Daily Health Policy Report

Tuesday, July 9, 2013

Last updated: Tue, Jul 9

KHN Original Reporting & Guest Opinion

Health Reform

Coverage & Access

Administration News

Capitol Hill Watch

Health Spending And Fiscal Battles

Health Care Marketplace

Health Information Technology

State Watch

Public Health & Education

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Some Doctors Questioning Whether Shorter Shifts For Interns Are Endangering Patients

Sandra G. Boodman, writing for Kaiser Health News in collaboration with The Washington Post, reports: "These days, interns, as first-year residents fresh out of medical school are known, no longer face the punishing shifts Casoy endured just four years ago. In July 2011, after more than two decades of impassioned debate, the Accreditation Council for Graduate Medical Education (ACGME) reduced the maximum allowable shift for the least experienced doctors from 30 straight hours to 16. ... But as a new class of interns, who arrived July 1, begins treating patients in teaching hospitals around the country, a recent spate of studies questions whether the rules have made the situation worse" (Boodman, 7/9). Read the story.

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Insuring Your Health: In Addition To Premium Credits, Health Law Offers Some Consumers Help Paying Deductibles And Co-Pays

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "For the plans being sold through the online health insurance marketplaces next year, much of the discussion has been on tax credits that can reduce the monthly premium for people with incomes up to 400 percent of the federal poverty level ($94,200 for a family of four in 2013). But the Affordable Care Act also established another type of financial assistance for people who buy plans on the marketplaces, also known as exchanges. Cost-sharing subsidies can substantially reduce the deductibles, copayments, coinsurance and total out-of-pocket spending limits for people with incomes up to 250 percent of the federal poverty level" (Andrews, 7/9). Read the column.

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Health Exchange Pitch To Sports Fans Started In Fenway

Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: "It’s a Wednesday night in Boston, and Amy O’Leary is out at Fenway enjoying a Red Sox game and hoping for another year like 2007. That’s when the team won the World Series. ... It’s also the year that Massachusetts started requiring nearly all residents to have health insurance – and the Red Sox helped to get the word out about it. ... Now that other states are opening health insurance marketplaces, they’re trying the same strategy" (Whitney, 7/9). Read the story.

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Capsules: Researchers Look At Why Poor Patients Prefer Hospital Care

Now on Kaiser Health News blog, Ankita Rao looks at a study that explores where low-income patients seek health care: "Long wait times, jammed schedules, confusing insurance plans – there’s no shortage of obstacles between a patient and her doctor. That is, if she has a doctor. But a Health Affairs study published Monday says the barriers for poor people looking to get care are even higher, and it’s leading them away from preventive doctor visits and toward emergency rooms and costly, hospital-based care" (Rao, 7/8). Check out what else is on the blog.

 

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Political Cartoon: 'A Fixer-Upper?' By Dave Granlund

Kaiser Health News provides a fresh take on health policy developments with "A Fixer-Upper?" By Dave Granlund.

Meanwhile, here is today's health policy haiku:

FALL INTO THE GAP

National option,
the plan for filling the gaps,
with gaps of its own?

-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

Administration Defends Obamacare, Employer Mandate Delay Decision

The New York Times: Sebelius Defends Law And Zeal In Push To Insure Millions
[HHS Secretary Kathleen] Sebelius is on the defensive more than ever now that the White House has delayed a major provision of the law that requires larger employers to offer health insurance to full-time employees. Republicans say she has given a far too rosy picture of progress in carrying out the law. And they are demanding that she explain why people should be required to carry insurance next year if employers are not required to offer it. In her zeal to make the health care law work, Ms. Sebelius has tested the limits of her authority. After Congress refused to provide as much as she wanted for a nationwide campaign publicizing the new insurance options, she shuffled money between government accounts and sought cash from outside groups (Pear, 7/8).

The Hill: White House Downplays Delays
White House press secretary Jay Carney on Monday defended the administration's decision to delay Obamacare's employer mandate, and said the law's central pieces will take effect as planned. Carney said state-based insurance exchanges are set to launch "as advertised" by Oct. 1, despite delays implementing other provisions (Baker and Viebeck, 7/8).

National Journal: White House Has Known For Months Obamacare Implementation Wouldn’t Work
If you've been reading all the Obamacare stories lately, you might get the impression that the administration has just realized it will not be able to implement the massive health reform as designed. It has known for months (Sanger-Katz, 7/9).

The Associated Press: What Now? Q&A About Latest Snag In Health Care Law
Nothing's ever easy with President Barack Obama's health care law. The latest hitch gives employers an additional year before they must offer medical coverage to their workers or pay a fine (Cass, 7/9).

