health insurance, and they live in a state not expanding Medicaid (Wilemon, 7/6).

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Contract Renewed For Serco Processing Center Hit By Whistleblower Allegations

The $98 million contract extends operations of the facility where employees reported they sometimes slept or played board games for lack of work. Meanwhile, the Wall Street Journal reports that sign-ups may not be the only way to gauge the health law's success, a private exchange for restaurant workers debuts in D.C., and Health Net faces criticism in Arizona for its narrow network.

St. Louis Post-Dispatch: Serco Contract To Process Obamacare Applications Renewed For A Year
The federal government has renewed for another year the contract of Serco Inc., whose Affordable Care Act application processing facility in Wentzville was hit by whistleblower allegations that workers there had little to do. The new taxpayer-paid contract, which began July 1, will be worth about $98 million. The first-year contract was worth about $114 million, according to figures supplied Thursday by the Centers for Medicare and Medicaid Services (CMS), which oversees the contract. Serco and CMS had anticipated as many as 6 million paper applications to come in under the new health care law, commonly called Obamacare, but only about 300,000 came in, CMS acknowledged last month. Whistleblowers said employees sometimes slept or played board games for lack of work, and members of Missouri’s congressional delegation demanded inquiries. CMS Director Marilyn Tavenner responded in letters to the delegation last month, but did not address the whistleblower allegations (Raasch, 7/3).

The Wall Street Journal: Sign-Ups Not the Only Way To Gauge Health Law's Success
In April, after enrollment for Obamacare had closed, the president announced that 8 million people had signed up ... While sign-ups exceeded expectations, other measures are more important and, at this point, uncertain. For example, relatively few young people signed up. Significantly more females, who are pricier to insure, enrolled than males. And little is known about the overall health of the sign-up group, although early studies suggest they are older and sicker than other insured Americans. To keep up with enrollment projections, twice as many people must sign up next year (McGinty, 7/4).

The Washington Post: Restaurant-Specific Insurance Exchange Debuts In D.C. 
As a former Matchbox employee married to a Graffiato bartender, Alisia Kleinmann knows a thing or two about the lack of health insurance in the restaurant industry. “My husband is 35 years old. We have two kids. He never had insurance,” said Kleinmann, president of the hospitality trade organization Industree. “I just kept thinking, something has to change. Something has to get better.” Last week Kleinmann, 33, rolled out Industree Exchange, a private insurance exchange geared at Washington-area restaurants and bars with more than 100 employees (Bhattarai, 7/6).

The Arizona Republic: Health Net Vows To Improve Health-Care Coverage, Service
Many Arizonans who chose the lowest-cost insurance plans available under the ­Affordable Care Act soon learned that securing the health care they signed up for wasn't as easy as flashing an insurance card at the nearest doctor's office or hospital. Health Net sold the least-expensive plans in Arizona and dominated the market, signing up about 80,000 residents, or two out of every three who enrolled for coverage under the federal health-care law. While its low monthly premiums appealed to consumers, Health Net's narrow choice of doctors and at-times long phone waits for customer service led to far more complaints than were filed against any other insurer (Alltucker, 7/6).

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Pending Health Law Legal Action Threatens Premium Subsidies And Exchanges

One of the key questions, according to The Fiscal Times, is whether the premium subsidies available to people shopping on the federal exchange are legal.  

The Fiscal Times: Court Challenges To Subsidies Threaten Obamacare
Obamacare suffered a setback from the Supreme Court last week that may have seriously undermined the administration’s efforts to provide women with free access to FDA-approved birth control devices. The high court ruled in Burwell v. Hobby Lobby that family-owned businesses could choose not to provide birth control to employees if it offended the owners’ religious beliefs. Now, a bigger and more fundamental problem may lie ahead for Obamacare. As early as this week, a D.C. appellate court could rule against the administration on the most basic question: Are the massive premium subsidies flowing to low-income people through the federal insurance exchanges legal, or should that money be cut off? (Pianin, 7/7).

The Associated Press: Judge To Mull Senator's Suit Over Health Exchanges
A federal judge will hear arguments this week on whether to toss a U.S. senator's lawsuit challenging rules that force congressional members and their staffs to obtain government-subsidized health insurance through small business exchanges. Republican Sen. Ron Johnson of Wisconsin contends that senators, representatives and their employees aren't eligible for the exchanges under the federal health care law because they work for a government that employs millions. Government attorneys have asked U.S. District Judge William Griesbach to throw the case out of court. They argue Johnson hasn't shown how the rules hurt him or his staff (Richmond, 7/6).

