Daily Health Policy Report

Monday, August 11, 2014

Last updated: Mon, Aug 11

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Veterans Health Care

Women's Health

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Washington's $10 Billion Search For Health Care's Next Big Ideas

Kaiser Health News staff writer Jay Hancock reports: “The Affordable Care Act was supposed to mend what President Barack Obama called a broken health care system, but its best-known programs — online insurance and expanded Medicaid for the poor — affect a relatively small portion of Americans. A federal office you’ve probably never heard of is supposed to fix health care for everybody else” (Hancock, 8/11). Read the story, which also appeared in The Washington Post.

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Capsules: If You Have A Stroke, Better It Should Be In Paris

Now on Kaiser Health News’ blog, Frank Browning writes: “I had a stroke last month, oh boy. It’s just that I didn't know it. Here’s what happened: Only after three days of flashing, floating visual squiggles — commonly known as ocular migraines that usually last 20 minutes — do I e-mail my old friend Dr. John Krakauer, who helps run stroke recovery at Johns Hopkins Hospital in Baltimore. After a few questions he told me to get an MRI scan as soon as possible. In the U.S. that could involve the emergency room (with its hours-long wait) or a complicated process of getting the referral — and then finding a radiologist who would take my coverage. Here, it is so much simpler” (Browning, 8/11). Check out what else is on the blog

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Political Cartoon: 'Mechanic Panic?'

Kaiser Health News provides a fresh take on health policy developments with "Mechanic Panic?" by Dave Granlund.

Meanwhile, here's today's haiku:

PUBLIC HEALTH COMMUNICATION

Papers scream our doom.
Ebola not in the states.
Calm Down! You are fine.
-Jacob Eckles

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

 

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Health Reform

Health Law Funds New Search For Health Care Improvements

News outlets report on aspects of the health law designed to foster and test innovation in the nation's health care delivery system.

Kaiser Health News: Washington's $10 Billion Search For Health Care's Next Big Ideas
The Affordable Care Act was supposed to mend what President Barack Obama called a broken health care system, but its best-known programs — online insurance and expanded Medicaid for the poor — affect a relatively small portion of Americans. A federal office you've probably never heard of is supposed to fix health care for everybody else (Hancock, 8/11). 

Chicago Tribune: Obamacare Law Funds Studies On Better Health Care
On a recent afternoon, Dr. Evan Lyon of the University of Chicago Hospitals ... set off to see a patient. Katie White, the patient, was not in a clinical setting but in the bedroom of her small South Side home, about 2 miles from the hospital. The 74-year-old greeted Lyon from a hospital bed that filled the small room — the bed to which she has been confined for a little over a year. "Glad you could make it," she said with a touch of attitude. White is participating in a clinical trial designed to test an old-new system of delivering health care: having the same doctor treat patients both in the hospital and elsewhere, including making house calls when necessary. The $6 million study is one of dozens of research projects made possible by the Affordable Care Act (Peres, 8/10).

Chicago Tribune: As Others Get Money, Hospitals Fear Cutbacks In Research Funding
Although the Affordable Care Act is directly funding a new variety of medical research, some experts fear the health overhaul also could cut into the money available to fund studies traditionally carried out at academic medical centers. Such institutions typically make money by treating privately insured patients in a fee-for-service environment where sophisticated, high-tech procedures carry hefty price tags. That money then can be used to cover the costs of publicly insured or uninsured patients as well as research projects. But that environment is changing, with a move toward capitated reimbursement systems or bundled payments. The act encourages doctors and hospitals to form networks that share financial and medical responsibility for providing care to patients, and the networks are rewarded when they provide that care more efficiently (Peres, 8/11).

Meanwhile, on another health law implementation issue -

Bloomberg: Freshway Contraceptive Coverage Bar Allowed By Court
Fresh Unlimited Inc. won't have to provide contraceptive coverage for its employees under the Obama administration’s health-care reform law, in what may be the first exemption granted since a June U.S. Supreme Court ruling. The parent of Freshway Foods today won an appeals court ruling that qualifies it for the same treatment the high court approved in its June 30 Hobby Lobby decision allowing family-run businesses to claim a religious exemption from the requirement to include contraceptives in their health insurance plans. The suit by Francis and Philip Gilardi, who own Sidney, Ohio-based Freshway, is one of about 50 filed by for-profit businesses over religious objections to the Patient Protection and Affordable Care Act of 2010’s birth-control coverage mandate. The Gilardis are Roman Catholic and said that complying with the U.S. Department of Health and Human Services mandate would require them to violate deeply held religious beliefs (Zajac, 8/8).