Related, earlier KHN story: FAQ: What Workers And Employers Need To Know About The Postponed Employer Mandate (7/3)

The Associated Press: A Break For Smokers? Glitch May Limit Penalties
Some smokers trying to get coverage next year under President Barack Obama's health care law may get a break from tobacco-use penalties that could have made their premiums unaffordable. The Obama administration — in yet another health care overhaul delay — has quietly notified insurers that a computer system glitch will limit penalties that the law says the companies may charge smokers. A fix will take at least a year to put in place (Alonso-Zaldivar, 7/9).

Related, earlier KHN stories: 
California Moves To Protect Smokers From Higher Obamacare Insurance Costs (O'Neill, 4/30).
Mass. Advocates Want To Snuff Out Higher Premiums For Smokers (Bebinger, 5/24).

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Sen. Hatch Questions Increase In Subsidy Costs

The Utah senator writes to President Barack Obama to ask why the administration's subsidy funding has risen. Meanwhile, KHN examines cost-sharing assistance available under the law.

Fox News: Cost Of Obamacare Subsidies Has Increased Dramatically, Critics Say
The cost of subsidies for those seeking government aid through Obamacare has increased dramatically, critics say – even before a single dollar has been collected. Republican Sen. Orrin Hatch of Utah wrote a letter to the administration asking why the president is already requesting 107 percent more than three years ago to pay for subsidies (Angle, 7/8).

Kaiser Health News: Insuring Your Health: In Addition To Premium Credits, Health Law Offers Some Consumers Help Paying Deductibles And Co-Pays
For the plans being sold through the online health insurance marketplaces next year, much of the discussion has been on tax credits that can reduce the monthly premium for people with incomes up to 400 percent of the federal poverty level ($94,200 for a family of four in 2013). But the Affordable Care Act also established another type of financial assistance for people who buy plans on the marketplaces, also known as exchanges. Cost-sharing subsidies can substantially reduce the deductibles, copayments, coinsurance and total out-of-pocket spending limits for people with incomes up to 250 percent of the federal poverty level (Andrews, 7/9).

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Study: Some Current Medicaid Enrollees May Not Qualify For Benefits

George Washington University researchers find that key preventive services included in the health law -- and slated for millions who will get coverage in the law's Medicaid expansion -- may not be extended to people already covered by Medicaid.

Politico: Study: Some On Medicaid Lose Out Under Obamacare
As millions of low-income adults gain access in just a few months to Medicaid coverage under Obamacare, those already in the program could be shut out of some of the key preventive services included in the law. And the new enrollees could have a hard time actually getting a doctor. Those are the findings of two Health Affairs studies published Monday (Millman, 7/8).

Bloomberg: Twist In U.S. Health Law May Create Two-Tiered Medicaid
Colonoscopies, diabetes screenings and other preventative services mandated by the U.S. health law may be offered only to new Medicaid program enrollees next year, leaving existing patients with second-tier care, a study found.  Excluding people already in the Medicaid program for the poor may penalize a population more prone to chronic conditions, researchers from George Washington University said in an article published today in the journal Health Affairs (Adams, 7/8).

Stateline: Current Medicaid Patients Miss Out On Better Preventive Care
A hallmark of President Obama’s health law is that it requires insurers to cover early detection and disease prevention services at no cost to the patient. The new preventive care guidelines are intended to improve overall health, reduce the number of preventable deaths and lower costs. But some of the nation’s unhealthiest people — 25 million low-income adults who already qualify for Medicaid — aren’t likely to receive those benefits, because the requirements in the Affordable Care Act pertain only to private insurers, Medicare and Medicaid expansion programs (Vestal, 7/8).

NBC News: Health Reform May Leave Big Gaps In Medicaid Coverage – For Some, Survey Finds
The healthcare reform law may be specific about what health insurers have to cover starting in 2014, but there's a group that's left out – people already covered by Medicaid in many states, researchers reported on Monday. Whether your Medicaid coverage will pay for basic preventive services such as colon cancer screening or vaccines depends on what state you live in, the team at George Washington University found (Fox, 7/8).

And in other Medicaid news -

CQ HealthBeat: Medicaid-CHIP-Exchange Rule Draws Concerns from Patient Advocates
A final health law regulation — dubbed by some the "cats and dogs" rule for its wide-ranging scope — is raising concerns among policy analysts over provisions relating to Medicaid, the Children’s Health Insurance Program, and insurance exchanges. The 606-page regulation punted on some matters that stakeholders were waiting for. The rule did not include a final word on a certified application counselor program in the new marketplaces, which will start to enroll consumers on Oct. 1. Other provisions that were not finalized include those affecting appeals processes in the new marketplaces and how they would be coordinated with Medicaid and the Children's Health Insurance Program, the simplification of Medicaid eligibility categories and other provisions affecting CHIP (Adams, 7/8).