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Nonprofit Religious Groups Pose Next Challenge To Contraceptive Mandate

The issue in more than four dozen lawsuits from faith-affiliated colleges, hospitals and charities is how far the government must go to accommodate them. Meanwhile, the administration weighs steps to provide contraceptive coverage, and the high court's Hobby Lobby decision may help Democrats mobilize female voters.

The Associated Press: Nonprofits’ Contraceptive Cases Next For Justices
How much distance from an immoral act is enough? That’s the difficult question behind the next legal dispute over religion, birth control and the health law that is likely to be resolved by the Supreme Court. The issue in more than four dozen lawsuits from faith-affiliated charities, colleges and hospitals that oppose some or all contraception as immoral is how far the Obama administration must go to accommodate them (7/6).

The New York Times: Obama Weighs Steps To Cover Contraception
The Obama administration, reeling from back-to-back blows from the Supreme Court this week, is weighing options that would provide contraceptive coverage to thousands of women who are about to lose it or never had it because of their employers’ religious objections. ... One proposal the White House is studying would put companies’ insurers or health plan administrators on the spot for contraceptive coverage, with details of reimbursement to be worked out later (Pear and Liptak, 7/4).

The Washington Post: High Court’s College Birth-Control Ruling May Further Outrage Democrats, Mobilize Them
Democrats have crafted much of their strategy in 2014 — a midterm year in which securing a House majority seems improbable and they may lose control of the Senate — around the imperative of turning out women voters, especially unmarried women. ... Within hours of the Hobby Lobby decision, progressive and left-leaning groups that focus on women’s issues, such as Planned Parenthood and EMILY’s List, were using it for midterm fundraising. On the right, the Hobby Lobby decision galvanized groups that saw it as an opportunity to file many more lawsuits such as Wheaton’s (Lowery, 7/4).

The Boston Globe: Supreme Court Rulings Jolt Women’s Groups Into Action
On the day the nation’s highest court ruled that family-owned businesses can decline to provide insurance coverage for contraception, Karyn Polito made sure a room full of Republican women knew exactly where she stands: in favor of women’s access to contraception and abortion. “We are our own brand on the social issues . . . embracing a woman’s right to choose,” said Polito, a Republican candidate for lieutenant governor, referring to herself and running mate, Charlie Baker. “That’s our message,” Polito said to rousing applause. Two recent Supreme Court cases — striking down Massachusetts’ abortion clinic buffer zone law and the federal requirement that employers cover contraception — have energized Massachusetts voters, politicians, and women’s organizations around issues of women’s health (Johnson, 7/7).

The Wall Street Journal: Christian School's Relief On Contraception Coverage Could Embolden Others
Thursday's order, which sets no legal precedent and applies only to Wheaton, allows the school to avoid covering birth control without filing a form with its insurer asserting religious objections to emergency contraception—which would trigger the third-party coverage. The order will expire once a federal appeals court rules in the school's case. Dozens of religious nonprofit schools, organizations and business owners have pursued legal challenges to the health care law's birth-control-coverage requirements. ... But entities could request arrangements like the one spelled out in the Wheaton injunction while their cases are pending in federal courts (Bravin, 7/4).

PBS NewsHour: Birth Control Injunction For Religious College Draws Dissent From Female Justices
The Supreme Court temporarily exempted a religious college from the contraception coverage provisions of the Affordable Care Act. The decision, which comes just days after a ruling in favor of some businesses objecting to provide birth control, has provoked sharp rebuke from the court’s three female justices. Judy Woodruff gets the details from Marcia Coyle of The National Law Journal (Woodruff, 7/4).

The Associated Press: Free Birth Control Is Emerging Standard For Women
More than half of privately insured women are getting free birth control under President Barack Obama's health law, a major coverage shift that's likely to advance. This week the Supreme Court allowed some employers with religious scruples to opt out, but most companies appear to be going in the opposite direction. Recent data from the IMS Institute document a sharp change during 2013. The share of privately insured women who got their birth control pills without a copayment jumped to 56 percent, from 14 percent in 2012. The law's requirement that most health plans cover birth control as prevention, at no additional cost to women, took full effect in 2013 (Alonso-Zaldivar, 7/6).