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Exchange News: Oracle Sues Ore. For $23M; Mass. Sticks With State-Run Website

Oracle Corp., the primary developer behind Oregon's dysfunctional health insurance website, sued Cover Oregon and accused Gov. John Kitzhaber of conducting a "smear campaign" against the company. Meanwhile, Massachusetts officials decided to replace that state's failed exchange with another from a private company, rather than shifting to the federal marketplace.

Los Angeles Times: Oracle Sues Oregon Over Botched Obamacare Exchange
The legal battle over Oregon's dysfunctional health insurance exchange officially began this week when Oracle Corp. sued the state agency operating the exchange, alleging breach of contract and accusing Gov. John Kitzhaber of attempting to systematically "vilify the company in the media." In a 21-page complaint filed Friday in federal court for the District of Oregon, Portland Division, Oracle charges that during the early months of this year, state officials privately continued to request Oracle's help to fix their system while engaging in a campaign of "constant public slander" against the tech company (Reston, 8/9).

The Associated Press: Oracle Sues Oregon Over Health Insurance Exchange
Oracle Corp. has sued the state of Oregon in a fight over the state's health insurance exchange, saying government officials are using the technology company's software despite $23 million in disputed bills. Oracle's breach-of-contract lawsuit against Cover Oregon was filed Friday in federal court in Portland. It alleges that state officials repeatedly promised to pay the company but have not done so (Cooper and Wozniacka, 8/8).

The Oregonian: Cover Oregon: Oracle Comes Out Swinging, Files Lawsuit, Accuses Kitzhaber Of 'Campaign'
Oracle Corp. launched a full frontal assault against the state of Oregon Friday when it sued Cover Oregon and accused Gov. John Kitzhaber of conducting a "smear campaign" against the company. Oracle essentially beat Oregon to the punch when it filed the breach of contract complaint in U.S. District Court of Oregon. Kitzhaber asked Oregon Attorney General Ellen Rosenblum 9 weeks ago to consider a suit against the technology company. Oracle was the state's lead contractor on its disastrous health-insurance exchange. In the complaint filed Friday, Oracle says the state's poor management doomed the exchange (Manning, 8/8).

The Oregonian: Oregon Faces Uphill Legal Battle Against Oracle Corp. Over Health Insurance Exchange Debacle
Even if Oracle Corp. lied about the quality of its software and its work for the Cover Oregon health insurance exchange, the state's lawyers face a tough challenge to recoup any of the $130 million paid to the firm, legal experts say. Attorney General Ellen Rosenblum has awarded a $2 million contract to an outside law firm and issued a number of investigative demands in advance of filing a lawsuit against Oracle, which could be imminent. State officials blame the California software giant for the state's health exchange fiasco that began last fall (Budnick, 8/8).

Bloomberg: Oracle Sues Oregon For $23M Over Health Exchange
Kitzhaber, a 67-year-old Democrat who has come under political attack on the issue as he seeks a fourth term, has been trading blame with Oracle over the failure to create a website that Oregonians could use to enroll in health coverage under President Barack Obama’s Affordable Care Act. Technical flaws in the Cover Oregon website, the portal to a $305 million state-run insurance exchange, caused thousands of consumers to file paper applications until the state gave up in April and directed enrollees to the federal website (Rosenblatt, 8/8).

The Wall Street Journal: Massachusetts To Replace Health Exchange With Privately Run System 
Massachusetts will replace its failed online health-insurance exchange with another from a private company rather than shifting to the federally run marketplace, a state health official said Friday. The state has been scrambling to replace the old system after a problem-plagued enrollment period late last year. In June, it cut ties with the system's architect, CGI Group Inc. (Kamp, 8/8).

WBUR: Mass. Pledges New State-Run Insurance Website Will Work
The decision is in: Massachusetts will go with a new state-run health insurance website. The Patrick administration revealed Friday that it is no longer building out the option of sending residents shopping for coverage to the federal health insurance site, HealthCare.gov. "We are poised to offer consumers a streamlined, single point-of-entry shopping experience for health care plans in time for fall 2014 Open Enrollment," Gov. Deval Patrick wrote in a letter to federal officials, dated Thursday (Bebinger, 8/8).

