Daily Health Policy Report

Monday, July 8, 2013

Last updated: Mon, Jul 8

KHN Original Reporting & Guest Opinion

Health Reform

Medicaid

Health Care Marketplace

State Watch

Public Health & Education

Editorials and Opinions

KHN Original Reporting & Guest Opinion

National Health Plans, Designed To Spur Competition, May Be Unavailable In Some States Next Year

Kaiser Health News staff writer Julie Appleby, working in collaboration with The Washington Post, reports: "National health insurance plans aimed at giving consumers more choice might be unavailable in some states next year, leaving residents with fewer options and potentially higher premiums. Such "multi-state" plans were included in the federal health law to boost competition among insurers, particularly in states with few carriers. They were also seen as a consolation to supporters of the failed effort to require a government-run "public option" (Appleby, 7/5). Read the story.

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FAQ: What Workers And Employers Need To Know About The Postponed Employer Mandate

Kaiser Health News examines the implications of a change in the health care law implementation: Surprising both friends and foes of the health law, the Obama administration on Tuesday announced the delay of a key provision: the requirement that all but the smallest employers offer medical coverage or pay a fine. ... Here’s what the change means — and doesn’t mean — for workers and employers (KHN Staff, 7/3). Read the story.


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Advocates Urge More Government Oversight Of Medicaid Managed Care

Jenni Bergal, writing for Kaiser Health News in collaboration with USA Today, reports: "Advocates and experts say that the need for When the federal government recently gave Florida the green light to vastly expand its experiment with privatizing Medicaid, patient advocates quickly raised an alarm. They cited serious problems with the state’s five-county pilot managed care program and urged close monitoring of the companies that run private Medicaid plans to ensure that they don’t scrimp on care. oversight is growing nationally as states have increasingly contracted out the huge state-federal program for the poor to insurance companies, aiming to control costs and improve quality through close management of patient care" (Bergal, 7/5). Read the story.

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A Busy ER Doctor Slows Down To Help Patients Cope With Pain

Alaska Public Radio's Annie Feidt, working in partnership with Kaiser Health News and NPR, reports: "Dr. Linda Smith walks into a room at Providence Alaska Medical Center, ready with a stethoscope and a huge grin. She teases her patient, Dawn Dillard, saying that her spiky hair recently resembled a 'faux hawk.' Dillard found out she had uterine cancer a year ago. Her oncologist gave her a year to live. The 57-year-old has beaten those odds, but now her kidneys are failing. After the laughs are over, Smith sits down on the edge of Dillard's bed, leans in, and starts talking about a surgical procedure to help her kidneys" (Feidt, 7/5). Read the story.

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How Baby Erik Got Insurance

The Philadelphia Inquirer's Don Sapatkin, writing in partnership with Kaiser Health News, reports: "Two days after Erik Friedman was born, his parents applied for coverage under Pennsylvania's universal Children's Health Insurance Program. Six months later, they got it. What happened in between were 86 phone calls, two lost applications, a calculation error that tripled their income (and raised their premium), incorrect advice that they should (and did) drop their baby's catastrophic health insurance to qualify, multiple promises of responses that never came, and collection agency letters for hospital bills, which, of course, hadn't been paid" (Sapatkin, 7/8). Read the story.

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Capsules: New AMA President On Implementing The Health Law

Now on Kaiser Health News' blog, KHN’s Mary Agnes Carey and The Washington Post’s Sarah Kliff interviewed Dr. Ardis Hoven, the new American Medical Association president, for an episode of the C-SPAN program "Newsmakers" that aired Sunday. The three talked about implementation of the health care law, a shortage of primary care practitioners, as well as the AMA's decision to classify obesity as a disease and what to expect from her tenure as president. Check out what else is on the blog.

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Political Cartoon: 'Hand Me The Retractor?' By Lisa Benson

Kaiser Health News provides a fresh take on health policy developments with "Hand Me The Retractor?" By Lisa Benson.

Meanwhile, here is today's health policy haiku:

IT'S A LONG SEASON

Before trade deadline
team finds utility man:

-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

Conservative Group Plans $1 Million Ad Campaign To Oppose Health Law

The effort will counter advocates' campaigns to get people to sign up for online insurance marketplaces. In other health law news, a Clinton administration veteran is joining the Obama health team.

The New York Times: Conservatives' Aggressive Ad Campaign Seeks To Cast Doubt On Health Law
Though many of its rules will not take effect for months, President Obama’s health care law is already the subject of an aggressive advertising campaign by Republicans to sow doubts about how it will work. In one of the largest campaigns of its kind, Americans for Prosperity, a conservative advocacy group financed in part by Charles and David Koch, will begin running television commercials this week asserting that the law will limit Americans’ health care choices (Peters, 7/6).

The Hill: Tea Party Group Launces $1M Ad Blitz Against ObamaCare
The Tea Party-Affiliated Group Americans for Prosperity is launching a $1 million ad campaign opposing ObamaCare. The move comes as the administration is ramping up its own efforts to enroll the public in the new insurance exchanges and as Democrats express concerns that a botched rollout could hurt their 2014 election chances (Joseph, 7/7).

The Washington Post: Obamacare Backers Launch Campaign, Want Moms To Convince Their Youths To Get Coverage
The Obama administration and its allies need lots of healthy young adults to sign up for insurance this fall to make the president’s health-care law successful. So they are going after their moms. They put up Web ads on Facebook and Allrecipes.com alongside slogans such as “Moms know best: ‘Get yourself health insurance.’ ” They have enlisted the help of parent-activist groups such as Moms Rising (Somashekhar, 7/6).

The New York Times: Clinton Aide Joins Obama On Health Care
In an effort to put President Obama’s health care program back on track, the White House has recruited Chris Jennings, a respected veteran of the Clinton administration, to join the Obama team as a health policy coordinator and strategist, the White House said on Sunday night. The White House expects to announce the hiring of Mr. Jennings and other health care personnel later this week (Pear, 7/7).