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Capitol Hill Watch

Health Overhaul Continues To Put Democratic Congressional Candidates In Hot Seat

News outlets report on how the health law is playing in various House and Senate races.  

The Associated Press: Senate Democrats Try To Pull Focus From Obamacare
Similar themes are playing out in other crucial Senate races, as voters have four months to decide which party will control the chamber in the final two years of Barack Obama's presidency. For Republicans, it's all about tying Democrats to Obama -- especially to a health care law that remains unpopular with many Americans. And for Democrats, the election is about just about anything else, especially if they can steer attention away from Washington and federal matters. It's a political strategy that sometimes gives the campaigns an inside-out feel, with veteran senators running as if they were first-timers without a Washington resume to defend or tout (Babington, 7/6).

The Wall Street Journal: House Centrists In Both Parties Are Under Attack
Rep. Collin Peterson plays in a rock band named the Second Amendments. His staff includes a former GOP state legislator. He voted against the Affordable Care Act, and he worked with House Speaker John Boehner (R., Ohio) to hash out part of this year's farm bill. For more than two decades, Mr. Peterson's conservative bent and focus on agricultural policy has helped him maintain his hold on the western Minnesota district he flies himself around in a Beechcraft Bonanza single-engine plane. But as one of just seven Democrats running for re-election in districts lost by President Barack Obama in 2012, he faces a new level of scrutiny this election cycle as he seeks his 13th term in the House. As the ranks of centrist lawmakers in both parties have thinned, political operatives' efforts to oust them have intensified (Peterson, 7/6).

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House Of Representatives' Lawyers Ask Judge To Reject SEC Lawsuit

In what is viewed as an ongoing power struggle between two branches of the federal government, the House lawyers termed the investigation related to Medicare insider-trading allegations to be a "fishing expedition."  

The Wall Street Journal: House Attorneys Seek Dismissal Of SEC Suit
Lawyers for the U.S. House of Representatives asked a federal judge to reject a lawsuit the Securities and Exchange Commission filed against Congress in June, saying the suit amounts to "a remarkable fishing expedition for congressional records." The move late Friday is the latest in a power struggle between two branches of government in a possible insider-trading case (Ackerman, 7/4).

Reuters: House Panel Opposes Giving SEC Documents For Medicare Insider Trading Probe
A U.S. House of Representatives panel said on Friday it should not have to comply with a federal regulator's demand for documents sought for an insider-trading probe involving the staff director of a subcommittee and a lobbyist. The House Ways and Means Committee argued in a court filing that U.S. District Judge Paul Gardephe in New York should deny the Securities and Exchange Commission's attempt to subpoena documents from the committee and its healthcare subcommittee staff director Brian Sutter. The SEC went to court June 20 to enforce subpoenas it issued as it sought information related to a probe into whether Sutter leaked material nonpublic information about Medicare reimbursement rates to Mark Hayes, a lobbyist at Greenberg Traurig LLP (7/4).

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Medicare

Medicare Proposes 2.1% Pay Boost For Outpatient Care

The increased rate highlights a trend towards discouraging unnecessary admissions. Meanwhile, the agency announces a pilot project to cut down appeal waits for long-term care providers.

Bloomberg: Hospitals To Get 2.1% Pay Boost On Medicare Outpatients
Medicare payments to hospitals for care they provide on an outpatient basis would increase 2.1 percent under an Obama administration proposal highlighting a trend toward discouraging unnecessary admissions. ... The proposed increase for 2015 was released yesterday in a regulation from the U.S. Centers for Medicare and Medicaid Services. ... The Medicare agency already proposed trimming payments for admissions at hospitals next year by about $241 million. Those cuts are in part due to the Affordable Care Act, which ordered reductions in Medicare costs to help pay for its expansion of insurance coverage, in a deal with the hospital industry (Wayne, 7/4).

McKnight’s: CMS Announces Medicare Appeals Without Administrative Law Judges
Long-term care providers will be able to appeal certain Medicare claims decisions without utilizing an administrative law judge, the Centers for Medicare & Medicaid Services announced Friday. Settlement Conference Facilitation is an alternate dispute resolution process that would bring providers and CMS representatives together to negotiate and settle Medicare disputes with the help of a third party. ... This "settlement conference facilitator" would be an employee of the Office of Medicare Hearings and Appeals, which is a separate agency from CMS, according to a fact sheet on the pilot program (Mullaney, 7/7).

Related KHN coverage: As HHS Moves To End Overload Of Medicare Claims Appeals, Beneficiaries Will Get Top Priority (Jaffe, 1/21).