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Exchanges: Vermont Announces Rates;Marketing Efforts Take Shape

The Associated Press: Vermont Announces Rates Under Health 'Exchange'
Vermont regulators on Monday announced monthly rates for health insurance to be sold under Vermont Health Connect, the health insurance exchange being set up to comply with the federal Affordable Care Act. Middle- and upper-class consumers who begin buying through Vermont Health Connect when it takes hold of Vermont's individual and small-group health insurance markets in January won't notice much difference in costs of insurance and benefits provided (Gram, 7/8).

Kaiser Health News: Health Exchange Pitch To Sports Fans Started In Fenway
It’s a Wednesday night in Boston, and Amy O’Leary is out at Fenway enjoying a Red Sox game and hoping for another year like 2007. That’s when the team won the World Series. ... It’s also the year that Massachusetts started requiring nearly all residents to have health insurance – and the Red Sox helped to get the word out about it. ... Now that other states are opening health insurance marketplaces, they’re trying the same strategy (Whitney, 7/9).

The Oregonian: Multimillion-Dollar Oregon Ad Campaign To Tout Health Insurance Marketplace
On Tuesday, a multimillion-dollar state ad campaign will break out across Oregon introducing people to something that's not even open yet: Cover Oregon, the state's new health insurance marketplace. ... Aside from its health-related slogan, the campaign goes conspicuously light on words like federal health reforms, insurance or the Affordable Care Act -- aka Obamacare. Instead, the ads describe Cover Oregon as "our healthcare marketplace." The idea is to avoid controversy and the polarized debate surrounding the federal law (Budnick, 7/8).

MPR News: Latinos Important To Success Of Obamacare In Minnesota
While Latinos comprise only about 5 percent of Minnesotans -- a small fraction of the state's population -- they are a big part of the uninsured population. ... That makes Latino communities a likely focus for efforts to reduce the number of Minnesotans lacking health coverage. ... [Eva Sanchez of Portico Healthnet] said health insurance itself can be a foreign concept for Latino immigrants, particularly if they grew up in a small town as she did. They often have no experience filling out health insurance forms, because where they lived there was no health insurance. Patients pay the doctor at the visit (Stawicki, 7/9).

Related, earlier KHN story: Latino Enrollment Key To Success Of Health Law Marketplaces (Gold, 6/25)

Meanwhile, the law's Medicaid expansion provision continues to draw attention. 

The Associated Press: Michigan GOP Leader Defends Medicaid Call
The leader of the Michigan Senate may press ahead in search of a Medicaid expansion plan to pass muster with fellow Republicans, but it's clear he doesn't appreciate how the governor called the Senate out for refusing to vote. If anything, Majority Leader Randy Richardville said, he saved Gov. Rick Snyder from a big defeat more than two weeks ago by not calling a vote on House legislation to expand eligibility for government-provided health insurance to 320,000 low-income adults in 2014 (Eggert, 7/8).

St. Louis Post-Dispatch: Medicaid Studies Kick Off With Marathon Hearings This Week
The battle lines were familiar Monday as a Missouri Senate committee kicked off an in-depth study of Medicaid, the health care program for the poor. While Democrats urged that Medicaid be expanded to cover the uninsured, Republicans said their top priority is overhauling the $9 billion system, to make it more cost-efficient and promote personal responsibility (Young, 7/9). 

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Rural Hospitals, Clinics At Center Of Obamacare Success Or Failure For Poor

A new hospital and network of rural health care clinics in Missouri highlight the challenges that Obamacare has in treating the nation's poor -- a key tenet of the health law.

St. Louis Post-Dispatch: Poplar Bluff's New Hospital Faces Tough Challenges 
Robotic surgery systems. High-tech diagnostic equipment. State-of-the-art birthing suites. Poplar Bluff Regional Medical Center, which opened earlier this year, was built at a cost of $173 million by its parent, for-profit Health Management Associates Inc. of Naples, Fla. But this jewel of a hospital on the edge of a faded factory town of 17,023 residents is only one link in the health care chain's efforts to serve the region's rural population. The hospital also operates seven family clinics in four counties of southeast Missouri. The Affordable Care Act’s success or failure will depend in large part on the efforts of rural hospitals such as Poplar Bluff to treat the poor (Doyle, 7/7).

St. Louis Post-Dispatch: Puxico Clinic Provides Care To A Farming Community's Poor 
[Dr. Angela] Patterson runs a family clinic in Puxico, population 861, where a small staff of physicians and nurses tend to patients who might otherwise not receive care. Their busy offices, located in the rear of a bank building, are cluttered with medical files, a refrigerator for lab tests, an X-ray machine, and supplies. "I've been to patients' homes. I've been to their Little League games. I know who’s getting married and divorced," said Patterson, a specialist in internal medicine, who grew up in the nearby town of Fisk in Butler County. Her father farmed; her mother taught school (Doyle, 7/7). 