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For A Year, Consumers Will Be On The Honor System For Health Law Subsidies

With the delay in the employer mandate, the administration announced Friday that it would scale back verification rules on enrollees' income and health status.

The Washington Post: Health Insurance Marketplaces Will Not Be Required To Verify Consumer Claims
The Obama administration announced Friday that it would significantly scale back the health law's requirements that new insurance marketplaces verify consumers' income and health insurance status. Instead, the federal government will rely more heavily on consumers' self-reported information until 2015, when it plans to have stronger verification systems in place (Kliff and Somashekhar, 7/5).

Reuters: Delay In Obamacare Requirement Puts Onus On The Honor System
Data on what coverage employers offer and what it costs, to be provided to the Internal Revenue Service, is also meant to help verify whether consumers qualify for government subsidies to purchase health insurance on state- and federally run online exchanges that open on October 1. President Barack Obama's healthcare reform needs millions of people to enroll in coverage sold on the exchanges in their first year in order to work, spreading the financial risk among millions of consumers (Begley, 7/5). 

Kaiser Health News: FAQ: What Workers And Employers Need To Know About The Postponed Employer Mandate
Surprising both friends and foes of the health law, the Obama administration on Tuesday announced the delay of a key provision: the requirement that all but the smallest employers offer medical coverage or pay a fine. … Meanwhile other parts of the law remain on track for implementation next year, according to officials. Here’s what the change means — and doesn't mean — for workers and employers (KHN staff, 7/3).

The Wall Street Journal: Health-Law Penalty Delay Clouds Individual Mandate
Supporters of the 2010 Affordable Care Act characterized the delay as a hiccup and said new health-insurance exchanges for individuals will likely go ahead as planned. But other observers said that by declining to enforce the rules on employers, the Obama administration might find it harder to carry out the individual mandate under which people must carry health insurance or pay a tax penalty (Radnofsky, Mathews and Weaver, 7/3).

Los Angeles Times: Obamacare Delay Has Foes Focusing On Flaws
The Obama administration's surprise decision to delay penalizing large employers that fail to provide health coverage appears unlikely to unravel the president's signature healthcare law, despite claims from Republicans that the law's collapse is imminent. But the move casts a spotlight on a central dilemma facing the administration as it moves to implement the complex law: Even supporters acknowledge that some of the Affordable Care Act's provisions may not work as written. But partisan tensions in Washington have made changes all but impossible (Levey and Terhune, 7/4).

The New York Times: Postponing Health Rules Emboldens Republicans
Republican leaders of the House Energy and Commerce Committee demanded documents and other information from the Treasury secretary and the secretary of health and human services about the decision announced Tuesday to put off for a year, until 2015, the law’s reporting requirements and penalties. Some Republicans said the White House was trying to help Democrats by postponing the changes until after the midterm elections, but others saw no gain for Democrats either way (Calmes and Pear, 7/3).

The New York Times: Health Law Delay Puts Exchanges In Spotlight
The Obama administration's decision, announced on Tuesday, to delay for a year a requirement that larger employers provide insurance or pay a penalty has made the operation of the state exchanges — where individuals can shop for insurance starting Oct. 1 — more critical to the success of the new health care  (Abelson and Thomas, 7/3).

The Associated Press: Analysis: Health-Care Law Loses Momentum
President Barack Obama's health care law, hailed as his most significant legislative achievement, seems to be losing much of its sweep. On Tuesday, the administration unexpectedly announced a one-year delay, until after the 2014 elections, in a central requirement of the law that medium and large companies provide coverage for their workers or face fines (Alonso-Zaldivar, 7/3).

The Fiscal Times: New Winners And Losers In The Obamacare Delay
The postponement raises uncertainties about both the economy and a 2014 election in which Democrats hope to preserve their Senate majority. While the number of businesses that would have been forced to provide insurance is relatively miniscule, growing publicity about companies considering layoffs and cutting back employee hours to avoid the mandate has caused a headache for the administration. In fact, an estimated 96 percent of all firms in the United States—or 5.8 million out of 6 million businesses – have fewer than 50 full time employees and therefore are exempt from this part of the Affordable Care Act (Francis, Pianin and Boak, 7/5).

CNN Money: For Fatburger And Others, Obamacare Delay Came Too Late
Delaying the Obamacare employer mandate has simply put off rules business had already started adjusting to. Under the Affordable Care Act, companies with 50-plus full-time employees must start offering them health insurance or face stiff penalties. ... Because a 30-hour work week counts as full-time under Obamacare, Fatburger fast-food restaurants had started cutting worker hours below that threshold, CEO Andy Wiederhorn said (Pagliery, 7/8).

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HHS Awards Contract To British Company To Run Obamacare Exchanges

The New York Times: British Company Is Awarded Contract To Administer Health Rollout
Racing to meet an October deadline, Obama administration officials said Thursday that they had awarded a contract worth as much as $1.2 billion to a British company to help them sift applications for health insurance and tax credits under the new health care law. The company, Serco, has extensive experience as a government contractor with the Defense Department and intelligence agencies ... [b]ut it has little experience with the Department of Health and Human Services or the insurance marketplaces, known as exchanges, where individuals and small businesses are supposed to be able to shop for insurance (Pear, 7/4).

Kaiser Health News: National Health Plans, Designed To Spur Competition, May Be Unavailable In Some States Next Year
National health insurance plans aimed at giving consumers more choice might be unavailable in some states next year, leaving residents with fewer options and potentially higher premiums. Such "multi-state" plans were included in the federal health law to boost competition among insurers, particularly in states with few carriers. They were also seen as a consolation to supporters of the failed effort to require a government-run "public option" (Appleby, 7/5).

