Daily Health Policy Report

Monday, August 12, 2013

Last updated: Mon, Aug 12

KHN Original Reporting & Guest Opinion

Health Reform

Women's Health

Health Care Marketplace

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

In States That Don't Expand Medicaid, Some Of The Uninsured May Still Get Help

Kaiser Health News staff writer Phil Galewitz reports: "Some of the millions of poor people expected to lose out on Obamacare coverage next year because their states are not expanding Medicaid might have a way to get help, but the strategy carries risk. Experts say the key is for them to project their 2014 income to at least the federal poverty level, about $11,500 per person or $23,500 for a family of four" (Galewitz, 8/11). Read the story.

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Capsules: More High-Deductible Plan Members Can't Pay Hospital Bills

Now on Kaiser Health News' blog, Jay Hancock writes: "As employers and insurance companies shift more health costs into workers’ pockets, hospitals are making a discovery. The pockets aren't bottomless" (Hancock, 8/12). Check out what else is on the blog.

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Political Cartoon: 'Here Goes The Funny Bone?'

Kaiser Health News provides a fresh take on health policy developments with "Here Goes The Funny Bone?" by Gary Varvel.


Obama asks vets 
to speak up for the health law--
saying it won't hurt.

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

Obama's Health Law Promises Put To The Test

The Hill checks up on five health law promises from the president as implementation continues. Meanwhile, Kaiser Health News examines how some low-income people might gain insurance if their state doesn't expand its Medicaid program, but the strategy will carry risks. 

The Hill: ObamaCare Vows Met And Unmet
President Obama's promises about healthcare reform are being put to the test. Both the president and congressional Democrats made a number of pledges about the healthcare law when building support for passage in 2009 and 2010 (Baker and Viebeck, 8/12).

Kaiser Health News: In States That Don't Expand Medicaid, Some Of The Uninsured May Still Get Help
Some of the millions of poor people expected to lose out on Obamacare coverage next year because their states are not expanding Medicaid might have a way to get help, but the strategy carries risk. Experts say the key is for them to project their 2014 income to at least the federal poverty level, about $11,500 per person or $23,500 for a family of four (Galewitz, 8/11).

Meanwhile, in the background -

The Wall Street Journal: Lost Amid Health Policies
People can only handle so much complexity. And few things in life seem more complex than the American health-care system. How complex? A new paper suggests that even those who have health insurance have a poor understanding of their coverage. Researchers commissioned two surveys of covered Americans and found that only 14% could explain all four key health insurance concepts: deductible, copay, coinsurance and out-of-pocket maximum. Only 11%, given all the necessary information, could calculate the cost of a four-day hospital stay to within $1,000 (Akst, 8/9).

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State Health Insurance Marketplaces Progress With Fits And Starts

The Washington Post reports on tools that will be available to residents in D.C., Maryland and Virginia to help them get up to speed on the health law, and The Associated Press details how some insurers are opening retail stores to help educate potential consumers about the health law. Other news outlets report on the latest developments in Georgia, Oregon, California, Idaho, Pennsylvania, New Jersey and Minnesota.

The Washington Post: Uninsured Will See Differing Levels Of Help For Obamacare In Maryland, Virginia, D.C.
Maryland consumers who want to buy health insurance under Obamacare in the fall will be able to read glossy fact sheets that spell out the law in simple language. Or talk to one of 325 specially trained workers who will explain the intricacies and help them enroll. Or get information via Facebook, Twitter and YouTube. In Virginia, it's a different story. People can seek assistance from about two dozen special guides. Or they can go to their state legislators, who might refer them to phone numbers and Web sites operated by the federal government (Sun, 8/9).