In the meantime, total hospital outpatient spending by Medicare is forecast to increase next year by nearly 10 percent, a new rule released Monday says --

CQ HealthBeat: Payments For Hospital Outpatient Care Rise Under Proposed Rule
Total hospital outpatient payments under Medicare are projected to increase next year by nearly $4.4 billion, or 9.5 percent over 2013, under a proposed rule released late Monday. Payments for ambulatory surgical centers would rise by about $133 million, or 3.5 percent, in 2014. The proposed increase in payment rates for hospital outpatient departments is 1.8 percent (Adams, 7/8).

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Coverage & Access

One Woman Fails To Get Hospital Estimate Of Baby Delivery Bill

A New York Times reporter details her uninsured daughter's struggle to find out what she will have to pay when she gives birth.

The New York Times: What Does Birth Cost? Hard To Tell
We're continually told that when it comes to health care, we need to be savvy and shop around for the best prices. To that end, policy experts and politicians promote health care savings accounts, saying they make "health care consumers" (a k a patients) more conscious of prices, bringing down the cost of medical care. Here is what happened to my daughter, Therese Allison, when she tried to be just the sort of shrewd and informed patient that politicians should love (Kolata, 7/8).

Meanwhile, a new study examines coverage options and choices for low-income consumers.

Kaiser Health News: Capsules: Researchers Look At Why Poor Patients Prefer Hospital Care
Long wait times, jammed schedules, confusing insurance plans – there's no shortage of obstacles between a patient and her doctor. That is, if she has a doctor. But a Health Affairs study published Monday says the barriers for poor people looking to get care are even higher, and it's leading them away from preventive doctor visits and toward emergency rooms and costly, hospital-based care (Rao, 7/8).

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Administration News

Obama Touts Health Care In Government Technology Push

President Obama says government should do what his administration did with the new healthcare.gov and health insurance application -- make better use of technology to make government more efficient.

Los Angeles Times: Obama Urges Cabinet To Use Technology To Make Government Smarter
President Obama has told his staff to use all the technology at their disposal to make the federal government "smarter, quicker and more responsive" in his second term. ... Online shopping sites help users fill in some of their information so the consumer doesn't have to do so every time, Obama said. Government forms on the Web should do the same, he said. In addition, people applying for federal benefits should be able to track the status of their applications in real time, just as they can follow delivery of a package to their doorstep, he said. The Obama administration recently started HealthCare.gov, which orients consumers on how to use the Web-based exchanges that will sell insurance and allows side-by-side comparisons of plans. Obama noted that when the prototype of the insurance application came in at 21 pages, his team rejected it. "It's now three pages long," he said. If the innovations seem incremental, that's partly because Obama is resorting to changes he can make unilaterally, without the help of Congress (Parsons, 7/8).

And CNBC talks with Obama's chief technology officer about the efforts --

The New York Times/CNBC: 10 Questions For Obama’s Chief Technology Officer (Video)
Todd Park, a former Silicon Valley entrepreneur, serves as President Obama’s chief technology officer. His role has taken on heightened importance after several recent developments, including the implementation of the new health care law, efforts to reduce the backlog in Department of Veterans Affairs claims processing, and privacy issues raised by disclosures about data collection by the National Security Agency. Mr. Park spoke with John Harwood of The Times and CNBC at the White House as Mr. Obama publicly challenged his administration to improve the government’s innovation and efficiency in his second term (Harwood, 7/8).

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Capitol Hill Watch

With 2014 Budget Process Beginning, NIH Cuts Decried

Sen. Barbara A. Mikulski, D-Md., is joined by executives from the National Institutes of Health and Johns Hopkins to call for an end to sequestration cuts of medical research budgets.

Baltimore Sun: Federal Medical Research Cuts Decried At Hopkins
The head of the nation's medical research agency and leaders of Johns Hopkins hospital and medical school warned Monday that progress in fighting diseases could be slowed, jobs lost and scientists driven overseas unless across-the-board federal funding cuts are reversed. Dr. Francis Collins, director of the National Institutes of Health, joined Sen. Barbara A. Mikulski, Hopkins executives and a stroke survivor at Hopkins' Children's Center to appeal for restoration of $1.5 billion in NIH funding cuts as part of the budget "sequester" approved last winter by Congress (Wheeler, 7/8).