The Associated Press: Obamacare: Health Insurers Fear Young People Will Opt Out
Dan Lopez rarely gets sick and hasn't been to a doctor in 10 years, so buying health insurance feels like a waste of money. … Persuading young, healthy adults such as Lopez to buy insurance under the Affordable Care Act is becoming a major concern for insurance companies as they scramble to comply with the law, which prohibits them from denying coverage because of pre-existing conditions and limits what they can charge to older policy holders (Kennedy, 7/8).

Chicago Tribune: Health Care Void Fills Immigration Debate
It has been nearly two years since a car hit Jesus Arroyo as he crossed a Chicago street on his way home from work, an accident that crushed his left side, fractured his skull in multiple places and left him in a coma for six months. Today, Arroyo, 38, remains partially paralyzed and in constant pain, his plight an illustration of a health care problem that Congress sees as politically toxic and that area hospitals and other medical facilities are struggling to address: Who will pick up the health care tab for millions of immigrants who could become citizens under new immigration reform legislation? (Olivo, 7/6).

Kaiser Health News: Video: New AMA President On Health Law
KHN's Mary Agnes Carey and The Washington Post's Sarah Kliff interviewed Dr. Ardis Hoven, the new American Medical Association president, for an episode of the C-SPAN program "Newsmakers" that aired Sunday. The three talked about implementation of the health care law, a shortage of primary care practitioners, as well as the AMA's decision to classify obesity as a disease and what to expect from her tenure as president (7/8).

USA Today: Obamacare Requires Most Insurers To Tackle Obesity
There's new hope for heavy people desperate to lose weight. Many insurers are stepping up their coverage of obesity. Some insurance companies have helped obese patients fight fat for years. They've offered weight-loss and wellness programs at businesses, schools and in communities. Some have paid for prescription obesity medications and even covered expensive bariatric surgeries, including gastric bypass (Hellmich, 7/4).

The Associated Press: Newly Insured To Deepen Primary Care Doctor Gap
Getting face time with the family doctor could soon become even harder. A shortage of primary care physicians in some parts of the country is expected to worsen as millions of newly insured Americans gain coverage under the federal health care law (Sanner, 7/7).

Politico: Tax Talk Third Rail: The Health Care Exemption
The tax break on employer-sponsored health plans is one of the government's largest tax expenditures, costing the feds $200 billion to $300 billion a year, depending on who's doing the estimating. But it's also proved to be one of the hardest to undo -- arguably even more so now that the Affordable Care Act is full steam ahead. ... [L]awmakers are wary of any policy changes that could contribute to higher health care costs for businesses, which already fear the health law will hurt their bottom line (Cunningham, 7/8).

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Marketplace Falls Behind Schedule In Conn.; How Dental Plans For Kids Will Be Sold In Calif.

With the Oct. 1 deadline for launching markeplaces approaching, states struggle with health law implementation issues.

The Washington Post: In Connecticut, A Struggle To Launch Obamacare
At a monthly board meeting of Connecticut's health insurance exchange, members of the standing-room-only crowd got a reminder that they, too, were behind schedule. The insurance marketplace they were working on nights and weekends won't be completely ready on time. "It is highly complex, it's unprecedented and it's not going to be smooth," Kevin Counihan, chief executive of the state's exchange, Access Health CT, told the group. That's why Connecticut — like other states across the country — has lowered the bar, doing what it can in the time it has left before the health-care law's major programs are launched Oct. 1 (Kliff, 7/4).

Los Angeles Times: State Insurance Chief, Health Exchange Differ On Kids' Dental Care
Backed by children's health advocates, California Insurance Commissioner Dave Jones is challenging the state's health insurance exchange over the way it wants to provide children's dental benefits. At issue is whether pediatric dental care should be part of the basic health insurance package sold through the exchange or sold separately. The exchange has proposed selling it on a stand-alone basis to parents (Terhune, 7/5).

Dallas Morning News: Community Groups Gear Up For Health Insurance Exchanges
Come Oct. 1, the health insurance exchanges created by the Affordable Care Act will start open enrollment for people to shop for health insurance. Before that, however, begins a huge undertaking in educating consumers about the exchanges, also known as the health insurance marketplace, and about the act itself. Many Americans remain unaware of, or confused about, the health care law, according to the Kaiser Family Foundation, a private, nonprofit foundation that explores health care issues. Some believe Congress repealed the law and some believe the U.S. Supreme Court overturned it. But Congress hasn’t repealed it, and the high court left its basic provisions standing (Yip, 7/7).

Des Moines Register: Doctor Visits Likely To Rise With New Health Plan
Iowa clinics and hospitals should expect a wave of chronically ill people when a new state health insurance program starts in January, a report suggests. The report from the Public Policy Center assesses the health of people now on IowaCare, a limited health care program for poor adults. IowaCare covers about 70,000 people, most of whom are expected to switch next year to the new Iowa Health and Wellness Plan, which will provide broader insurance coverage to roughly 150,000 poor Iowans (Leys, 7/6).

The Miami Herald: After Healthcare Law Delay, Medicaid Expansion In Florida Remains In The Shadows
The Obama administration's decision to delay the Affordable Care Act health insurance mandate on employers has lessened some of the leverage advocates of expanding Medicaid in Florida had on lawmakers, but it won’t end the debate (Klas and Mitchell, 7/4).

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Medicaid

Advocates Raise Concerns About How States Handle Medicaid Managed Care

Patient advocates are urging greater oversight of the private programs. In other news, a Philadelphia couple details their struggle to get health insurance for their son.

Kaiser Health News: Advocates Urge More Government Oversight Of Medicaid Managed Care
When the federal government recently gave Florida the green light to vastly expand its experiment with privatizing Medicaid, patient advocates quickly raised an alarm. They cited serious problems with the state's five-county pilot managed care program and urged close monitoring of the companies that run private Medicaid plans to ensure that they don’t scrimp on care (Bergal, 7/5).