The Associated Press: Blue Cross Reaches Out Over Insurance Law Changes
Just down from the Target and Gander Mountain big-box stores and between a nail salon and dental office, North Carolina's largest health insurer opened its first retail store. It has some exercise offerings -- step aerobics classes and stationary bike workouts -- but for now, its main product is providing in-person information about changes coming in October with the health insurance overhaul law. Blue Cross and Blue Shield of North Carolina is opening half a dozen of these offices in strip malls statewide to first educate and then, starting in October, enroll consumers shopping for coverage because of the federal Affordable Care Act, also known as "Obamacare." Blue Cross affiliates in Florida and Pennsylvania have had similar stores open for years (Dalesio, 8/10).

Georgia Health News: Just Around The Corner, A Big Change In Coverage
Fifty-one days. That's the time left until enrollment starts on the health insurance exchange. "The clock is ticking," said Sandy Praeger, the Kansas insurance commissioner, during a health care panel Sunday at the legislative summit for the National Conference of State Legislatures, which opened in Atlanta (Miller, 8/11).

The Wall Street Journal: Oregon To Debug Insurance Exchange
Oregon's health-insurance exchange -- the marketplace created by federal law to let consumers shop online for coverage -- will open for business on Oct. 1, but with a glitch: Consumers won't be able to access it online. Officials at Cover Oregon, as the exchange is called, said people will be able to use the new website at home by the end of October. They decided to limit access for two to four weeks while they debug the site, fixing flaws before opening it up to the general public (Weaver, 8/9).

Bloomberg: Oregon Exchange Delay Adds To Scale-Down Of Health Law
Oregon, a Democratic-led state that has embraced President Barack Obama's Affordable Care Act, won't meet all the requirements for its health-insurance exchange when the online marketplace opens Oct. 1. For at least two weeks, people using Cover Oregon won't be able to complete their purchase without help from a certified insurance broker or community group, said Lisa Morawski, an exchange spokeswoman. Consumers in all 50 states were supposed to be able to freely shop for health plans on their own (Wayne, 8/9).

Los Angeles Times: Health Insurance Ratings To Be Dropped From State Website
Californians shopping for health insurance in a new state-run market this fall may not see quality ratings for those health plans alongside the monthly price. To the dismay of consumer groups, state officials are dropping plans to post those insurance company ratings in their online enrollment system, which opens Oct. 1 under the federal health care law (Terhune, 8/9).

The Spokesman-Review: Idaho Must Rely On Feds' Site In First Year
The Idaho Legislature will not get its wish for a health insurance exchange website built by and for Idahoans. Not in the first year, anyway. The Legislature's decision simply came too late. Federal law requires creation of a marketplace for health insurance coverage by Oct. 1 for every state. If states don't do it, the law says, the federal government will. ... According to Jody Olson, the spokesman for Idaho’s exchange, for 2014 Idaho will rely on the federal government’s exchange site, www.healthcare.gov/. Idaho's new contract calls for the Boston firm to put an Idaho "skin" on Idaho's section of the federal site. Skin, Olson said, means the Web pages will feature a few pictures of Idaho and some Idaho-selected colors (Webster, 8/11).

The Associated Press: State-Run Health Insurance Exchange To Be Delayed A Year
Idaho will be relying on the federal health insurance exchange for at least a year while it develops its own. Idaho was late to endorse the idea of its own insurance exchange, a key component to the 2010 federal health care law. States that don't run their own, will have a federally run exchange (8/11).

The Philadelphia Inquirer: An Early Look At Health Exchanges In Pa. And N.J.
Health insurance marketplaces in Pennsylvania and New Jersey are open -- but not for business. People who need health insurance can now go online to www.healthcare.gov and create an account with a user name, password, and security questions so they will be ready to go when enrollment begins Oct. 1. When the exchanges do open for business, Pennsylvanians will find as many as 15 insurers -- including Independence Blue Cross and Aetna but not UnitedHealthcare -- competing for their business (Calandra, 8/11).

MPR: MNSure Forum Via Twitter Set For Monday
Minnesota's upcoming online insurance marketplace will be holding a different kind of town hall forum on Monday to answer questions about how MNsure will work. The forum will take place on the social networking site Twitter. It's a site for short comments and questions, and messages cannot exceed 140 characters (Stawicki, 8/10).