The Associated Press: Massachusetts Will Keep State-Based Health Website
Massachusetts officials overseeing the state's hobbled health care exchange decided Friday to stick with new software designed to upgrade the website rather than switching over to the federal government's health insurance market. For the past several months the state has adopted a "dual-track" approach that called for buying software that has powered insurance marketplaces in other states while also laying the groundwork for a switchover to the federal marketplace if necessary (LeBlanc, 8/8).

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Medicaid, CHIP Enrollments Top 7 Million

The Department of Health and Human Services reported Friday that 7.2 million people gained insurance through these programs since the health law's eligibility changes began last October. In addition, Arkansas and New Hampshire offer snapshots of their states' enrollment pictures, while Kansas and Missouri hospitals brace for the price of state decisions not to expand the low-income health insurance program.   

The Hill: Medicaid Enrollments Top 7M Under O-Care
Medicaid and CHIP sign-ups have exceeded 7 million since Obamacare's new coverage options opened for enrollment last October, the government reported Friday. The Department of Health and Human Services (HHS) announced that 7.2 million people have gained health insurance through Medicaid or the Children's Health Insurance Program (CHIP), both designed to serve families with lower incomes (Viebeck, 8/8).

Reuters: New Medicaid Enrollments Top 7 Million Under Obamacare
More than seven million Americans have gained health coverage through government programs including Medicaid since enrollment in Obamacare health insurance was launched Oct. 1, the U.S. administration said on Friday. The U.S. Department of Health and Human Services (HHS) said 7.2 million new participants in Medicaid and the Children's Health Insurance Program by June brought overall Medicaid enrollment to 66 million people. The enrollees include uninsured Americans who gained coverage through traditional Medicaid, as well as a special Medicaid expansion in 26 of the 50 U.S. states under President Barack Obama's Affordable Care Act (8/8).

The Associated Press: More Than 192,000 in Arkansas Signed Up For Medicaid
The Arkansas Department of Human Services says nearly 8,000 more Arkansans were approved for coverage under the state's expanded Medicaid program last month. That brings the total number to 192,210 signed up for the program. Arkansas' expanded Medicaid program was authorized by the 2010 federal healthcare overhaul law and approved by the Legislature last year (8/10).

Concord Monitor: About 8,200 Enrolled In Medicaid Expansion Since July
A month since applications for the New Hampshire Health Protection Program went live, it has attracted about one-sixth of the 50,000 people the state estimated would be eligible for expanded Medicaid benefits. So far, officials said they’re not worried about the pace of enrollment; they expect it to pick up in the months ahead as the department ramps up its outreach efforts (McDermott, 8/9).

Kansas Health Institute News Service: Rejection Of Medicaid Expansion Costing Kansas, Missouri Hospitals Billions
A new study by the Urban Institute says that not expanding Medicaid will cost hospitals in Kansas and Missouri more than $9 billion over a 10-year period. The analysis from the nonpartisan research organization pegs the loss to Kansas hospitals at $2.6 billion between 2013 and 2022. Missouri hospitals would forfeit $6.8 billion over the same period. Hospitals in the 24 states that have so far declined to expand Medicaid to cover more low-income adults would lose a combined total of $167.8 billion (McLean, 8/8).

Meanwhile, Medicaid expansion is a campaign issue in Florida and Virginia --   

The Associated Press: Medicaid Expansion Talk Key In Fla. Governors Race
Expanding Medicaid to an additional 1 million Floridians under President Barack Obama’s new health law is turning into one of the biggest issues of this year’s gubernatorial race. Former Gov. Charlie Crist brings up the topic on most campaign stops and says one of the first things he’ll do if elected is call a special session to expand Medicaid. His opponent, incumbent Republican Gov. Rick Scott, seems to be waning in his support. Scott says he’s open to taking roughly $51 billion over the next decade from the federal government, but only as long as Florida taxpayers aren’t left with the bill (Kennedy, 8/9).