Medpage Today: Federal Research $$$ On Senate Agenda This Week
Advocates of robust funding for biomedical research have a busy week ahead of them in their efforts to restore the budget for the National Institutes of Health. Sen. Barbara Mikulski (D-Md.), chair of the powerful Senate Appropriations Committee, reiterated her feelings on restoring nearly $1.5 billion in automatic spending cuts the NIH suffered earlier this year as a result of the sequester on federal spending. … The move has been criticized because its across-the-board nature gives no discretion to traditionally bipartisan work like NIH research. The research agency went from more than $30 billion in annual funding to roughly $28.5 billion. The result: roughly 700 grants lost funding, [NIH Director Francis] Collins said Monday (Pittman, 7/8).

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Health Spending And Fiscal Battles

OMB Finds Deficit Shrinking But Poised To Rise Without Entitlement Fixes

The White House budget office expects the deficit to go down to $496 billion in 2018 before heading to $593 billion in 2022.

The New York Times: Projections Show U.S. Budget Deficit Will Shrink
The federal budget deficit will fall to $759 billion for the fiscal year that ends this September, a $214 billion improvement from the projection made in March, as spending cuts, tax increases and an improving economy begin to tame the government’s red ink, the White House budget office said on Monday. ... But absent structural changes to Medicare and Social Security, the forecast makes clear that such short-run improvements may not last. The White House projected the deficit to bottom out at $496 billion in 2018, then start ticking back up to $593 billion in 2022 (Weisman, 7/8).

The Washington Post: OMB Shrinks Its Budget Deficit Forecast
Sen. Jeff Sessions (Ala.), the top Republican on the Senate Budget Committee, said the budget projections were worrisome. "Ominously, the president provides no serious proposal for strengthening and preserving our unsustainable Medicare and Social Security programs," he said in a statement. "The president's plan is simply to tax more in order to spend more: avoiding any attempt at reducing the waste and inefficiency that plagues the federal budget" (Goldfarb, 7/8).

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Health Care Marketplace

Doctors Weigh Changes In Intern Hours, Role With Patients, Pay Models

Many changes in the way America's doctors deliver care are challenging long-held notions of how health care functions for patients.

Kaiser Health News: Some Doctors Questioning Whether Shorter Shifts For Interns Are Endangering Patients
These days, interns, as first-year residents fresh out of medical school are known, no longer face the punishing shifts Casoy endured just four years ago. In July 2011, after more than two decades of impassioned debate, the Accreditation Council for Graduate Medical Education (ACGME) reduced the maximum allowable shift for the least experienced doctors from 30 straight hours to 16. ... But as a new class of interns, who arrived July 1, begins treating patients in teaching hospitals around the country, a recent spate of studies questions whether the rules have made the situation worse (Boodman, 7/9).

In the meantime, a study looks at doctors' roles in coordinating care and the savings that it could bring --

Detroit Free Press: Blue Cross Study: 1 Doctor Overseeing Care Better For Health, Cuts Costs
A single doctor overseeing your care not only improves your health, it shrinks the cost of maintaining it, according to a new study based on the actual cases by Blue Cross Blue Shield of Michigan doctors. The study found adult patients who belong to a Patient Centered Medical Home (PCMH) saved an average of $26.37 a month per person, or an estimated $155 million collectively over the first three years, according to the study published this month in the journal, Health Services Research (Erb, 7/8).

And doctors report difficulties with new payment methods --

Medpage Today: Group Practices Struggle With New Pay Models
Collaborating with payers to implement new payment models was an intense challenge this year, according to a survey of 1,067 group practice executives. In fact, preparing for different reimbursement models was executives' second-biggest concern, behind rising operating costs, a survey of members of the Medical Group Management Association (MGMA) -- American College of Medical Practice Executives (ACMPE) showed (Pittman, 7/8).

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Health Information Technology

Study: Popular Search Engines Share Search Data About Medical Conditions

Researchers find that popular websites share search data with advertisers and other third parties.

Politico: Health Sites May Be Sharing Search Terms
The National Security Agency is tracking your phone calls. And online snoops may be keeping tabs on your Internet health searches, too. And that includes use of terms such as "depression" or "herpes." A research letter published Monday by JAMA Internal Medicine found that seven of 20 widely used health websites are passing on users' searches to third parties. Those sending the information along include widely used free commercial websites like Health.com and Drugs.com, as well as popular news sites like The New York Times and Men's Health Magazine (Norman, 7/8).

Reuters: Some Health Websites Share User Search Terms: Study
Some health media websites share users' search terms with outside companies that track consumers and target advertising, according to a new study. Dr. Marco Huesch, from the University of Southern California in Los Angeles, used interception software and found seven out of 20 popular health sites passed search information to third parties (Pittman, 7/8).