On the Medicaid front -

USA Today: States Scramble To Drive Down Medicaid Drug Costs
A little-known provision of the 2010 health care law has states and their governors scrambling to take advantage of potential savings in how states distribute medication to Medicaid patients. The Affordable Care Act (ACA) allows states to receive drug rebates even if they move their Medicaid prescription benefit to managed-care organizations. The federal government has also asked states to fix the wide disparities in dispensing costs for drugs distributed through Medicaid (Kennedy, 8/11).

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Advocates For Disability, Autism Care Brace For Impact Of Health Law

The result of some elements of the health law that were initially viewed as victories are now not so clear-cut.

Stateline: Q&A: How ACA Will Affect People With Autism
Autism advocates celebrated what they thought was a major victory when President Barack Obama signed the Affordable Care Act in 2010: They expected the law to require all insurance companies to cover pricey, potentially lifelong treatments for those with the incurable condition. But instead of creating a national standard for autism coverage, the administration bowed to political pressure from states and insurers and left it to states to define, within certain parameters, the "essential benefits" that insurance companies must provide (Vestal, 8/9).

The Oregonian: Disability Rights Advocates, Families Fight New Provision Of Affordable Care Act
Deana Copeland has cared for her 22-year-old, medically fragile daughter since she was born, but she's afraid that a new provision of the Affordable Care Act could force her to place her daughter in foster care. Her daughter, Andrea Hood, suffers from cerebral palsy, spina bifida and autonomic dysreflexia, a potentially life-threatening condition, and requires around-the-clock care (Zheng, 8/11).

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Obama Urges Veterans To Speak Up For The Health Law

President says overhaul won't affect veterans' benefits. Meanwhile, religious leaders in Illinois are promoting the law.

Bloomberg: Obama Urges Military Veterans To Defend Health-Care Law
President Barack Obama urged military veterans to defend his signature health-care law and press Republican lawmakers to end budget cuts that threaten future spending on benefits. In remarks to the Disabled American Veterans National Convention in Orlando, Florida, Democrat Obama said critics of the health insurance expansion that he championed are spreading "misinformation." Veterans benefits won't be affected by the Affordable Care Act, he said (Talev and Woellert, 8/10).

The Associated Press: Faith Leaders Emerge As Key To New Health Law Outreach
Religion and the nation's new health law haven't exactly been viewed as friendly partners in the public eye, with most of the attention focused on religious employers' objections to covering the cost of birth control. But under the radar, leaders in some Illinois faith communities are spreading the word about the Affordable Care Act to make sure their uninsured members know about new benefits available starting in 2014 and about the approaching enrollment start date (Johnson, 8/11).

Also, a major donor to a pro-health law group is asking for an end to an HHS review of his billing practices -

Reuters: Big Donor To Group Promoting Obamacare Launches His Own Campaign
When cardiologist Asad Qamar gave $50,000 earlier this year to the non-profit group established to promote President Barack Obama's national agenda it was one of the group's biggest single donations from the state of Florida. … At the same time, Qamar has been engaged in a campaign of his own. Since January, he has sent letters and emails to government leaders, including Obama and members of Congress, complaining about a lengthy review of the billing practices led by the Department of Health and Human Services at his own Ocala, Florida, Institute of Cardiovascular Excellence, which he says is delaying payments and threatens to put him out of business (Debenedetti, 8/12).

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Women's Health

Abortion Fights In The States Turn To Digital World

Eleven states now ban abortion by telemedicine, the Guttmacher Institute says in a new study. In the meantime, the Government Accountability Office is investigating how Planned Parenthood and other related organizations spend public money.

USA Today: New Abortion Restrictions Take A Digital Turn
The war over abortion is going digital. Missouri last month joined six other states that have enacted bans this year on abortion by telemedicine. That's a process in which women take pregnancy-ending medication that a doctor remotely administers during a video conference. The practice, available to women in their first nine weeks of pregnancy, is now prohibited in 11 states, according to the Guttmacher Institute, a research group that supports abortion rights (Railey, 8/11).