Tampa Bay Times: Scott Affirms Support For Medicaid Expansion But Sticks To Pro-Business Principles On Health Policy
In an interview with the Times/[Miami] Herald Friday, Scott reaffirmed his support for Florida taking $51 billion in federal money to provide health insurance for up to 1 million poor Floridians. And he said he sees no contradiction in the positions he has taken. "While they spend 100 percent, I'm not going to stand in the way of the federal government doing something," he said. "What I'm not willing to do is put Florida taxpayers on the hook. … I've been very consistent and let's all remember that Obamacare is an absolute bad bill for patients, for families, for employers, for employees" (Mitchell, 8/8). 

The Associated Press: Crist Opponents Question His Political Conversion
Crist’s reputation for being a say-anything-for-a-vote politician isn’t new. … President Barack Obama’s health care overhaul: As a Republican Senate candidate in 2009, Crist said Obama’s plan was “cockamamie” and “nuts” and demanded its repeal; as a 2010 independent Senate candidate, Crist said there were positive things about the law and it should be fixed, not repealed; as a 2014 Democratic gubernatorial candidate, he says it’s “great” (8/10).

Bristol Herald Courier/Roanoke Times: Special Election Will Affect Debate Over Medicaid Expansion
Medicaid expansion continues to be a hot-button issue in the 38th District Virginia Senate race, as candidates try to define their positions on a subject that has divided the district -- and the state -- since the seat was vacated unexpectedly earlier this year. The June resignation of former Sen. Phillip Puckett, D-Russell County, threw the balanced Senate into Republican control and affected the Senate vote on whether to expand Medicaid. ... The resignation came just days before the General Assembly voted to pass the budget without Medicaid expansion. ... Now, as three candidates vie for Puckett’s seat in the Aug. 19 special election, the Medicaid expansion issue is still on the table (Gibson, 8/9). 

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Capitol Hill Watch

GOP Efforts To Become 'Party Of Yes' Will Likely Include 'Realistic' Proposals To Change The Health Law

In what is emerging as an aggressive strategy for Congressional Republicans, these proposals would likely follow an early and largely symbolic vote to repeal the overhaul. Meanwhile, much is at stake in state-level elections.

The New York Times: Uniting To Take Congress, G.O.P. Tries To Become The Party Of ‘Yes’ 
With control of Congress within reach, Republicans are quietly assembling an aggressive 2015 agenda built around a push for a balanced budget and quick passage of measures, like approval of the Keystone XL pipeline and repeal of a medical equipment tax, to show they can govern. ... Republicans say they would lay the procedural groundwork within the budget for more sweeping changes on taxes and in social programs such as Medicare and Medicaid by initiating an arcane budget process known as reconciliation. The procedure can protect legislation from a filibuster and its 60-vote threshold and reduce the need for Democratic support. ... Even as they talk about pragmatic achievable solutions, though, Republicans also say they are likely to take an early symbolic vote on repeal of the health care law, which would face a certain veto by Mr. Obama. After that showdown, Republicans say, they could move on to more realistic proposals and changes in the law (Hulse, 8/9).

The New York Times: Midterms Give Parties Chance For Sweeping Control Of States
Republicans are looking to take over senates in Colorado, Iowa, Oregon, Maine and Nevada, and houses in Kentucky, New Hampshire and West Virginia. Republicans could emerge with complete control of the legislatures in New Hampshire and Kentucky, though both of those states have Democratic governors. They hope these victories will help them push through legislation that has been stymied by Democrats until now, such as pressing the kind of restrictions on labor organizing the party passed in Wisconsin, or rolling back gun laws in Colorado. In Iowa, Republicans are looking to eliminate a tax on manufacturing and enact a ban there on telemedicine abortions, where women in rural areas obtain abortion pills after videoconference consultations with faraway doctors (Nagourney, 8/10). 

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Veterans Health Care

New VA Secretary Orders Independent Audit Of Scheduling Practices

Robert McDonald promised to fix problems at the Department of Veterans Affairs that kept veterans from getting care. His comments came in a speech to a Disabled American Veterans conference and after touring the Phoenix veterans hospital at the epicenter of the scandal that prompted a change in VA leadership and a major increase in funding from Congress.

The New York Times: New V.A. Chief Promises To Mend Practices
In his first public address since taking the helm of the embattled Department of Veterans Affairs, Secretary Robert A. McDonald vowed on Saturday to restore trust in the agency by initiating an independent audit of its scheduling practices and holding poorly performing officials accountable. Speaking to about 4,000 people at the Disabled American Veterans national conference [in Las Vegas], Mr. McDonald acknowledged systemic problems that have plagued the agency; attempts to "game the system" to hide problems; and a culture that failed to protect whistle-blowers who pointed them out (Curtis, 8/9).