Also, adoption of electronic health records is on the rise, but they may not always improve efficiency or quality --

Los Angeles Times: More Doctors, Hospitals Use Electronic Over Paper Medical Records
Hospitals are increasingly switching from paper to electronic medical records but aren’t necessarily using them to improve the quality or efficiency of care, according to a new report by the Robert Wood Johnson Foundation. Forty-four percent of hospitals had basic electronic health records in 2012, up from 27 percent the previous year, according to the report. Overall, the number of hospitals using such medical records has tripled since 2010. Some of the biggest jumps occurred in rural hospitals, which increased from 1 in 10 in 2010 to 1 in 3 in 2012 (Gorman, 7/8).

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State Watch

Judge Blocks New Wis. Abortion Law; Texas Rallies Draw Thousands

Milwaukee Journal Sentinel: Judge Delays Enforcement Of Wisconsin Abortion Law
After a hastily called hearing, a federal judge Monday put a 10-day freeze on a new state law requiring doctors who perform abortions to have hospital-admitting privileges. In a 19-page opinion issued Monday evening, U.S. District Judge William M. Conley cited a "troubling lack of justification" for the law and said he would stay enforcement of the admissions provision until July 18, a day after a more deliberate courtroom hearing scheduled before him next week. … Conley's ruling does not affect a separate provision of the new law requiring women to undergo an ultrasound before having an abortion (Stein, 7/9). 

The Associated Press: Judge Blocks New Wisconsin Abortion Law
Conley granted the order following a hearing in a lawsuit filed Friday by Planned Parenthood of Wisconsin and Affiliated Medical Services. It alleged the requirement would unconstitutionally restrict the availability of abortions in the state, violates the U.S. Constitution's due process guarantee and unconstitutionally treats doctors who perform abortions differently from those who perform other procedures. The restraining order will remain in place pending a fuller hearing July 17 (Bauer, 7/8).

The Associated Press: Thousands Flock To Texas Capitol Over Abortion
Texas Republicans pushed ahead Monday with aggressive efforts to pass tough new abortion restrictions they failed to approve last month, scheduling a House vote as thousands flocked to the Capitol for an anti-abortion rally and a marathon public hearing about the legislation. Activists for and against the proposed restrictions descended on the Capitol for the hearing that started at 10 a.m., wearing their signature colors. About 2,000 anti-abortion demonstrators in blue staged a Capitol evening rally that heavily invoked God and Biblical teachings (Vertuno, 7/8).

Texas Tribune: Activists Rally To Speak On Abortion Bills
"Tonight, it's not so much that the eyes of Texas are upon you," [Former Arkansas Gov. Mike] Huckabee told the crowd, which was dressed in blue. "It's that the eyes of America are on Texas." ... If passed, the legislation would ban abortions at 20 weeks post-fertilization, require physicians performing abortions to have admitting privileges at nearby hospitals, make abortion facilities meet the same standards as ambulatory surgical centers and impose new regulations on the administration of abortion-inducing drugs (Luthra, 7/8).

Dallas Morning News: Hundreds Testify For, Against Sweeping Abortion Bill, As Sides Rally At Texas Capitol
The battle over the measure has drawn national attention as the latest front in the war over the divisive social issue. ... Earlier, at a hearing before the Senate Health and Human Services Committee, Democrats sharply questioned the Republican author of the measure on its key provisions. They argued that his primary goal is to restrict access to abortions in Texas. Sen. Glenn Hegar, R-Katy, insisted he’s trying to protect the health of women seeking an abortion (Stutz, 7/8).

North Carolina Health News: Opposition To Recent Abortion Bill Drives Many Protestors
In what was probably the largest Monday protest yet at the General Assembly, two thousand or more people gathered to express their grievances with the legislature. And many said they were there because of an abortion bill passed by the Senate last week (Hoban, 7/9).

PBS NewsHour: New Abortion Restrictions Reignite Culture Wars
States across the country are advancing legislation that advocates say restrict abortions, a re-ignition of the culture wars ahead of the midterm elections and key gubernatorial contests in 2014. The movement is something that's been slowly building at the state level for years, beginning when Republicans captured larger majorities in legislatures as part of the 2010 tea party wave that returned them to control of the House (Bellantoni and Burlij, 7/8).

Bloomberg: Abortion Foes Guide States In Pushing New Restrictions
When Bette Grande, a state representative in Fargo, North Dakota, wanted to make it illegal for a woman to end a pregnancy after learning her unborn child would suffer from Down syndrome or another chromosomal abnormality, she turned to a trusted source [Americans United for Life]. ... So far in 2013, 17 states have enacted 45 new curbs on abortion. In addition to providing legislative language and data, the group created a state ranking system to stoke an anti-abortion arms race of sorts (Hirschfeld Davis, 7/9).

Politico: Marco Rubio In Tough Spot On Abortion
Urged by anti-abortion rights groups and Republican lawmakers to take up their cause, [Sen. Marco Rubio, R-Fla.] is mulling over introducing legislation to ban abortions after 20 weeks nationally — just a few days after he helped pass a comprehensive immigration bill that created waves among conservatives. But there’s one major difference between the star Republican’s lead role on immigration and his potential abortion action. The abortion bill is most likely going nowhere in the Senate (Everett, 7/8).