Philadelphia Inquirer: How Baby Erik Got Insurance
Two days after Erik Friedman was born, his parents applied for coverage under Pennsylvania's universal Children's Health Insurance Program. Six months later, they got it. What happened in between were 86 phone calls, two lost applications, a calculation error that tripled their income (and raised their premium), incorrect advice that they should (and did) drop their baby's catastrophic health insurance to qualify, multiple promises of responses that never came, and collection agency letters for hospital bills, which, of course, hadn't been paid (Sapatkin, 7/8).

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Health Care Marketplace

Washington Area Hospital Group Launches Health Insurance Plan

In other industry news, the growth of jobs in the health care sector could be a double-edged sword and hospitals seek a solution to "alarm fatigue."

The Washington Post: Is This The End Of Health Insurers?
In 2012, MedStar Health, like many large employers, struggled to keep up with rapidly rising health-care costs. For three years, the company held down premiums for its 19,000 employees by absorbing the increases itself. Most employers would have had no choice but to raise premiums — in this case, by about $550 for a family — and cope with frustrated employees. MedStar, one of the Washington area's largest health systems, saw another option. It would launch its own health insurance plan (Kliff, 7/5).

Earlier, related KHN story: Hospitals Look To Become Insurers, As Well As Providers Of Care (Rabin, 8/12/12) 

Milwaukee Journal Sentinel: Economists Warn Surge In Health Care Jobs May Signal Trouble
The nation has grown increasingly dependent on health care as a creator of jobs, with the number of people working in the sector rising 22.7% during the past decade, compared with 2.1% for all other industries, a new report says. And in all 100 of the largest U.S. metropolitan areas, including Milwaukee, more people work in health care now than before the start of the recession, according to the Brookings Institution report. The figures show the sector's resilience during the economic downturn and the slow recovery. But having a large percentage of jobs in health care may be a troubling sign, economists say (Boulton, 7/6).

The Washington Post: Too Much Noise From Hospital Alarms Poses Risk For Patients
Walk into a hospital intensive-care unit and hear the din: A ventilator honks loudly. An infusion pump emits a high-pitched beep-beep every six seconds. A blood pressure monitor pushes out one long tone after another. ... The sheer number — several hundred alarms per patient per day — can cause alarm fatigue. Nurses and other workers, overwhelmed or desensitized by the constant barrage, sometimes respond by turning down the volume on the devices, shutting them off or simply ignoring them — actions that can have serious, potentially fatal, consequences (Sun, 7/7).

Earlier, related KHN story: Sounding An Alarm On Alarms (Tran, 4/15).

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State Watch

Anti-Abortion Bills In Wisconsin, Texas, North Carolina Show GOP Muscle

Anti-abortion activists in Republican-dominated states have succeeded in pushing various bills that limit the procedure.

Los Angeles Times: Wisconsin Governor Signs Bill Restricting Abortion
Wisconsin this week became the latest state to pass legislation restricting abortions, though opponents of the measure quickly filed suit. The bill, signed Friday by Gov. Scott Walker, would require women to view an ultrasound of the fetus before an abortion. Providers would be required to point out the fetus' features on the ultrasound (Kelly, 7/6).

CNN: Wisconsin Governor Signs Tough Abortion Bill
The woman also must be provided a means to see any heartbeat, according to the law. The bill, which passed the Republican-controlled Legislature in June, also places stricter standards on abortion clinics by prohibiting doctors without admitting privileges at local hospitals from performing abortions. Pregnancies that result from rape or incest are excluded from the requirements (Killough, 7/5).

The Hill: Abortion Bills In State Legislatures Gaining National Attention
Efforts by conservatives to restrict abortion in several state legislatures are receiving national attention, as Republicans work to pass national versions. In Texas, state Sen. Wendy Davis (D) found herself in the national spotlight after filibustering a proposal that would ban abortions after 20 weeks of pregnancy. ... Republican legislators' efforts to pass similar laws in other states have received national attention as well (Strauss, 7/7).

The Washington Post: Abortion Limits At State Level Return Issue To The National Stage
The measures are part of a wave of abortion limits passed this year by conservative lawmakers and governors, who have approved more than 40 restrictions in statehouses around the country, according to data from the Guttmacher Institute, which tracks the issue. The push has been aided by the expanded control of state governments by Republicans, who now hold a majority of governerships and legislatures and who enjoy veto-proof majorities in twice as many states as Democrats (Eilperin, 7/5).

The Hill: Perry Vows Texas Will Pass Abortion Bill
Texas Gov. Rick Perry (R) on Sunday promised his state will push through a law restricting abortion rights, which has gained national attention, within the next 10 days. "We have a special session with some important issues in front of us. We're going to pass some restrictions on abortion in Texas so that Texas is a place where we defend life. That's the powerful message here, that's what we're focused on," Perry said on Fox News Sunday (Joseph, 7/7).

Politico: 'Turn Texas Blue' Hits Headwinds With Abortion
Democrats are gearing up to spend millions of dollars to "turn Texas blue" by bringing in a new generation of Latino voters. So when an abortion fight flared in Austin this summer, it seemed the stars had aligned — liberals had a hot-button cause to galvanize new supporters who just might stick around for the long haul. There’s just one problem: Latinos as a group oppose abortion more strongly than most other voting groups (Nather, 7/8).

North Carolina Health News: NC Senators Pass Sweeping Abortion Restrictions
On a party-line vote, state senators passed a bill to enact a number of sweeping changes to North Carolina’s abortion regulations that could have the effect of closing down many of the state's 36 abortion providers. The Family, Faith and Freedom Act, introduced late Tuesday and tentatively passed Tuesday evening, would place tighter regulations on clinics, restrict many health plans from offering coverage for the procedure, ban sex-selective abortions and require doctors to be present during all phases of an abortion, among other provisions (Hoban, 7/4).