The Wall Street Journal: New VA Secretary Seeks Independent Review Of Scheduling Practices
The Department of Veterans Affairs will launch an independent review of its scheduling practices beginning in the fall, the VA announced Friday. In one of his first major announcements as VA secretary, Robert McDonald said the Joint Commission, the largest health care accrediting body in the country, will a make a sweeping, independent review of the VA's scheduling practices (Kesling, 8/8).

The Associated Press: VA Chief Makes 1st Hospital Visit Amid Scandal
Veterans Affairs Secretary Robert McDonald visited a VA hospital [in Phoenix] Friday for the first time since taking over the embattled agency last month, meeting with veterans and health care providers and vowing to restore trust in the organization. Reports that dozens of people died while waiting to see a doctor and that employees covered up long wait times at the Phoenix VA hospital helped touch off a national firestorm over veteran care (Kashfi, 8/9).

The Hill: VA Chief Vows To Make Up For 'Failed Leadership'
McDonald, speaking to a Disabled American Veterans Conference in Las Vegas, said he would never underestimate the tough challenge in shoring up a department known for falling short in delivering care. ... McDonald, confirmed unanimously by the Senate last month, also noted that the VA hospital in Phoenix had been tagged as the "epicenter" of the department’s problems, even though those issues were widespread and systemic. McDonald visited the hospital this week in his first site visit since taking over the department's reins. "That's a bad reputation to have, and it’s going to take time and action to change it," he said (Becker, 8/9).

Texas Tribune: Doctors Laud Expansion Of VA Voucher Program
In light of whistle-blower claims that staff members at agency hospitals nationwide fudged records to make it appear that veterans were experiencing shorter waiting times, the system is expanding the voucher program as part of a major overhaul to help address the massive backlog. Doctors and patients in the (Rio Grande) Valley welcomed the additional resources, but they said the voucher program must be improved to maximize its effectiveness. Vouchers are a common form of currency for the 30,000 veterans who seek care in the VA Texas Valley Coastal Bend Health Care System, which includes the state’s 20 most southern counties. Many physicians said the process was marked by difficulties accessing patients’ medical records and collecting past-due payments (Rocha, 8/10).

Los Angeles Times: PTSD Continues To Afflict Vietnam Veterans 40 Years After The War
Four decades after the Vietnam War, 11% of its veterans still suffer from post-traumatic stress disorder, according to new research suggesting that for some people it is a condition unlikely to ever go away. The findings, presented Friday at a meeting of the American Psychological Assn., provide a rare look at the long-term course of PTSD in veterans. The research updates a landmark study conducted in the 1980s, when researchers found that 15% of Vietnam veterans had the disorder. Despite the passage of many years and the increasing availability of effective treatments for PTSD, the picture remains much the same (Zarembo, 8/8).

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Women's Health

Out-Of-State Clinic Key To Texas Abortion Law Battle

Challengers of a tough Texas law regulating abortion clinics argue that it would soon close El Paso’s sole abortion clinic. That, critics say, could leave women seeking abortions to drive 550 miles or else go to an out-of-state clinic where those state regulations do not apply, undermining the law’s patient-safety arguments and constituting an "undue burden" on women.

Texas Tribune: A New Test for Texas’ Abortion Restrictions
The latest legal challenge to Texas’ sweeping abortion measures went to trial in a federal courthouse in Austin last week, as federal judges around the country grapple with the question of how far states can go in regulating abortion -- a question that seems likely to end up in the U.S. Supreme Court. The crux of the matter is what the Supreme Court meant when it ruled in 1992 that abortion regulations may not impose an “undue burden” on women seeking an abortion. Some judges have held that as long as a law has a “rational basis” and does not prevent most women from getting an abortion, it does not impose an undue burden. But others have suggested that laws making abortions harder to get must have a good reason for doing so (Edelman, 8/11).