Politico: Government Accountability Office Probing Planned Parenthood
Spurred by a group of anti-abortion lawmakers, the Government Accountability Office is investigating how Planned Parenthood, the Guttmacher Institute, and other prominent family planning-related organizations spend public funds, the GAO confirmed Friday. ... Chuck Young, GAO managing director of public affairs, said the scope of the investigation was still being determined, and no completion date had been set. Planned Parenthood Federation of America Vice President Eric Ferrero said in a statement that the move was not an investigation, but instead "a routine report by GAO in response to a request by opponents of Planned Parenthood in Congress" (Drusch, 8/9).

And a Colorado college files a lawsuit seeking to avoid having to provide emergency contraception under the health law --

Medpage Today: College Renews Fight Over Birth Control Mandate
The nonprofit Colorado Christian University (CCU) has again filed suit against the Department of Health and Human Services (HHS), trying to avoid an Affordable Care Act mandate to provide emergency contraceptives in its health plans. CCU asked the U.S. District Court in Colorado on Wednesday to declare an HHS rule requiring them to seek third-party coverage of certain contraceptives unconstitutional and to issue an injunction against its enforcement in the meantime. The school is the first nonprofit to challenge the rule, which became final in late June, according to the Becket Fund for Religious Liberty, who is representing the university in the case (Pittman, 8/9).

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Health Care Marketplace

Foreign Docs Face Challenging Transition To U.S. System

News outlets report on issues ranging from how foreign doctors are assimilated into the U.S. health care system to how nurse practitioners might help address the physician shortage and the job market nurses are facing.  

The New York Times: Path To United States Practice Is Long Slog To Foreign Doctors
The involved testing process and often duplicative training these doctors must go through are intended to make sure they meet this country's high quality standards, which American medical industry groups say are unmatched elsewhere in the world. Some development experts are also loath to make it too easy for foreign doctors to practice here because of the risk of a "brain drain" abroad (Rampell, 8/11).

NBC: Bracing For Obamacare: Nurse Practitioners Fill Doc Shortage Gap
It's 8:15 a.m. on a warm July Wednesday and the parade of patients is already lining up for Mary Fey, a family nurse practitioner on the front lines of health reform in this rural community 100 miles south of Portland. … Like nurse practitioners across the U.S., Fey is girding for the onset of reforms put in place by the 2010 Affordable Care Act, which offers some 32 million Americans new access to health insurance -- but no guarantee of access to care (Aleccia, 8/9).

CT Mirror: Once Healthy Job Market For New Nurses Has Weakened
For years, the common wisdom has been that because of a nursing shortage, newly graduated nurses are practically guaranteed a job in their desired field. But the job outlook for nurses in Connecticut and nationally has changed dramatically in recent years because of the economic downturn and health care reforms. Some hospitals have been coping by moving nurses between different hospital units, while others have had layoffs or hiring freezes (Merritt, 8/9).

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Medtronic Adds Disease Management To Its Portfolio

Medtronic wades into the business of disease management in a bid to find business outside its medical device offerings. In the meantime, a popular calorie-counting app gets $18 million in new venture capital funding.

The Wall Street Journal: Medtronic Expands Into Disease Management
The $200 million, all-cash deal puts Medtronic in the business of working with hospitals and insurers to limit the costs of treating patients with chronic diseases, such as heart failure and diabetes, and gives it a hand in the care of patients who don't need costly, high-tech implantable devices that are Medtronic's core offerings (Weaver, 8/11).

The Wall Street Journal: MyFitnessPal App Gets Venture Backing
While Weight Watchers struggles to keep its membership rolls from shrinking, its upstart challengers are beefing up. The popular health-monitoring app MyFitnessPal LLC is getting $18 million in new funding from Kleiner Perkins Caufield & Byers and Accel Partners, a bet by the venture-capital firms that Americans are ready to take more control over monitoring their health. The investment values MyFitnessPal -- which claims 40 million users and is profitable -- at between $100 million and $120 million, a person familiar with the matter said (Ziobro, 8/12).