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State Highlights: Ore. Nonprofit Hospitals Increase Revenues; Calif. Shift Means Lost Autism Treatment

Oregonian: Oregonian Hospitals' Post-Recession Recovery Comes With Charity Care Drop: Report
A new state report shows the average Oregon hospital more than doubled its margin, or profit, between 2009 and 2011, even as its provision of charity care went down. The findings trace the hospital sector rebound from recessionary lows in 2008, and how expanded Medicaid enrollment in Oregon has helped boost hospitals' bottom line even as many continue to expand to some assessors' dismay (Budnick, 7/5).

Los Angeles Times: An Autism Treatment Lost In California's Shift From Healthy Families
Evan Kim was 2 years old when he was diagnosed as autistic last year, and his parents searched for some way to curb his head-banging tantrums. Using a state-financed health care program for low-income families, they found therapists who could provide a specific kind of autism treatment aimed at analyzing and improving behavior. ... Evan's therapy was a casualty of the state's effort to phase out its Healthy Families insurance program and shift the nearly 900,000 children it covered into Medi-Cal, the broader health care program for the poor. Despite officials' assurances that the transition would not jeopardize services, activists say hundreds of children are losing coverage for applied behavior analysis (Megerian, 7/7).

Boston Globe: Surgical Errors Rise In Mass. Despite New Controls
Errors disclosed to state health officials since 2011 included anesthesia injected into the wrong leg, a guidewire left inside a patient’s vein, and a catheter threaded into a patient who didn’t need one, according to hospital safety leaders. Several of them said the reported number of such incidents is rising as more care shifts to outpatient clinics, procedure rooms, and physicians’ offices, where administrators and caregivers generally have been less vigilant about implementing safety protocols of the sort required in most hospital operating rooms (Kowalczyk, 7/7).

Sacramento Bee: California Midwives Push To Scrap Doctor-Supervision Requirement For Home Births
Tiny, 1-month old Aaliyah slept quietly in a rainbow sling around Adams' neck on a recent morning at the state Capitol. Around her, under a white tent erected against the sweltering July sun, dozens of children who had also been born at home scampered and dozed. Their parents had gathered in Sacramento to support a bill that would loosen restrictions on the midwives who had brought the assembled children into the world. … Midwives say current law does exactly that, denying insurance coverage and creating an untenable relationship with physicians (White, 7/8).

Oregonian: Medical Marijuana Bill Passes Oregon House, Now Goes To Governor
The Oregon House on Saturday passed a bill legalizing medical marijuana retail establishments, moving what has been a booming but legally hazy industry squarely into the mainstream and handing medical marijuana advocates a major victory. House Bill 3460, now headed to Gov. John Kitzhaber’s desk, creates a registry of businesses that sell the medical marijuana (Crombie, 7/6).

Kaiser Health News: A Busy ER Doctor Slows Down To Help Patients Cope With Pain
Alaska Public Radio's Annie Feidt, working in partnership with Kaiser Health News and NPR, reports: "Dr. Linda Smith walks into a room at Providence Alaska Medical Center, ready with a stethoscope and a huge grin. She teases her patient, Dawn Dillard, saying that her spiky hair recently resembled a 'faux hawk.' Dillardfound out she had uterine cancer a year ago. Her oncologist gave her a year to live. The 57-year-old has beaten those odds, but now her kidneys are failing. After the laughs are over, Smith sits down on the edge ofDillard's bed, leans in, and starts talking about a surgical procedure to help her kidneys" (Feidt, 7/5).

The Associated Press: Aging America: Home Repair For Health? Simple Fix-Ups May Keep Low-Income Seniors Independent
Alberta Hough struggles to feed herself a snack, her arms shaking badly from Parkinson's disease. Days earlier, the 84-year-old fell while eating, sliding off her kitchen chair. … Now a major research project will bring handymen, occupational therapists and nurses into the homes of 800 low-income seniors in Baltimore to test if some inexpensive fix-ups and strategies for daily living can keep them independent longer, and save millions in taxpayer dollars spent on nursing home care (Neergaard, 7/8).

Kansas Health Institute: Report: Two-Thirds Of KC Metro Residents Are ‘Medically Vulnerable’
Two-thirds of the residents in the region surrounding the Kansas City metropolitan area are part of at least one medically vulnerable population, according to a report issued this week by the REACH Healthcare Foundation. The "Kansas City Regional Health Assessment Report" is an analysis of data from an 11-county region that includes approximately 2 million residents on both sides of the Missouri-Kansas state line (Sherry, 7/5).

North Carolina Health News: What Regional Differences Mean To Cancer Survivors
Rural cancer patients often have a harder time dealing with a cancer diagnosis … and all of the issues following diagnosis and treatment. New research sheds a light on what it means to them (Hoban, 7/8).

Healthy Cal: Jails Look To ACA To Insure Inmates
When the signature reforms of the Affordable Care Act go into effect on January 1st, millions of Californians will have expanded access to government subsidized health care benefits. Counties, some of which saw their jail populations and health care costs swell since prison reforms took effect in 2011, want to make sure that jail inmates will be among the newly insured (Flynn, 7/7).

Minneapolis Star Tribune: Insurance Exchange Presents Technical Challenges On Tight Deadline
The no-frills space where high-tech wizards are building Minnesota's health insurance exchange looks like a war room for a political campaign. IT consultants work elbow to elbow around computers in a center island. Along one wall, stripes of blue tape and clusters of neon-colored notes demark key dates on the march to an unrelenting Oct. 1 launch date (Crosby, 7/7).

Des Moines Register: Hospitals To Screen All Infants For Heart Defects
All Iowa hospitals soon will be using a special screening to help detect critical congenital heart defects before newborns leave the hospital. Gov. Terry Branstad signed legislation that requires pulse oxi­metry screening into law last month (Villanueva-Whittman, 7/5).

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Public Health & Education

Providers Search For New Ways To Diagnose, Treat Mental Illness

Health care providers are trying to find tests and create new smartphone and tablet apps to better diagnose and treat mental illness.