The New York Times: Out-of-State Clinic Is Central In Texas Abortion Law Fight
Of all the clinics and facilities at the center of a federal lawsuit challenging Texas’ sweeping abortion law passed last year, one has stuck out. It is not in Texas, but about a mile across the state line in Santa Teresa, N.M. Its role in the case gets to the heart of the legal questions swirling around the trial here this week. The law will soon force El Paso’s sole abortion clinic to shut its doors, leaving no abortion providers in all of West Texas. ... [T]he state’s reliance on the New Mexico clinic is being disparaged by the law’s critics, who say Texas’ use of an out-of-state clinic is contrary to a recent abortion ruling in Mississippi. And it remained unclear whether the Santa Teresa clinic meets the new standards Texas has mandated (Fernandez, 8/8).

The Washington Post: Admitting-Privileges Laws Have Created High Hurdle For Abortion Providers To Clear
Among the raft of abortion restrictions passed by states in the past few years, one did not initially gain much notice -- a requirement that doctors performing abortions obtain admitting privileges at a local hospital. But the measure, which 11 states have passed in some form, has proved an especially high hurdle for abortion providers to clear and a potent tool for antiabortion activists seeking to shut down abortion clinics (Somashekhar, 8/10). 

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Public Health & Education

Efforts To Treat, Contain Ebola Virus Trigger Policy, Ethical Questions

A push to fast-track an experimental treatment is gaining momentum, but questions persist about this serum's effectiveness, whether the drug should be brought to the places currently confronting outbreaks of the disease and who should have access to its limited supplies.

The New York Times: Ebola Drug Could Save A Few Lives. But Whose?
A history of controversy about drug testing in Africa is just one of the complexities facing public health authorities as they wrestle with whether and how to bring that drug and possibly other experimental ones to the countries afflicted with Ebola. Who should get such a scarce supply of medicine? Health workers? Children? The newly infected who are not yet as sick? There are virtually no remaining supplies of the drug, called ZMapp, that was used to treat the two Americans, United States officials say. And even a few months from now, according to various estimates, there may be no more than a few hundred doses (Pollack, 8/8).

The Hill: Obama’s Ebola Dilemma
The Obama administration is grappling with ethical questions over its response to an increasingly dire outbreak of the Ebola virus in West Africa. At the center of the debate is an experimental treatment given to two American Ebola patients that was facilitated in part by a U.S. government health worker. Calls are rising for health agencies to fast-track approval of the drug for use by African patients. But President Obama said that move would be “premature” given questions about the serum’s effectiveness (Viebeck, 8/9).

The New York Times: Fighting Deadly Diseases Without Breaking A Sweat
The diversity of infectious ailments in the city was part of what drew Dr. Phillips to New York. As a young epidemiologist, he dreamed of battling tuberculosis in Eastern Europe. Then he met Dr. Marcelle Layton, a city health official. She persuaded him to instead battle communicable diseases in the city as an epidemic intelligence service officer for the Centers for Disease Control assigned to the health department in 2000. “I get to eastern Brooklyn,” Dr. Phillips said. “It’s just as good.” Over the years, he has learned to expect the unexpected (Swarns, 8/10).

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State Watch

State Highlights: Mo. Drops Many From Medicaid; Mich. Medicaid Shift Savings

A selection of health policy stories from Texas, Missouri, Illinois, Michigan, Florida, Pennsylvania, North Carolina and Minnesota.

The Associated Press: Texas Sees Little Change Despite Insurance Gains
Harris Health System -- like other programs across the state -- hasn't enjoyed the expected savings from the Affordable Care Act because most of its 48,000 patients eligible for subsidized insurance instead chose to remain enrolled in the county's cheaper taxpayer-funded medical care. Now, public entities from Houston to El Paso are scrambling to tweak rules to make those who qualify for subsidized insurance ineligible for the local programs (8/9).

The Associated Press: Missouri Led Nation in Medicaid Roll Reductions
Missouri's Medicaid program is leading the nation in the number of people dropped from its rolls. New figures from the U.S. Department of Health and Human Services show that Missouri's Medicaid enrollment dropped by 37,260 people in June, compared with its average enrollment from July through September of last year. That was the largest numerical decrease of any state, though it ranked second behind Nebraska in terms of the percentage decline (8/11).

Detroit News: Medicaid Shift Could Save Michigan Prisons $19M
The Michigan Department of Corrections expects to save at least $19 million on health care next year by enrolling inmates and parolees in the state’s expanded Medicaid health care program. Corrections officials and experts argue that providing uninsured ex-cons with treatment for the mental illness, substance abuse and chronic health conditions that otherwise can lead them to commit crimes again could reap future savings in the state’s $2 billion-a-year corrections budget (Bouffard, 8/11).