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Health Information Technology

Federal Push For Electronic Health Records May Make Fraud Easier

USA Today reports on this development. Meanwhile, in other health IT news, The Fiscal Times reports on how hospitals are getting more involved in big data collection.

USA Today: Feds Push Electronic Records That Make Fraud Easier
The federal government is rewarding doctors and hospitals for moving to electronic health records — and will soon punish them if they don't — even though these records currently make it easier for health care providers to defraud government-paid health programs, fraud experts say (O’Donnell, 7/6).

The Fiscal Times: Don’t Eat That Doughnut: Your Doctor Is Watching
Hospitals are now getting in on the game of big data collection by monitoring their patients’ consumer information—like credit card purchases at fast food joints—to identify people with health risks before they walk in the door. And you thought the NSA was a problem. The largest hospital network operating in North and South Carolina, Carolinas HealthCare System, is gathering data on 2 million people to throw into predictive algorithms designed to flag high-risk patients, Bloomberg’s Businessweek first reported (Ehley, 7/3).

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Coverage & Access

Long Waits For Medical Attention Are Normal In Many Parts Of U.S.

The New York Times reports on what it calls the health care system's "waiting game." 

The New York Times: The Health Care Waiting Game
One small consolation of our high-priced health care system -- our $2.7 trillion collective medical bill -- has been the notion that at least we get medical attention quickly. ... Yet there is emerging evidence that lengthy waits to get a doctor’s appointment have become the norm in many parts of American medicine, particularly for general doctors but also for specialists. And that includes patients with private insurance as well as those with Medicaid or Medicare (Rosenthal, 7/5).

In other news about the health care system --

The Associated Press: No Practicing On Patients:  New Docs Instead Get Boot Camp
First-day jitters come with any new job but when the work involves pushing needles into strangers' bellies, stitching up gaping wounds or even delivering babies, that debut can be especially nerve-wracking -- for everyone involved. Brand-new doctors often launch right into patient care within weeks of graduating from medical school. To make sure their skills are up to snuff, many medical schools and hospitals run crash courses in the basics for these new interns. It's called boot camp at Northwestern Memorial Hospital and its adjoining Feinberg medical school, a program involving two to three days of intense practice before letting the newbies loose on patients. Young doctors are tested on a variety of skills, from the proper technique for handling newborns during childbirth -- make sure the head comes out slowly -- to delivering bad news -- use empathy, eye contact and listen to the patient. More than 90 percent pass the first time. The rest are tested again until they do (Tanner, 7/7).

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Public Health & Education

Stress Levels Run High And Take Toll On Americans' Health

NPR: For Many Americans, Stress Takes A Toll On Health And Family
Stress is part of the human condition, unavoidable and even necessary to a degree. But too much stress can be toxic – even disabling. And there's a lot of toxic stress out there. A national poll done by NPR with our partners at the Robert Wood Johnson Foundation and the Harvard School of Public Health finds that more than one in every four Americans say they had a great deal of stress in the previous month (Knox and Neighmond, 7/7).

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Medicaid

Fla. Hospitals On The Hook For $267 Million In Medicaid Overpayment

The federal government says the hospitals were paid too much, and it wants the entire overage back this year. That is a tough demand for two of the state's safety-net hospitals. Meanwhile, a Florida teen battling cancer hits Capitol Hill to lobby for funding for Medicaid and other children's programs.

Tampa Bay Times: Demand That Hospitals Repay Medicaid Funds Latest Sign Of D.C.-Tallahassee Rift
The federal government wants to recover $267 million from Florida hospitals it says were paid too much to care for the poor. And it wants the entire amount this year — a demand that is hitting safety-net hospitals like Jackson Memorial in Miami and Tampa General hard. ... It's not unusual for health care funding to be audited and adjustments required. Justin Senior, director of the state Medicaid program, noted that $267 million, a figure accrued over the past eight years, pales compared with the $1 billion annual appropriation. But the one-year repayment is a sticker shock. Hospital and state officials have asked for three years instead, and assurances that the audits are final (Mitchell, 7/3).