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State Highlights: Mass. Bill Would Pay Spouses For Providing Care; Ore. Lawmakers Pass Midwife Regulations

WBUR: Bill Would Allow Spouses To Qualify For Personal Care Pay
If your spouse were disabled, or had a debilitating disease such as Alzheimer's, would you want to be paid to care for them at home? Under state law, residents who qualify for MassHealth benefits can hire a personal care attendant, or PCA, to help with daily tasks. They can choose a stranger, a sister, an uncle or most any other family member, but not their spouse. A bill in the Legislature would change that (Bever, 7/9).

The Lund Report: Lawmakers Regulate Midwives, Pot Dispensaries, Community Health Workers; Launch Health Care Study
The Legislature cleared through dozens of bills on Saturday, including a study of universal health care and the regulation of midwives, marijuana dispensaries and traditional health workers as lawmakers moved to close the session (Gray 7/8).

Boston Globe: State Board Gave Reprieve To Webster Pharmacy
Just months before a meningitis outbreak exposed major holes in the state’s oversight of pharmacies, regulators abandoned a plan to shut down a Massachusetts pharmacy whose medication error sent a teenager to the emergency room with a heart attack. They have yet to discipline the company for the mistake (Wallack, 7/9). 

California Healthline: Sorting Out The Dozens Of Health Care Bills That Passed And Failed This Year
Two high-profile legislative movements died in committee and now are in legislative limbo at least until the fall session. The first involved an attempt to eliminate all or part of the 10 percent Medi-Cal provider reimbursement rate that the Legislature imposed in 2011. The move had both Democratic and Republican support -- in fact, prior to hitting Appropriations in their house of origin, all of the committee votes were unanimous for AB 900 … The second major legislative push of the just-ended session was to expand scope of practice for non-physician practitioners -- physician assistants, nurse practitioners, nurse midwives, optometrists and pharmacists. Those efforts took the form of four different bills, and none of them passed this session (Gorn, 7/8).

Health Policy Solutions (a Colo. news service): Collaboration Targets Reducing Hospital Readmissions
It's much easier to develop innovative health care initiatives in Colorado because "we're not having the conversation about who’s the biggest Bolshevik," said U.S. Sen. Michael Bennet at the opening of the Healthy Transitions Colorado collaborative Monday. The goal of the collaborative over the next few years is to save $80 million in health care costs, prevent 8,700 hospital re-admissions and keep people out of the hospital a cumulative 34,000 days, Bennet said, all the while providing “greater care for the people you serve and the people I serve” (Carman, 7/8).

The Lund Report: DHS Budget Bolsters Child Welfare, Person-Centered Care
The new budget for the Department of Human Services provides a windfall of funding for child welfare and helps further advance Oregon's lead in directing care to the state's elderly and people with disabilities through their homes and in their communities. The Senate approved the $9.1 billion budget 23-7 on Wednesday and the House followed suit with a special Saturday session on a 38-21 vote as the Legislature worked to wind up its work this summer, having blown its traditional July 4 deadline to adjourn (Gray, 7/8).

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Public Health & Education

Americans Live Longer, But May Be More Prone To Disability That Hinders Independence

New studies this week suggest that more Americans will suffer a disability that threatens their independence near the end of their lives.

Los Angeles Times: A Downside Of Living Longer: Oldest Often Disabled In Last Months
Don't expect old age to be all golf and cruises: As Americans live longer and longer, more of us should expect to suffer some sort of independence-threatening disability in the final phase of life, two new studies published online Monday suggest (Brown, 7/8).

And public health evidence for public smoking bans may be thinner than touted --

PBS NewsHour: The Real Reason Behind Public Smoking Bans
Summer has officially begun and for many, it's time for sun, sand and swimming. But don't count on lighting up a cigarette while you're at the beach. Over the last few years, you may have noticed more "no smoking" signs have cropped up on parks and beaches. They're part of a larger trend banning smoking at outside, public areas. In fact, smoking has been banned in 843 parks and more than 150 beaches in the last two decades. … Public health officials have long argued the bans are meant to eliminate dangers from secondhand, or "sidestream smoke," reduce the environmental impact of cigarette butts and to keep young, impressionable children from picking up on bad habits. Makes sense, right? But a new article in this month's Health Affairs looks at the shockingly slim evidence behind these bans (Clune, 7/8). 

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Editorials and Opinions

Viewpoints: Employer Mandate: Suspension Of Law Or Bump In Road?

Columnists and editorial boards examine the implications of the postponed employer mandate deadline.