USA Today: What Ails Appalachia Ails The Nation
Diabetes is slowly ravaging Alisha Blankenbeckler's body -- stealing her eyesight, impairing her kidneys and damaging her nerves so severely she can barely walk across a parking lot without help. And she's only 48. ... This week, U.S. Centers for Disease Control and Prevention Director Tom Frieden made a "house call" to find out more about the underlying causes of the region's ills and how to treat them — and in the process gain traction against the rising burden of chronic disease that ails the nation. … Appalachia, like some blighted urban areas and Native American reservations, mixes several ingredients of poor health: doctor shortages and access-to-care problems; stressful, unhealthy lifestyles; low education levels; and insidious poverty (Ungar, 8/8).

Chicago Tribune: Illinois Prison Hospice Offers Care, Redemption
Ralph Pollock, in the ninth year of a 25-year sentence for a drunken driving crash that killed two children, bent forward in his chair, rested the book on the bed in front of him and quietly read to a man lying under a blanket. Propped up against a pillow, his eyes closed, the man listened as Pollock read from "The Purpose Driven Life." Pollock, 55, is a volunteer in the hospice program for prisoners at Dixon Correctional Center, one of only about 20 prison hospices nationwide where the caregivers are inmates. Both patients and caregivers have been convicted of grievous crimes. But the hospice program is based on the belief that everyone deserves compassion as they are dying. And the program's supporters say inmates who extend that compassion as volunteers can be transformed. The infirmary where the dying receive hospice care is in the prison's health care unit (Brotman, 8/11).

Health News Florida: No Documents? No Problem Here
The dirt road and lush tree canopy leading to the Catholic Charities medical clinic is in stark contrast to the bright lights surrounding the nearest hospital. Here, sirens would be drowned out by choruses of crickets and katydids. But this refurbished double-wide trailer off a rural highway in Dover is a medical refuge for some agricultural workers and their families. Dozens show up at the San Jose Mission medical clinic every Monday night, knowing Sister Sara Proctor and her team of volunteers won't ask for what they don't have: money or documentation. The Pew Research Center estimates that 825,000 immigrants in Florida today live here illegally. And regardless of any government policy or ongoing political debate, they sometimes get sick (Shedden, 8/8).

Philadelphia Inquirer: Health System Forms Preferred Provider Network For Nursing Homes To Decrease Readmissions
The handoff of patients from hospitals to nursing homes has taken on increased significance now that Medicare penalizes hospitals if too many patients are readmitted unnecessarily within 30 days of discharge. To help prevent a breakdown in that transition and to generally improve care for its patients, Virtua, which bills itself as South Jersey's biggest health system, has formed a preferred provider network for nursing homes and rehabilitation centers. The plan is part of an effort at Virtua to cast a wider net of care in the community it serves in preparation for a time when insurers will pay health systems for keeping people out of the hospital, not just for procedures and stays in the hospital. Starting about five months ago, Virtua signed contracts with 36 nursing-home operators in Burlington, Camden, Gloucester, and Mercer Counties. It's not meant to be an exclusive list. It includes 29 of the 46 nursing homes in Burlington, Camden, and Gloucester Counties, which is where most of Virtua's operations are located (Brubaker, 8/11).

Raleigh News & Observer: DHHS Doubles Money Paid In No-Bid Medicaid Contract 
In doubling a no-bid contract to $6.8 million, the state Department of Health and Human Services has turned over the financial management of North Carolina’s $13 billion Medicaid program to a Washington-area consulting firm. Recently released contract documents spell out how Alvarez & Marsal is running the day-to-day financial operations of Medicaid, developing budgets, managing cash and contracts, and preparing reports for the legislature and governor. In addition, the department has tapped the consulting firm to reorganize the entire Medicaid division (Neff, 8/9).

Minnesota Public Radio: Pharmacists Ready, Worry Over New Role: Medical Pot Dispenser
When medical cannabis becomes available next July, a pharmacist -- not your doctor -- will help you figure out your exact dosage. And that pharmacist will be one employed by the companies selected to manufacture the drug. Minnesota will be just the second state to use pharmacists to dispense medical cannabis. While some pharmacists say it makes sense to tap their expertise in handling medications, they also see many challenges in dispensing a drug that has a lot of variability and limited research to guide them (Benson, 8/10). 