The Associated Press: Fla. Teen Cancer Survivor Lobbies Capitol Hill For Sustained Medicaid/CHIP Funding
A 14-year-old southwest Florida cancer survivor is lobbying lawmakers on Capitol Hill to fund Medicaid and other children's programs. Tony Colton recently joined more than 25 patients and families from across the country for the Children's Hospital Association's advocacy day. Colton spoke with U.S. Sen. Bill Nelson, D-Fla., and representatives Gus Bilirakis, Vern Buchanan, Kathy Castor and David Jolly about Medicaid and the Children's Health Insurance Program. Tony has been a patient at All Children's Hospital patient since 2011, after being diagnosed with clear cell sarcoma of the kidney, a rare pediatric cancer. Tony and his family urged lawmakers to fund these specialty programs. Nearly 70 percent of patients at All Children's Hospital are Medicaid recipients (7/5).

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State Watch

Ill. Supreme Court Rules State Can't Cut Retiree Health Benefits

The Court said the benefits are protected under the Illinois Constitution. The state wants to cut the benefits to save money on the state's pension liabilities.

The Wall Street Journal: Illinois Supreme Court Rules Against Cuts In Retiree Health Benefits
A ruling by the Illinois Supreme Court Thursday is casting new doubts on an overhaul of the public employee retirement system that passed last year to prop up the state's deeply underfunded pensions. The court ruled health-insurance subsidies for retired state workers are protected under the Illinois Constitution, siding with public-sector unions who challenged cuts to the benefits passed by lawmakers two years ago. The decision set off renewed debate over the constitutionality of a larger overhaul of the retirement system, which passed last fall and is being challenged by state workers and retirees on similar grounds (Peters, 7/3).

Reuters: Illinois High Court Rules Constitution Protects Retiree Health Benefits
The Illinois Supreme Court decided Thursday that health care for retired state workers is a constitutionally protected pension benefit, a ruling with implications for pension reform legislation passed by the state legislature earlier this year. The 6-to-1 decision allows the continuation of class-action challenges to a 2012 Illinois law that gave the state the right to impose health care insurance premiums on its retired workers. The challenge to the state effort to change health care benefits centered on a constitutional provision that membership in any public sector pension or retirement system "shall be an enforceable contractual relationship, the benefits of which shall not be diminished or impaired” (Plume, 7/3).

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Lines Drawn Over San Francisco Court-Ordered Outpatient Mental Illness Treatment

Elsewhere, a program in Wisconsin assigns peer specialists to help those with mental illness reintegrate into society, cuts to mental health programs in Iowa haven't materialized and North Carolina lawmakers look for ways to prevent suicide.

Los Angeles Times: San Francisco Is Likely To Approve Laura’s Law Mental Health Program
Family members of those who have suffered multiple mental health crises and refuse help or fail to stick with it are begging for a Laura's Law program -- which could court-order the intractably ill into outpatient treatment. Police officers and firefighters who see the same people cycle through hospitalizations and jail want it too. Then there are the mental health consumers who are well enough to speak of the trauma inflicted by coercive care. It doesn't work, they say. It drives people from treatment (Romney, 7/6).

The Milwaukee Journal Sentinel: Peer Specialist Draws On Own Struggles To Stem Mental Health Crisis
If Milwaukee County is going to slow the revolving door on its psychiatric hospital, it will need more people like Fraser Hartig. Hartig can do what few doctors or nurses can: Speak from experience. "I struggle with my mental illness. They struggle with theirs," said Hartig, 26, a soft-spoken guy with dark brown eyes and a scruffy goatee. "We are the same." Hartig is part of a program launched by the county in September 2012 known as CLASP, the Community Linkages and Stabilization Program. The goal is to promote recovery in the community by assigning peer specialists such as Hartig to those who are being discharged from the county psychiatric hospital (Kissinger, 7/5).

Des Moines Register: Feared Mental Health Cuts Didn’t Materialize In Iowa
Local officials are tamping down their skepticism about a new way of organizing mental health services for tens of thousands of Iowans. Front-line administrators had worried that the statewide reorganization would lead to cuts in programs, but such fears are easing as the new plan takes hold. The state's 99 counties used to be responsible for their own mental health systems unless they voluntarily partnered with neighbors. They now have joined 15 regional authorities, which formally took control Tuesday (Leys, 7/5).

North Carolina Health News: Lawmakers Call For Action On Reducing Suicides 
The North Carolina House of Representatives passed a resolution Wednesday authorizing legislative staff to study ways to prevent suicide among minors and veterans in the state. Lawmakers listened as Rep. Carla Cunningham (D-Charlotte), one of the resolution’s sponsors, struggled to contain her emotions as she described her son’s struggle with mental illness and developmental disabilities (Singh, 7/3).