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Public Health & Education

U.S. Probes Whether Medicaid Programs Over-Prescribe Antipsychotics To Children

Health officials are investigating whether health care professionals are prescribing antipsychotic drugs too often to children on Medicaid. In the meantime, a Texas compounding pharmacy has become the latest to have its products recalled over meningitis concerns.

The Wall Street Journal: U.S. Probes Use Of Antipsychotic Drugs On Children
Federal health officials have launched a probe into the use of antipsychotic drugs on children in the Medicaid system, amid concern that the medications are being prescribed too often to treat behavioral problems in the very young. The inspector general's office at Department of Health and Human Services says it recently began a review of antipsychotic-drug use by Medicaid recipients age 17 and under. And various agencies within HHS are requiring officials in all 50 states to tighten oversight of prescriptions for such drugs to Medicaid-eligible young people (Lagnado, 8/11).

USA Today: FDA: New Voluntary Recall From Compounding Pharmacy
The Food and Drug Administration has announced a voluntary nationwide recall of all sterile products from a Texas compounding pharmacy, the latest in a series of recalls since last year's outbreak of fungal meningitis. Fifteen patients at two Texas hospitals have developed bacterial bloodstream infections after receiving injections from Specialty Compounding from Cedar Park, Texas, the FDA said Sunday (Szabo, 8/11).

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State Watch

State Highlights: Hundreds Lost D.C. Medicaid Without Cause, Some Allege

A selection of health policy stories from the District of Columbia, New York, California, Florida, North Carolina and Colorado.

The Washington Post: Hundreds In D.C. Lost Medicaid Assistance Without Cause, Attorneys Say
The Washington Post found that the District cut 366 people from all or some of the services they may have been eligible to receive in the nine months ended March 2012, according to records on file at the D.C. Attorney General's Office. About a third of those people died, the office said. The District doesn't know how they died because the program doesn't get copies of death certificates, officials said (Campbell, 8/11).

The New York Times: Two Firms Accused Of Using Political Ties To Bilk Medicaid
A Congressional committee released letters on Friday alleging that a pharmacy and a nutrition company in New York State "got away with inappropriately billing the Medicaid program by millions of dollars" by using political connections in the Democratic Party, including Edward G. Rendell, the former governor of Pennsylvania, to influence the Cuomo administration (Bernstein, 8/9).

The New York Times: Public Unions Fight New York's Effort To Curb Health Costs
In his final months in office, Mayor Michael R. Bloomberg set himself an ambitious goal: tackling New York's rapidly rising health care costs by finding cheaper insurance for the city's nearly 300,000 employees, 200,000 retirees and their families. On Friday, his chances of accomplishing that appeared dimmer than ever. The Municipal Labor Committee, a coalition of unions that negotiates with the city on health benefits, filed a complaint against the city and obtained a temporary restraining order stopping the administration for now from seeking new coverage (Taylor, 8/9).

The Associated Press: Court Stalls NYC Plan To Get Health Insurance Bids 
A judge told the city Friday to hold off seeking bids for health insurance for its huge workforce, days after Mayor Michael Bloomberg spotlighted the plan in a speech about safeguarding the city's fiscal health. ... New York's health insurance bill has doubled since 2002, to $6.3 billion this year. The request for proposals will look to save up to $400 million a year, he said (8/9).

Los Angeles Times: OxyContin Maker Closely Guards Its List Of Suspect Doctors
Over the last decade, the maker of the potent painkiller OxyContin has compiled a database of hundreds of doctors suspected of recklessly prescribing its pills to addicts and drug dealers, but has done little to alert law enforcement or medical authorities. Despite its suspicions, Purdue Pharma continued to profit from prescriptions written by these physicians, many of whom were prolific prescribers of OxyContin (Glover and Girion, 8/11).

