Daily Health Policy Report

Thursday, August 15, 2013

Last updated: Thu, Aug 15

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch



Coverage & Access

Women's Health

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Talking Scales And Telemedicine: ACO Tools To Keep Patients Out Of The Hospital

MPR News' Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "When Bill Hill prepares to weigh himself each morning, a mechanical voice speaks to him from a small box on his nightstand that is connected to the scale on the floor. … For Hill, who was diagnosed with heart failure more than seven years ago, the morning weigh-in has become as routine as putting on his shoes. Like countless other patients nationwide, he's becoming more involved in his healthcare. That's a major goal of the federal health care overhaul. Essentia Health has been taking care of patients like Hill with telehealth tools like the special scale since 1998. And now it is an Accountable Care Organization, or ACO. That means it takes responsibility for the health of a population of Medicare beneficiaries and can share any savings created by keeping people like Hill out of the hospital" (Stawicki, 8/15). Read the story.

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Capsules: Report: Mass. Residents Paying More, Getting Less From Health Insurance; HHS Watchdog Says Rural Hospital Program Needs A Trim

Now on Kaiser Health News' blog, WBUR's Martha Bebinger, working in partnership with KHN and NPR, reports on a new study regarding Massachusetts insurance cost and coverage: "If Massachusetts residents have the feeling they're getting less coverage from their health insurance even though it's costing more, there's now evidence that they're right. A state report says Bay State premiums rose 9.7 percent between 2009 and 2011, while the value of that coverage shrank 5.1 percent" (Bebinger, 8/14).

Also on Capsules, Jenny Gold reports on a federal government program designed to help rural hospitals: "The federal government's program to help rural hospitals has grown bloated and unwieldy, according to a report released Thursday by the Office of Inspector General of the Department of Health and Human Services. Trimming the program could save the government and Medicare beneficiaries up to a trillion dollars a year, the agency found" (Gold, 8/15). Check out what else is on the blog.

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Political Cartoon: 'Brick Break?'

Kaiser Health News provides a fresh take on health policy developments with "Brick Break?" by Nick Anderson.

And here's today's health policy haiku:


Stubborn IT Mess?
Nervous Employers? High cost
staff - wait one more year!
-Chris Koller

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

As The Health Law Reshapes The Marketplace, Concerns Emerge

Narrow networks and other steps to control costs are gaining media attention.

The Wall Street Journal: Many Health Insurers To Limit Choices Of Doctors, Hospitals
Many of the plans [offered on the new health marketplaces] will include relatively few choices of doctors and hospitals. In some cases, plans will layer on other limits, such as requirements that patients get referrals to see specialists, or obtain insurer authorization before pricey procedures. A McKinsey & Co. analysis of 955 consumer exchange-plan filings, from 13 states that were among the earliest to make them public, found that 47% were health-maintenance organizations or similarly designed plans. Such plans generally don't pay for care provided outside their networks. A number of other plans, though classed as preferred-provider organizations, or PPOs, will also have limited choices of doctors and hospitals in their networks (Mathews, 8/14).

The Associated Press: Businesses Seek Cure For Health Care Cost Surge
A year ago, Teresa Hartnett was on the verge of expanding her small business. The company had hit $1 million in sales, and requests from clients were flowing in. She planned to transition from nearly 30 freelancers to a full-time staff of 60 by 2014. Then the reality of the Affordable Health Care Act hit. Hartnett realized she might not be able to afford to carry out her plan. … The expected surge in health insurance costs under the ACA has many small business owners changing the way they operate. For many like Hartnett, hiring and expanding is going on the back burner. Others expect to cut back on some of the services their companies provide, raise prices or cut employees' hours and bonuses (Rosenberg, 8/14).

Kaiser Health News: Talking Scales And Telemedicine: ACO Tools To Keep Patients Out Of The Hospital
When Bill Hill prepares to weigh himself each morning, a mechanical voice speaks to him from a small box on his nightstand that is connected to the scale on the floor. … For Hill, who was diagnosed with heart failure more than seven years ago, the morning weigh-in has become as routine as putting on his shoes. Like countless other patients nationwide, he's becoming more involved in his healthcare. That's a major goal of the federal health care overhaul. Essentia Health has been taking care of patients like Hill with telehealth tools like the special scale since 1998. And now it is an Accountable Care Organization, or ACO. That means it takes responsibility for the health of a population of Medicare beneficiaries and can share any savings created by keeping people like Hill out of the hospital (Stawicki, 8/15).