Chicago Tribune: It's Obvious: Dump Obamacare 
In a nutshell, the administration could not figure out how to make sure that businesses with more than 50 full-time employees are providing a minimum level of health insurance. So the administration decided to violate the law by putting off the requirement until 2015, instead of next year. Why? Because the administration couldn't come up with a workable, straightforward, timely and affordable way for companies to report whether they were complying with the law (Dennis Byrne, 7/9).

The Wall Street Journal: Obama Suspends The Law 
President Obama's decision last week to suspend the employer mandate of the Affordable Care Act may be welcome relief to businesses affected by this provision, but it raises grave concerns about his understanding of the role of the executive in our system of government. ... The employer mandate in the Affordable Care Act contains no provision allowing the president to suspend, delay or repeal it (Michael McConnell, 7/8).

Sacramento Bee: Bump In The Road For Health Reform But Not A Detour
Of 210,000 businesses in the United States with more than 50 employees, only 10,000 don't offer coverage. Should they be let off the hook? On the other hand, many observers believe that, over the long run, we'd be better off with a system in which people could buy insurance on their own – with a menu of choices in the state exchange and continuing coverage as they change jobs – rather than obtaining insurance through an employer. ... A one-year delay on the large-business requirement is a bump in the road, not a detour down a wrong path (7/9).

The Washington Post: Everyone Now Agrees: Obamacare Can't Be Implemented
If the president wants “fixes,” let him spell them out. And Republicans should get off their duffs and come up with their proposal to replace Obamacare. Since everyone agrees the current law is unworkable, the entire measure should be held in abeyance until the president and Congress can revamp the legislation to meet the president’s original promises — it doesn’t add a dime to the deficit, allows Americans to keep their insurance, and expands affordable coverage. The current version doesn’t do that (Jennifer Rubin, 7/8).

The Washington Post: Obamacare Just Got Easier To Implement, Not Harder 
[T]he thinking among health-care experts is closer to the precise opposite of [Jennifer] Rubin’s bombastic headline: The Obama administration has decided to accept some bad media coverage now, and some higher costs later, in order to make Obamacare much, much simpler to implement next year (Ezra Klein, 7/8).

Baltimore Sun: Obamacare On The Ballot Is Bad News For The President
The political football of health insurance, supposedly taken off the playing field in 2012 by the Supreme Court decision declaring the Patient Protection and Affordable Care Act constitutional, is being kicked around again. ... As voters contemplate the future of Congress in the 2014 midterms, the president can't afford to have Obamacare revived as a central issue if he hopes to complete his presidency with Capitol Hill in more cooperative hands (Jules Witcover, 7/8).

The Washington Post: The Insiders: Obamacare And The Growth Of Part-Time Jobs 
The number of part-time employees is now at an all-time high of more than 8.2 million. To put that number into perspective, that’s equal to the entire population of the state of Virginia. It appears that employers were already preparing for Obamacare by working to reduce the number of full-time employees they would have had to buy health-care insurance for. Maybe the White House knew for certain what the rest of us just suspected, or the administration had a sneak peek at the June data and realized that the need to delay the Obamacare employer mandate was urgent (Ed Rogers, 7/8).

Some news outlets had opinions on other issues - 

Los Angeles Times: Night Terrors Of The Uninsured 
So I'm out of work. Again. And because healthcare in this country is tied to employment, we are out of luck. Again. I had cancer. My daughter was hit by a car and got a concussion and a fractured ankle. I know bad things can happen to me, to my family. We have to have health insurance. And we have to pay for it ourselves. And that keeps me up at night. I was excited when the Affordable Care Act was introduced. ... It's a step in the right direction, but for people like my husband and me, who make a pretty good income, it's unlikely to give us any kind of break. We'll still have to pay for our insurance entirely ourselves, and I'm not optimistic the price will go down (Diana Wagman, 7/6).

Health Policy Solutions (a Colo. news service): Who Is To Blame For Rising Health Costs?
Employer passivity has supported an opaque and chaotic pricing system, inappropriate incentives, rampant medical inflation, waste and lagging quality. Employers pay the largest portion of the ever-increasing premiums, and forgo profits. Consumers fund much of the waste through increased prices, and employees pay the rest through lost pay raises as dollars are diverted in inefficient delivery systems (Robert Smith, 7/8).

Los Angeles Times: Catholic Bishops Cry Wolf 
[T]he health insurance rules draw a distinction between churches and other houses of worship, which are totally exempt from the contraceptive mandate, and religiously affiliated schools and charities that serve and employ people of all faiths. Even then, the administration has taken pains to spare the latter from directly paying for contraceptive services. Instead, employees will receive contraception coverage from an insurance company or, if the employer is self-insured, from a third-party administrator. That's a fair concession (7/8). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

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