Los Angeles Times: California Cites 'Massive Prisoner Release' In Supreme Court Appeal
California lawyers late Friday filed the state's full appeal to the U.S. Supreme Court, asking the high court to set aside orders to reduce prison crowding by the end of December. ... The appeal cites the great progress the state has made in improving medical and mental health care of inmates. It says the three federal judges who in June issued the current prison population reduction order showed a "conspicuous insensitivity" to the powers Congress tried to give states when dealing with court orders to release inmates (St. John, 8/10).

Health News Florida: Inspectors: Surgery Offices 'Filthy'
Too many physician surgery offices in Florida are "filthy" and have poorly trained staff, putting patients at risk, health inspectors say. In some offices, floors are caked with dirt, surgical devices are not properly disinfected, no one knows how to run sterilizing machines and the doctors perform procedures after only minimal training, three inspectors told members of the Florida Board of Medicine at a recent meeting in Deerfield Beach (Lamendola, 8/9).

North Carolina Health News: Changes In Hospital Finances Drives Flurry Of Mergers
In this first part of a three-part series, North Carolina Health News looks at the challenges facing rural hospitals and what it means for small communities when the local hospital merges with a larger hospital system. Today’s story looks at the market and regulatory environments that are driving hospitals to merge (Porter-Rockwell, 8/12).

The Denver Post: Telemedicine Helps Doctors Beam Into Rural Hospitals, Treat Newborns
A premature baby born at high altitude faces challenges uncommon among newborns in Denver that often can't be treated by rural physicians. But expanded technology is helping beam the expertise of neonatal specialists in the city into critical-care situations at 33 remote hospitals in Colorado, Kansas and Wyoming (Marotti, 8/12).

The Sacramento Bee: California Supreme Court Decision Expected On Insulin Shots In School
The California Supreme Court is poised to rule today on one of the most emotional issues currently before it: whether school employees should be able to give insulin shots to diabetic students if a nurse is not available. The case pits parents who want voluntarily trained, non-nursing staff and faculty to give the shots to their children against a nurses union claiming that inappropriately administered shots could lead to harm and even tragedy (Walsh, 8/12).

Health Policy Solutions (a Colo. news service): 'My Dear Watson' – From Jeopardy To A Doc's Office Near You
IBM is now trying to tap the silicon genius' remarkable ability to digest information in nanoseconds for a variety of health care applications. Dr. Martin Kohn, an emergency physician for 30 years who is now IBM's chief medical scientist for care delivery systems, came here to the Colorado Health Symposium this week to share the latest concepts with health policy experts from Colorado and the U.S. at the conference sponsored by the Colorado Health Foundation (Kerwin McCrimmon, 8/9).

California Healthline: Exchange Pediatric Dental Mandate
Covered California yesterday decided to hold off on embedding pediatric dental services in 2014 health plans offered by the exchange. In a special hearing convened for the single topic of pediatric dental benefits, the board unanimously voted yesterday to adopt a staff recommendation to delay the idea, and to target 2015 to implement an embedded policy. That includes an aggressive timetable for decisions about how to properly do that. If the state insisted on soliciting dental plans to offer the embedded benefit, it would have had no takers, according to Peter Lee, executive director of Covered California (Gorn, 8/9).

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Editorials and Opinions

Viewpoints: Obama Overlooking Legal Constraints On Employer Mandate Delay; Bush's 'Unnecessary' Heart Procedure; Discrimination Against People With Mental Illnesses

The Wall Street Journal: Quote-Unquote, The Law
In his Friday remarks, Mr. Obama also claimed that he had the "executive authority" for the mandate delay. But if he really believes that, then why did he say he would normally ask for a legislative "tweak." Either the fix requires legislation or it doesn't. His comments are certainly revealing about his attitudes on Presidential power and the constraints of the U.S. Constitution. Article II, Section 3 instructs him to take care that the laws be faithfully executed, not merely what he thinks is "the essence" of laws (8/10). 