NPR: Finding Simple Tests For Brain Disorders Turns Out To Be Complex
If you're having chest pain, your doctor can test you for a heart attack. If you're having hip pain, your doctor could test for osteoarthritis. But what if you're depressed? Or anxious? Currently there are no physical tests for most disorders that affect the mind. Lab tests like these could transform the field of mental illness. So far efforts to come up with biomarkers for common mental health disorders have proven largely fruitless. That doesn't stop people from trying (Standen, 7/8).

Boston Globe: Developers Creating Apps To Treat Mental Health Issues
Late at night, in the middle of a panic attack, 25-year-old Zoe Quinn used to get out of bed to play video games. By the light of her computer screen, she immersed herself in another universe, and her anxiety slipped away. Now, the Dorchester woman wants to make gaming for others what it was for her: a therapeutic, purposeful way out of dark times. Her passion makes her part of a growing movement among gamers and doctors alike to use the medium to educate the public and diagnose, and even treat depression or anxiety (Sathian, 7/8).

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Clinics Focus On Helping Pregnant Women Deal With Prescription Drug Addictions

The Wall Street Journal examines the growing number of women addicted to pain killers and efforts to help them through pregnancies.

The Wall Street Journal: Fighting Drug-Based Births
When Tara Lee Bailey, a longtime pain-pill addict, became pregnant last year, she tried to quit cold turkey. But she said the experience was so miserable—with vomiting, cold sweats and aching bones—that she went right back to using. Then she learned about a program at the new Maternal Addiction and Recovery Center at Marshall University's medical school here and signed up. It's one of a small but growing number of clinics for mothers-to-be cropping up around the country in response to the prescription-drug epidemic, which has triggered a rise of addicted mothers giving birth to drug-dependent babies. The clinics, which are typically free for patients, are often tied to university medical centers and funded through a combination of Medicaid, health insurance and grants (Campo-Flores, 7/5).

In other public health news, the New York Times reports on a fungal disease that has officials concerned.

The New York Times: A Disease Without A Cure Spreads Quietly In The West
Coccidioidomycosis, known as "cocci," is an insidious airborne fungal disease in which microscopic spores in the soil take flight on the wind or even a mild breeze to lodge in the moist habitat of the lungs and, in the most extreme instances, spread to the bones, the skin, the eyes or, in Mr. Klorman's case, the brain. The infection, which the Centers for Disease Control and Prevention has labeled "a silent epidemic," is striking more people each year, with more than 20,000 reported cases annually throughout the Southwest, especially in California and Arizona. Although most people exposed to the fungus do not fall ill, about 160 die from it each year, with thousands more facing years of disability and surgery (Brown, 7/4).

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Editorials and Opinions

Viewpoints: Health Care's Hidden Consensus; Examining The Fee-For-Service Payment System

The New York Times: A Hidden Consensus On Health Care
The politicians' consensus is that health care reform shouldn't alter or disrupt the way the majority of Americans get their insurance today. ... The policy consensus, though, is that the status quo is actually the problem, and that it deserves to be threatened, undermined and replaced as expeditiously as possible. Wonks of the left and right disagree on what that replacement should look like. But they're united in regarding employer-provided coverage as an unsustainable relic (Ross Douthat, 7/6).

The Wall Street Journal: Another Obamacare Tax That Is Bad for Your Health
On Jan. 1, manufacturers of medical devices in the U.S. were hit with a new 2.3% tax on revenue, one of the many sources of money tapped to pay for Obamacare. This tax will likely cut into the profits of large medical-device manufacturers, a cost that will almost certainly be passed on to health-care consumers. But its effect on U.S. medical-device startups—the small companies that fuel innovation—may prove devastating (Fred Burbank and Thomas J. Fogarty, 7/7). 

Los Angeles Times: An Obamacare Insurance Exchange Gap
Covered California, the state's new marketplace for health insurance policies, has positioned itself as a powerful advocate for consumers and small businesses. But in a disputed move, it threatens to raise costs for one group of Californians: parents of young children who aren't covered by group plans at work. Against the advice of lawmakers and regulators, the insurance exchange has barred policies that include both medical and pediatric dental coverage. As a result, parents could face not only higher monthly premiums but also larger deductibles. That's wrong, and the exchange should reverse its stance (7/5). 

USA Today: Fee-For-Service Rewards Volume: Our View
Much more pervasive are the unnecessary surgeries (and tests and other procedures) that occur every year because of the way most Americans and their insurers pay for health care. This fee-for-service model rewards volume rather than outcomes. The more procedures that physicians, hospitals and other providers perform, the more money they make. Ideally, doctors do no more than a patient needs. In practice, with incentives pointing exactly the wrong way, it's just too easy to do more, whether it's to pad a bill or simply to resolve a judgment call where surgery might not be the best answer (7/7).

USA Today: Fee-For-Service Isn't The Problem: Opposing View
A lot of people think the great problem in health care is that we pay doctors and hospitals on a fee-for-service basis. They reason that the payment system encourages these providers to perform too many services — the more they perform, the more money they make. ... But consumer-driven health care, in which consumers are responsible for the first few thousand dollars, has been reducing the rate of inflation of the entire health care system for the past 10 years. It can be, and is being, done (Greg Scandlen, 7/7). 

Boston Globe: Unverified Science
In the debate about the impact of drugs on health care costs, most people focus on the end of the spectrum that hits closer to home: rising drug prices. But we must also think of where it all begins, and of the hundreds of millions that are wasted on scientific research that is unreliable. The National Institutes of Health invests $31 billion a year in medical research, a significant portion of which goes to funding preclinical studies at academic centers across the nation. That work is supposed to be the cornerstone of drug discovery, since it is used by biotechnology and pharmaceutical companies to design the drugs of the future (Sylvia Westphal, 7/8).

St. Louis Post-Dispatch: Trying To Unravel The Mysteries Of Medical Billing
While my heart is strong, my memory is weak. How much did I pay in the past for stress tests? Certainly not $1,328. At any rate, I wrote about the bill. Medical costs seem to be skyrocketing. What’s going on? (Bill McClellan, 7/7).