In Florida, the state becomes the first to offer a major Medicaid plan that caters to those with mental illnesses --

Kaiser Health News: Florida Shifts Medicaid Mental Health Strategy
Seeking to improve care and lower costs, Florida this month became the first state to offer a Medicaid health plan designed exclusively for people with serious mental illnesses, such as schizophrenia, major depression or bipolar conditions. The plan -- offered by Avon, Conn.-based Magellan Complete Care -- is part of a wave of state experimentation to coordinate physical and mental health care for those enrolled in Medicaid (Galewitz, 7/7).

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State Highlights: N.C. Medicaid Changes, Problems

A selection of health policy stories from California, North Carolina, Illinois, Wisconsin, Virginia, Texas and Colorado.

Kaiser Health News: Capsules: Advocates Say California Is Rejecting 'Free Money' To Renew Poor People’s Insurance
Consumer advocates and some legislators were surprised and frustrated when California health officials recently refused a $6 million donation to help people re-up their Medi-Cal health coverage. Now two senators have proposed an unusual solution: a bill to force the state to accept the offer from The California Endowment (Gorman, 7/4).

Charlotte Oberserver: With A Disabled Son, Cary Mom Wants A Voice In NC Medicaid Changes
Early last year, the state Department of Health and Human Services asked for the public’s input on reforming Medicaid. Colleen Leonard, the mother of a severely disabled teenager, Mason, wanted to have her say. She sees the Medicaid services as a blessing, literally a matter of life and death for her son, who was brain damaged at birth and cannot be left alone. ... Last year, a policy change eliminated weekend hours dedicated to teaching functional skills for Mason, 14, who is severely handicapped and needs constant attention during waking hours. He cannot dress or bathe himself, get a snack or keep himself safe in his own home. Changes proposed this summer by the state Senate could end Mason’s in-home services (Neff, 7/4).

Raleigh News & Observer: Medicaid Agency Has Been Perennial Headache
Perhaps Gov. Pat McCrory’s biggest inherited headache has been two new computer systems. NCFast is used to sign people up for benefits such as food stamps and Medicaid. Problems with NCFast have led to a backlog in Medicaid applications; officials cannot currently come up with the number of Medicaid recipients in North Carolina, a critical number for estimating future costs. Perhaps an even bigger problem is NCTracks, the state’s new Medicaid claims processing system, which was started during Gov. Mike Easley’s administration. Two years late and more than $200 million over its original budget, the claims system was troubled from the moment the McCrory administration launched it last July (Neff, 7/5).

The Associated Press: Illinois To Vote On Employer Contraception Coverage 
Illinois Gov. Pat Quinn has signed a November ballot question that'll ask voters if they think prescription drug coverage plans should be required to include birth control. The Chicago Democrat inked the non-binding question Sunday. In a statement, Quinn says a recent U.S. Supreme Court decision on birth control has brought the issue of women's rights to the forefront (7/6).

The Milwaukee Journal Sentinel: Milwaukee Health Services On The Mend
Hit with a string of setbacks that resulted in three years of losses and a painful restructuring, Milwaukee Health Services is again operating in the black, and its chief executive officer is optimistic that a difficult time in its 25-year history is coming to an end. ... But Milwaukee Health Services, which provides primary care and other services to about 27,000 people in some of the city's poorest neighborhoods, must now rebuild — and that will take time and money (Boulton, 7/5).

The Richmond Times-Dispatch: A Closer Look At Charity Care In Hospitals
Can you explain charity care? Charity care in general is free or discounted care provided to low-income people who qualify for financial assistance. The Virginia Department of Health, through the Certificate of Public Need program, can require hospitals and other providers to do charity care as a condition of having a project approved (Smith, 7/6).

Texas Tribune: In Texas, Less Progress On Reducing Teen Pregnancy 
In Texas and across the country, the rate of teenage births has declined significantly since its peak in 1991. Birth rates among teenagers in Texas dropped 43 percent between 1991 and 2012. In states like California and Connecticut, the drop was even larger, and nationwide, the rate declined 52 percent in that period. But despite the improvements in the Lone Star State, it is faring worse than most. ... Teenage birth cost Texas taxpayers $1.1 billion in health care, foster care and lost tax revenue in 2010, according to the National Campaign to Prevent Teen and Unplanned Pregnancy (MacLaggan, 7/6).