The New York Times: When A Co-Pay Gets In The Way Of Health
We want patients to receive the best care available. We also want consumers to pay less. And we don't want to bankrupt the government or private insurers. Something must give. The debate centers on how to make these trade-offs, and who gets to make them. ... What is a surprise is that amid these complex issues, one policy sidesteps these trade-offs. A few drugs — such as beta-blockers, statins and glycogen control medications — have proved very effective at managing hypertension, heart disease, diabetes and strokes. Most insurance plans charge something for them. Why not make drugs like these free? (Sendhil Mullainathan, 8/10).

USA Today: Contraception Mandate Applies To Business: Our View
Beginning this month, the Affordable Care Act requires that most health insurance plans give women access to FDA-approved contraception methods. ... The Institute of Medicine and common sense say contraception is basic health care for women, and the prevention of unplanned pregnancies can cut abortion rates and give women a better chance at education, work and planning family size. ... The effect of health insurance on business owners is indirect. Employees may or may not use insurance to pay for birth control, just as they may or may not use their salary to pay for something that would violate the company owners' faith. The circumstance might be discomforting. But the alternative — granting religious exemptions to private organizations — is more troubling. It would be open to abuse, putting the government in the position of determining which business owners were sufficiently religious (8/11).

USA Today: Religious Freedom Applies To Businesses: Opposing View
Can you make money and be religious? The Obama administration and a few courts have said no — at least in the context of forcing business owners to violate their religion by purchasing abortion-inducing drugs for their employees. Thankfully, most courts have rejected this view, leaving individuals and their businesses free to go to work without checking their conscience at the door (Mark Rienzi, 8/11).

The New York Times: Death Panels And The Apparatchik Mindset
Aaron Carroll reads the Wall Street Journal, which is outraged, outraged, at the prospect that Oregon's Medicaid system might seek to limit spending on treatments with low effectiveness and/or patients who aren’t going to live much longer in any case. Death panels! Carroll points us to the actual staff recommendation, which is far milder than the WSJ blast would have you believe. But as Carroll points out, the larger point is the absurdity of the Journal's position. On one side, it's fanatically opposed to Medicaid expansion — that is, it's eager to make sure that millions have no health coverage at all. On the other side, it claims to be outraged at the notion of setting priorities in spending on those who do manage to qualify for Medicaid. It's OK for people to die for lack of coverage; it's an utter horror if taxpayers decline to pay for marginal care (Paul Krugman, 8/10).

Georgia Health News: Expand Medicaid To Help Local Governments
With expanded Medicaid, anyone with an income below 133 percent of the federal poverty line would become eligible under the ACA, and many more inmates (state and local) would be eligible in Georgia. Georgia would save even more if the program were emphasized and made a state and local priority, as it is in North Carolina. The ACA is lowering hospitals’ governmental DSH (Disproportionate Share Hospital) reimbursements for low-income patients by $22 billion over 10 years. However, hospitals were told that these decreases were to be offset by having Medicaid cover patients who were then being served but not paid for (by private insurance, Medicaid or Medicare). When the U.S. Supreme Court ruled that states could opt out of expansion, that offset was no longer assured, but it continues to be a good idea (Jack Bernard, 8/9).

The New York Times: The Conscience Of A Liberal: The Power of Incumbency, Health Care Edition
President Obama is finally making a strong case for his own health reform, mocking Republicans for their obsession with denying insurance to 30 million Americans. It's about time; and many of us still feel that he did a remarkably bad job of explaining the reform in the past. Still, Brian Beutler has a good point here: the long delay in implementation made Obamacare hard to campaign on, because people had no experience of how it works in practice. Republicans could tell all kinds of lies, promulgate all kinds of misconceptions, and if the law's defenders tried to refute these claims, well, who was telling the truth? Remember how Medicare was going to destroy American freedom? (Paul Krugman, 8/11).

The Washington Post: President Bush's Unnecessary Heart Surgery
Former president George W. Bush, widely regarded as a model of physical fitness, received a coronary artery stent on Tuesday. Few facts are known about the case, but what is known suggests the procedure was unnecessary (Vinay Prasad and Adam Cifu, 8/9).