JAMA: For Physicians, A Choice Between Health Care Rationing Or Delivering Health Care More Rationally
The most important health care news of the past year has been the slowdown in the growth of total health care spending. Before the slowdown was apparent, there were repeated calls for massive payment cuts in Medicare and Medicaid and angry debates about the affordability of universal health care. Slower cost growth has allowed even the government to relax a little bit (David Cutler, 7/3).

The Wall Street Journal: NBA With The Assist
Health and Human Services Secretary Kathleen Sebelius disclosed recently that the Administration wants the National Basketball Association and other major sports leagues to promote the Affordable Care Act. We weren't aware LeBron James specialized in public policy, but HHS seems to believe his interest should be shared by pro athletes in football, golf, hockey, NASCAR and the "variety of sports affiliates" with which Ms. Sebelius claims HHS is having "active discussions" (7/5).

The New York Times: Diagnosis: Insufficient Outrage
Recent revelations should lead those of us involved in America's health care system to ask a hard question about our business: At what point does it become a crime? ... Medical care is intended to help people, not enrich providers. But the way prices are rising, it's beginning to look less like help than like highway robbery. And the providers — hospitals, doctors, universities, pharmaceutical companies and device manufactures — are the ones benefiting (Dr. H. Gilbert Welch, 7/4).

USA Today: Retail Clinics Carry Benefits, Drawbacks
For retail clinics to be viable for primary care, they should not compete with doctors by siphoning off patients, but join local practices so that patient records can be easily shared and follow-up care coordinated. Patients should also have the explicit option to fill prescriptions at any pharmacy where prices might be cheaper. Until that ideal is realized, retail clinics are fine to treat your sore throat but should not substitute for your primary care provider (Kevin Pho, 7/3). 

The New York Times: The Gap In Medical Testing
An alarming number of diagnostic medical tests have never been tested for safety and accuracy. That's because the federal government has a two-tier system for regulating such tests. If a diagnostic test is made by a traditional device manufacturer, the Food and Drug Administration reviews its safety and effectiveness before approving it for marketing. However, if a test is developed by a clinical laboratory for use at its own facilities, it can be sold without a premarket review (7/7).

The New York Times: Painkiller Overdoses In Women
Every month the federal Centers for Disease Control and Prevention turns its spotlight on a public health problem that merits attention. This month the C.D.C. has focused on a problem that is rapidly getting worse: the rise of prescription painkiller overdoses, especially among women. Dr. Thomas Frieden, director of the C.D.C., said that women are dying from prescription painkillers at "rates that we have never seen before." He called it "a sleeper problem," underrecognized by doctors and patients (7/7). 

Los Angeles Times: Alluring But Risky Medicine
But alternative medicine shouldn't be given a free pass. Just because something sounds harmless doesn't mean that it is harmless. If we are to take our healthcare seriously, we should insist that alternative products — many of which are made by large pharmaceutical companies — be held to the same standards of safety and effectiveness as any licensed product. Unfortunately, because of the 1994 Dietary Supplement and Health Education Act, dietary supplements are not regulated by the Food and Drug Administration, so companies are under little obligation to support their claims or admit their harms (Paul A. Offit, 7/6).

Detroit Free Press: How You Vote To Expand Medicaid And Oppose Obamacare
Last month, the Michigan House passed a bill that will make key changes to Medicaid. The fate of the bill in the state Senate may still be in question, but the positive impacts of the reforms are not. House Bill 4714 will give more people health insurance, modernize our Medicaid program to produce better results and make significant long-term reforms to this outdated federal program, all at a lower cost to taxpayers than the status quo (Joe Haveman, 7/6).

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Delay Of Employer Mandate: 'Astonishing Decision;' 'No Bearing' On Much Of Health Law

Commentators both for and against the health overhaul offered assessments of the administration's move, and the politics that surround it.

The New York Times: Obama's Insurance Delay Won't Affect Many
On Tuesday, the White House announced that it would delay for another year one provision of the 2010 health care reform act. Larger employers will now have until 2015 before they will have to provide insurance or face penalties. The administration's explanation is that it is listening to businesses' concerns about getting their coverage ready in time, and trying to be flexible. But what people are really concerned about is whether this will make a difference in health care coverage and the progress of reform. The short answer is no (Ezekiel J. Emanuel, 7/3).

Politico: The Obamacare Mess
Washington is riven by conflict and deep-seated division. It is rare indeed that both sides can agree on anything consequential. Therefore it is incredibly heartening that there is now bipartisan agreement that the implementation of Obamacare is a mess. Republicans have long maintained this of the Affordable Care Act. But now the Obama administration has lent its implicit assent with its astonishing decision to delay by a year the law's employer mandate (Rich Lowry, 7/3).

The New York Times: Letting Employers Off the Hook, For Now
The Obama administration made a reasonable decision this week to give employers another year before they will be required to make available affordable insurance to their workers or pay a fine. Republicans are portraying the decision as evidence that the whole health care reform is headed for a train wreck, but it actually affects only a narrow slice of companies and workers. It should have no bearing on whether the core provisions of the Affordable Care Act — notably the opening of health care exchanges and subsidized coverage for people on modest incomes — take effect on Jan. 1, 2014, as scheduled (7/3).

The Wall Street Journal: Employer Mandate? Never Mind
These columns fought the Affordable Care Act from start to passage, and we'd now like to apologize to our readers. It turns out we weren't nearly critical enough. The law's implementation is turning into a fiasco for the ages, and this week's version is the lawless White House decision to delay the law's insurance mandate for businesses, though not for individuals (7/3).