Denver Post: Colorado Claims Contraceptive Program Caused Big Drop In Teen Birth Rates 
A state health initiative to reduce teen birth rates by providing more than 30,000 contraceptive devices at low or no cost has led to a 40 percent drop in five years, Gov. John Hickenlooper said Thursday. The Colorado Family Planning Initiative, funded by a private anonymous donor for five years, has provided intrauterine devices and other implants to low-income women at 68 family-planning clinics across Colorado since 2009. The clinics are in local health departments, hospitals and private nonprofit facilities. The program also provided training and technical assistance to family planning clinics statewide (Draper, 7/3).

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Editorials and Opinions

Viewpoints: Wheaton Injunction Muddies Court's Ruling On Contraceptives; Boston Hospital Merger Problems; Advice For New VA Chief

Los Angeles Times: The Supreme Court's Muddy New Ruling On The Contraceptive Mandate
In a bizarre attempt to have it both ways, the Supreme Court held that a small evangelical Protestant college in Illinois did not have to include contraceptive coverage in employee health insurance even though it didn't fill out the paperwork the government required for claiming an exemption. ... Clearly, the Hobby Lobby ruling wasn't the end of the story as far as the Supreme Court and the contraceptive mandate. But as the court demonstrated Thursday on Wheaton's injunction, sometimes the steps it takes appear larger than they really are (Jon Healey, 7/3).

The Wall Street Journal: The Wheaton Overreaction
Our guess is that Supreme Court Justice Sonia Sotomayor may come to regret her furious dissent last week to a simple Court order granting a temporary religious liberty reprieve to Wheaton College from having to obey ObamaCare's contraception mandate. She and the two other female Justices accused the Court's majority of all sorts of legal offenses, not least dishonesty (7/6). 

Los Angeles Times: Does America Have The Political Maturity For Single-Payer Healthcare?
Responding to my post about how the Supreme Court's Hobby Lobby ruling demonstrates the necessity of a single-payer healthcare system, Ezra Klein raises the specter of unrestrained political interference in healthcare decisions. "A Republican-led government could decide that taxpayer dollars shouldn't be going to cover contraception at all, and then a single-payer system means no one's insurance covers contraception," he wrote. This is "one of single-payer's real problems." This is an important issue. Americans gain nothing if they evict insurance bureaucrats from the operating room only to make room for preening politicians. But experience -- in the U.S. and abroad -- suggests that Klein's concern is overwrought (Michael Hiltzik, 7/3).

Forbes: Does Hobby Lobby Signal The End Of Employer Sponsored Health Insurance?
Even if the Supreme Court avoids the minefield that Justice Ginsburg referenced in her dissent, the controversial decision has definitely thrown open Pandora’s proverbial box. If not legally, certainly in the mind of public opinion. Perhaps the biggest single fault line is the accident of American history ‒ Employer Sponsored Insurance (ESI). Even President Obama has openly acknowledged this artifact of legislation dating back to World War II. ... Today, the battle lines that appear to be forming around ESI aren't just employers with strong religious convictions either. Many employees are equally frustrated by personal privacy issues and cost-shifting that are now attached to their employer’s health benefits (Dan Munro, 7/6).

The Washington Post: Relax, Hobby Lobby Won't Take Away Anyone's Birth Control
Virtually all of the criticism of the Supreme Court’s Hobby Lobby decision has assumed that women who work for Hobby Lobby and other religious businesses will lose their free contraceptives. That's false. ... In this case, the government argued that the right to free exercise of religion was not implicated at all in a merchant's religiously motivated conduct. This time it lost that argument 5 to 2. So if one is looking for winners and losers in this case, one should count the decision as a significant victory for religious liberty, a substantial defeat for the government, and no less than a draw for women’s rights (Kevin Baine, 7/5).

The New York Times: A Company Liberals Could Love
Of course I’m talking about Hobby Lobby, the Christian-owned craft store that’s currently playing the role of liberalism’s public enemy No. 1, for its successful suit against the Obama administration’s mandate requiring coverage for contraceptives, sterilization and potential abortifacients. But this isn’t just a point about the company’s particular virtues. The entire conflict between religious liberty and cultural liberalism has created an interesting situation in our politics: The political left is expending a remarkable amount of energy trying to fine, vilify and bring to heel organizations — charities, hospitals, schools and mission-infused businesses — whose commitments they might under other circumstances extol (Ross Douthat, 7/5).