The New York Times: When Doctors Discriminate
If you met me, you'd never know I was mentally ill. In fact, I've gone through most of my adult life without anyone ever knowing — except when I've had to reveal it to a doctor. And that revelation changes everything. It wipes clean the rest of my résumé, my education, my accomplishments, reduces me to a diagnosis. I was surprised when, after one of these run-ins, my psychopharmacologist said this sort of behavior was all too common. At least 14 studies have shown that patients with a serious mental illness receive worse medical care than "normal" people (Juliann Garey, 8/10). 

The New York Times: California's Continuing Prison Crisis
Over the past quarter-century, multiple lawsuits have challenged California's state prisons as dangerously overcrowded. In 2011, the United States Supreme Court found that the overcrowding had gotten so bad — close to double the prisons' designed capacity — that inmates' health and safety were unconstitutionally compromised (8/10). 

The New York Times: Another Twist In The Saga Of Henrietta Lacks
The enduring constant in this saga has been the cavalier treatment of the Lacks family by medical researchers. Neither [Henrietta] Lacks nor others in her family were told that extracting cells from her tumor (and later taking cells from some of her relatives) was not being done for their benefit but for the benefit of science. That condescending attitude changed last week when the National Institutes of Health announced an agreement with the Lacks family that will restrict N.I.H.-financed research on the genome of HeLa cells (not the use of HeLa cells in experiments) and place two family members on a committee to approve such research (8/11).

Los Angeles Times: With Fewer Vaccinations, Is Your Child's School Safe?
Across the country, preschools and elementary schools are declaring themselves nut free or peanut free, asking families not to pack lunch foods that could pose life-threatening dangers to highly allergic children. And the prohibitions are expanding beyond nuts. ... But the great bulk of children face a far greater risk of harm from disease. If the goal is really to protect children, I'd like to see all schools declared "unvaccinated-free zones." The law in California mandates that students in public and private schools be immunized, but it also allows easy-to-get exemptions for personal beliefs. Although some 90% of the state's kindergartners are up to date on their immunizations, it is not uncommon for individual public elementary schools to report that more than one-third of their kindergartners are not (Dr. Nina Shapiro, 8/10). 

The New York Times: Wrestling With Dying Hospitals
Think about New York City and public health, and the mind instantly goes to soda cups and cigarette bans, to Mayor Michael Bloomberg's 12-year campaign of behavioral modification to make his fellow citizens ditch their bad habits. But eating better is not the only way to a healthier city, especially when so many New Yorkers lack access to decent health care in their own neighborhoods (8/11).

The New York Times: Opinionator: Bursting The Neuro-Utopian Bubble
Critics of the Human Genome Project have voiced many concerns about genomic sequencing, most of which can also be leveled at the Brain Initiative: What happens when health insurance companies get hold of this information? Could it lead to invasions of our privacy? And, perhaps most fundamentally, aren't these scientists once again trying to play God? (Benjamin Y. Fong, 8/11).

The New York Times: Room For Debate: Deconstructing Lyme Disease
Lyme disease, which is transmitted by tick bites, is one of the most common infectious diseases in the United States. It may also be one of the most controversial. Since it was recognized in 1975, Lyme has inspired bitter disputes, including over how to treat it and whether the illness can become chronic, dividing scientists, doctors and patients. Why is it so controversial? And what are the next steps to better understanding this mysterious affliction? (8/11).

Minneapolis Star Tribune: New Minnesota Law Helps Family Caregivers
Rick Hansen was a state employee some years ago whose good health had allowed him to accrue a number of unused "sick days." But when he wanted to use that time to take his ailing mother to the doctor, his request was denied. "Sick time" was for his own medical needs or those of his dependent children — no one else, he was told. As state Rep. Rick Hansen, DFL-South St. Paul, he set out to change that response (8/12)

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Stephanie Stapleton

Andrew Villegas

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.