The Wall Street Journal: ObamaCare's 'Liar' Subsidies
On the heels of last week's one-year suspension of the Affordable Care Act's employer mandate to offer insurance to workers, the Administration is now waiving a new batch of its own ObamaCare prescriptions. These disclosures arrived inside a 606-page catch-all final rule that the Health and Human Services Department published on July 5—a classic Friday news dump, with extra credit for the holiday weekend. HHS now says it will no longer attempt to verify individual eligibility for insurance subsidies and instead will rely on self-reporting, with minimal efforts to verify if the information consumers provide is accurate (7/7).

The Washington Post: The Real Hurdles In Obamacare
Whatever the reason, reports of the impending death of Obamacare have been greatly exaggerated. Indeed, reports that postponing the mandate demonstrate that the law is too unwieldy to work have been greatly exaggerated. Put another way, if you are a fan of the Affordable Care Act and worry about its implementation, or an enemy salivating at the prospect of its implosion, you should focus on other potential problem areas (Ruth Marcus, 7/4).

USA Today: ObamaCare Delay Hints At Deeper Troubles
This might just be what the White House says it is – a smart and needed pause to allow officials and businesses to refine complicated rules that govern how the mandate will work. And in at least one way it might be smart politics for Democrats. It buys temporary peace with businesses that deeply dislike the mandate and have threatened to slash workers or reduce them to part-time status to avoid the insurance requirement. The disruptive change will now kick in after next year's congressional elections. In another way, though, the delay is an indicator of deeper troubles that lie just ahead (7/3). 

Philly.com: Obamacare's Latest Delay May Not Mean Much
A key part of Obamacare will be delayed until 2015, putting it a year behind schedule. That is the provision penalizing large employers that don't offer health coverage to their workers. (Click here to read the administration's announcement.) The law's drafters included that provision to keep our current employer-based insurance system intact. They feared that companies might drop health benefits once health reform takes effect because the law enables their workers to find alternative coverage in the new insurance exchanges. They also wanted to encourage firms that offer no or limited policies, like some large retailers, to accept responsibility for their employees' health care (Robert Field, 7/8).

CNN: Obamacare Penalty Delay No Big Deal
Few laws can drive political discourse and posturing like the Affordable Care Act, otherwise known as Obamacare. The individual mandate was one of its most contentious aspects. Today, though, it's another mandate -- the employer penalty -- that is garnering headlines. The Obama administration announced it would delay the implementation of the employer penalty for a year, until 2015. This move is sure to please businesses that employ a large number of lower-wage employees who don't receive comprehensive health insurance. But it's also been met with other cries of dismay (Aaron Carroll, 7/7).

CNN: Obamacare Delay: Business Wins, The Rest Of Us Lose
As a rehabilitation physician, I've supported many of the ideas behind the Affordable Care Act since before Barack Obama's presidency began. During the hot summer of town hall debates surrounding the legislation in 2009, I wrote an essay called "Standing up for Obama's health plan," and I have continued highlighting the fundamental advances that all of us, most especially disabled Americans, stand to share under the ACA. But when the Obama administration decided last week to pull out a major pillar of the ACA, they lost my faith in their political wisdom (Ford Vox, 7/7).

Milwaukee Journal Sentinel: Delay Of Employer Mandate Need Not Delay Obamacare
In the face of enormous opposition from business groups, the president blinked last week: Barack Obama's administration delayed for a year a key provision of his signature health care effort — the rule requiring larger employers to provide coverage or pay a penalty. It was the right thing to do. Neither the government nor businesses appeared to be ready for implementation, so there is little harm in providing more time to get this right. Republicans see the decision as evidence that Obamacare is unworkable, but there isn't much to their partisan claims. The insurance exchanges where those without affordable insurance can buy policies are expected to open on time on Jan. 1; enrollment is expected to begin Oct. 1. The administration should make sure those deadlines are met (7/6).

The Hill: Hillary And Healthcare
As the chaos continues surrounding implementation of the new healthcare law, the 2014 election campaign begins and jockeying for the 2016 presidential campaign is underway, the two most intriguing political questions surrounding the healthcare law are these: First, how will Democrats running for the House and Senate in 2014 discuss healthcare during the campaign? (Brent Budowsky, 7/5).

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Exploring Abortion's 'Gray' Areas; The Importance Of Personal Experiences

News outlets offer opinion pieces on abortion policies.

The Washington Post: Abortion's Gray Areas
We have some models of what happens, even in very liberal societies, when public views prevail on abortion. Across most of Western Europe, abortion is legal during the first trimester but heavily restricted later in pregnancy — after the 14th week in France, Germany and Spain. These limits are not a violation of liberal principles but a recognition that the inherent violence of late-term abortion is at odds with liberal principles (Michael Gerson, 7/4).

The New York Times: My Mother's Abortion
Recently, I heard my mother reveal her experience to four friends who are devoted to protecting women's right to choose. Strikingly, two of them revealed that they had had an abortion, and the other two had close friends who’d had an abortion. None had told my mother before. What the movement for reproductive rights needs is for the faces of freedom to emerge from the captivity of shame. To my mother's generation, I ask: Speak openly about the choices you have made. To all women: ask your mothers, grandmothers, godmothers, aunts, sisters, daughters and partners about their reproductive histories. Show that abortion has myriad faces: those of women we love, respect and cherish. You have the power to cement in the minds of your communities and families the importance of reproductive freedom (Beth Matusoff Merfish, 7/7).

The Washington Post: North Carolina's Abortion-Law Sham
On Wednesday, just before the Fourth of July holiday, North Carolina Republicans added a slew of anti-abortion restrictions at the last minute to a bill otherwise concerned with banning Sharia law (already a questionable endeavor, but never mind that now). Following Virginia, whose General Assembly voted in 2011 to require abortion clinics to meet hospital — rather than doctor's office — standards, ostensibly in the name of safety, the North Carolina Senate joined a growing number of state legislatures mandating stricter standards for abortion clinics. Safety in abortion clinics is a legitimate concern, but these regulations probably will have little effect on patient safety (7/7).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.