The Washington Post: No, The Supreme Court’s Hobby Lobby Decision Is Not Based Upon A Scientific Mistake
Among the criticisms of the Supreme Court’s decision last week in Burwell v. Hobby Lobby is that it is "anti-science." Specifically, many charge that the majority’s decision in favor of two companies that objected to paying for a handful of contraceptive methods lacked any scientific basis. ... These critics are mistaken. There are reasonable arguments to be made against the Supreme Court’s Hobby Lobby decision, but the charge that the decision is based on science fiction is not among them (Jonathan H. Adler, 7/6).

On other health issues -

The New York Times: The Risks Of Hospital Mergers
In retrospect, it looks as if Massachusetts made a serious mistake in 1994 when it let its two most prestigious (and costly) hospitals — Massachusetts General Hospital and Brigham and Women’s Hospital, both affiliated with Harvard — merge into a single system known as Partners HealthCare. Investigations by the state attorney general's office have documented that the merger gave the hospitals enormous market leverage to drive up health care costs in the Boston area by demanding high reimbursements from insurers that were unrelated to the quality or complexity of care delivered. Now, belatedly, Attorney General Martha Coakley is trying to rein in the hospitals with a negotiated agreement that would at least slow the increases in Partners’ prices and limit the number of physician practices it can gobble up, albeit only temporarily (7/6).

The New York Times: When Beliefs And Facts Collide
[M]ore people know what scientists think about high-profile scientific controversies than polls suggest; they just aren't willing to endorse the consensus when it contradicts their political or religious views. This finding helps us understand why my colleagues and I have found that factual and scientific evidence is often ineffective at reducing misperceptions and can even backfire on issues like weapons of mass destruction, health care reform and vaccines. With science as with politics, identity often trumps the facts (Brendan Nyhan, 7/5).

Los Angeles Times: Same Surgery, Different Price: Patient Gets $15,000 Bill Second Time
It would be nice if Americans could declare independence from loony medical bills. But that day isn't here. Bill Erickson can attest to that. In 2010, he had his right knee replaced after "lots of abuse" as a high school and college baseball coach. His insurer, Anthem Blue Cross, apparently covered everything. Erickson, 64, had his left knee replaced last year. "Same doctor, same hospital, same procedure," he told me. But not the same medical bill (David Lazarus, 7/3). 

Los Angeles Times: Aging Parents, Scary Home
People have been growing old and dim forever, so we figured there must be experts to guide us. We asked around and learned that the person we wanted was called a geriatric social worker in elder care management. We made an appointment with one. My brother and I felt instant relief: A professional was coming to the rescue! Our hero talked slowly for someone charging $100 an hour (Amy Goldman Koss, 7/5).

The New York Times' The Upshot: Gingrich’s Correct Prediction About Medicare's Future
On Oct. 24, 1995, Newt Gingrich made an assertion about what would happen to Medicare if its beneficiaries could choose between it and private plans. Medicare is "going to wither on the vine because we think people are voluntarily going to leave it — voluntarily." Though he later walked this statement back, many observers viewed it as an attack on the program. In fact, over the nearly two decades since, Mr. Gingrich’s claim has undergone something of a test — and it has largely passed it (Austin Frakt, 7/7).

The Arizona Republic/USA Today: Advice For New VA Chief
Mr. Robert McDonald: We admire your courage. In accepting this nomination, you are about to confront one of the most daunting challenges in all of federal governance: reforming the VA hospital system. You face three great challenges (7/6). 

Bloomberg: Ritalin May Be Sabotaging Your Kids
Over the past 20 years, mental disabilities have overtaken physical disabilities as the leading limitation on children's activities. Today, attention deficit hyperactivity disorder is three times more likely than asthma to disable an American child. An often difficult question for parents is whether to put their child with ADHD on either Ritalin or Adderall .... Ritalin and Adderall can be essential, life-changing treatments for many children. But for some, the benefits are not so clear (Janet Currie & Mark Stabile, 7/3).

Journal of the American Medical Association: Patient Referrals: A Linchpin For Increasing The Value Of Care
The success of accountable care organizations (ACOs) under global payment may depend in part on a common yet poorly understood clinical decision: the patient referral in the outpatient setting. Fundamental to collaboration among physicians and other health care professionals, patient referrals have been largely ignored in the payment reform debate (Zirui Song, Thomas D. Sequist and Michael L. Barnett, 7/3).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Marissa Evans

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.