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Editorials and Opinions

Viewpoints: The Doctor Is In -- At Walmart; A 'Hole' In The Halbig Strategy

Bloomberg: Welcome To Wal-Mart, The Doctor Will See You Now
Wal-Mart Stores Inc. wants to disrupt another mass market: health care. The company is piloting what it hopes will be a broad network of primary-care clinics. ... A doctor’s visit at one of its primary-care clinics costs just $40, in cash .... This model makes a lot of sense to me. Doctor’s offices are, as the Affordable Care Act’s designers frequently stressed, remarkably inefficient compared to most of the rest of the economy. There are a lot of efficiencies that can be brought to the market by a big company employing staff physicians and centrally coordinating things such as purchasing and information technology (Megan McArdle, 8/8).

Politico: Another Hole In The Halbig Verdict
It is no secret that the people bringing the challenge to the Obamacare subsidies in the Halbig and King cases ... are some of the same people who brought the 2012 constitutional challenge to the Affordable Care Act before the high court. ... What's less known, however, is that in the 2012 constitutional case, these same challengers filed briefs describing Obamacare to the court in precisely the way they now say the statute cannot possibly be read. ... the challengers' 2012 statements are relevant as a legal matter because what the government has to prove to win—as a matter of black-letter law under the Chevron doctrine -- is that the statute is ambiguous (Abbe R. Gluck, 8/10).

The New York Times: A Judge Rules For Alabama Women On Abortion
In large parts of the country, women's access to safe and legal abortion care is increasingly coming to depend on the willingness of judges to rigorously examine and reject new (and medically unnecessary) restrictions imposed by Republican legislatures (8/10). 

Los Angeles Times: The Latest To Play The 'Male War Against Women' Game
[E]very time the three female justices vote as a bloc to dissent against a majority opinion in which the five conservative justices vote as a bloc -- such as, oh, say, the contentious 5-4 Hobby Lobby decision of June 30 -- liberals play a game called the "Male War Against Women." ... The latest to play the game is none other than [Justice Ruth Bader] Ginsburg herself, author of a 35-page dissenting opinion in Hobby Lobby in which she maintained that the craft chain’s owners had “no constitutional right to foist [their religious beliefs on abortion] on the hundreds and hundreds of women" working for them (Charlotte Allen, 8/8).

The New York Times: Controlling The Ebola Epidemic
On Friday, the World Health Organization formally declared an international public health emergency in response to what its director general, Dr. Margaret Chan, called "the largest, most severe, most complex outbreak" of the deadly Ebola virus "in the nearly four-decade history of the disease." And what has the world done in those 40 years to defend against the disease? Not much. Apart from inflicting a staggering human toll, the spread of the Ebola virus in West Africa has laid bare how unprepared the United States and other advanced countries are to protect and treat thousands of Africans whose lives are threatened by an extremely dangerous virus for which there is no cure (8/10). 

The Wall Street Journal: Private Money Pays Off For Medicine
Twenty-six years ago, Ted Stanley found his son, Jonathan, in a straitjacket in a locked psychiatric ward in Manhattan's Bellevue Hospital. The college junior had torn frantically through city streets for three days, convinced that secret agents were chasing him. Diagnosed with severe bipolar disorder, Jonathan was successfully treated with lithium and went on to lead a normal life, becoming a lawyer and mental-health advocate. Most of the 13 million Americans currently suffering from severe mental illnesses are not as lucky in finding effective treatment (Eric S. Lander and Louis V. Gerstner Jr., 8/10). 

The New York Times' Upshot blog: Can Family Leave Policies Be Too Generous? It Seems So
When measured by who holds a job, American women are falling behind women in other developed countries. Yet the American women who are working tend to have more high-achieving careers. Within that paradox lies a puzzle about how to shape maternity leave. The United States is the only country besides Papua New Guinea that mandates maternity leave but does not require that it be paid. ... Economists say paid leave is essential to making it possible for women to work. Beyond benefiting babies and families, it helps the economy by increasing the chances that women continue to work, even years later. ... But it turns out that long paid leaves can also hold back women. Researchers are finding that even as family leave boosts labor force participation by women, it can have negative effects on their job opportunities (Claire Cain Miller, 8/9).

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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.