Reuters: U.S. Schools Face Tough Decisions On Obamacare Benefits
Hit by years of budget cuts, some U.S. public school boards are looking to avoid providing health benefits to substitute teachers and supporting staff under President Barack Obama's reform law, education officials say. According to the law, employers will have to offer health coverage to all full-time employees, defined as those who work an average of 30 or more hours per week each month, or else pay a fine starting in 2015 (Abutaleb, 8/14).

Also in the news -

The New York Times: The Challenge Of Helping The Uninsured Find Coverage
Like many organizations across the country, Ms. Daily's agency, Northern Virginia Family Service, is hoping to win a federal grant to help uninsured people in the state sign up for coverage under President Obama's health care law. With the money, she hopes to hire at least a handful of "navigators" — a new category of worker created under the law to educate consumers about new health insurance options and, starting in October, to walk them through the enrollment process (Goodnough, 8/14).

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States Continue To Wrestle With Health Law Implementation Issues

Even as an Arkansas effort by a private group to block the health law appears to be falling short, states like Missouri continue to contemplate expanding Medicaid, and, in California, the health exchange experiences growing pains.

The Hill: Study: ObamaCare Benefit Mandates Pose Few Problems For States, Insurers
Adopting new benefit mandates under ObamaCare will not require major changes or cost increases, according to a study released Wednesday. Researchers at The Urban Institute and the Robert Wood Johnson Foundation said the states they surveyed are generally on track to enforce new requirements that insurers cover certain services (Baker, 8/14).

The Associated Press: Ark. Group Falls Short In Health Law Repeal Effort
A group pushing for a repeal of Arkansas' plan to use Medicaid funds to purchase private insurance for thousands of low-income residents won't have enough signatures to put the insurance expansion before voters next year, the head of the campaign said Wednesday. The chairman of Arkansans Against Big Government said the group had collected more than 26,000 signatures from registered voters — far short of the 46,880 needed to qualify for the 2014 ballot. Thursday is the deadline to submit signatures for the proposal (Demillo, 8/14).

St. Louis Beacon: Supporters Of Medicaid Expansion Pack State House Hearing
One by one they came to sit in front of the special House committee to deliver their three-minute remarks. Most had same message: Expand Missouri's Medicaid program. The lopsided testimony came from dozens of health-care professionals, civic activists and ordinary residents during Wednesday's daylong hearing of the Interim Committee on Citizens & Legislators Working Group on Medicaid Eligibility and Reform (Mannies, 8/14).

St. Louis Post-Dispatch: Suggestions Flow As Missouri Legislators Weigh Options For Medicaid
Give patients with chronic diseases a health care team. Monitor a state database to spot abuse of prescription drugs. Reward pregnant teens who keep their doctor appointments. Those were among the many suggestions that flowed Wednesday to a Senate committee examining ways to improve the quality and efficiency of Medicaid, the joint state and federal health care program for the poor (Young, 8/15).

California Healthline: Why One Insurer Quit Covered California
Ventura County Health Care Plan administrators won't soon forget May 23, 2013. That was the day that Covered California announced that VCHCP -- a small, county-run plan -- would join Anthem Blue Cross, Kaiser Permanente and 10 other insurers in next year's marketplace. … But 10 weeks later, Covered California has signed contracts with a dozen insurers -- and Ventura County Health Care Plan isn't one of them. Instead, the plan announced last week that it had withdrawn from the health benefits exchange for next year; a terse press release alluded to "ongoing analysis of enrollment projections, start-up costs and certain factors whose outcome and impact are difficult to predict" (Diamond, 8/14).

California Healthline: Questions, Concerns Greet Exchange Leaders At S.F. Town Hall Meeting
Dozens of outreach events are planned throughout the state leading up to the exchange's first day of business about six weeks from now. One of the first town hall meetings Friday at the UC-San Francisco Mission Bay campus attracted hundreds of people who packed a large room and filled out cards with questions about how the Affordable Care Act will be implemented in California. "You are a part of making history because the questions you ask are questions that hundreds of other Californians have," said Peter Lee, executive director of Covered California.  Lee said the meeting, and others like it to come, are intended to spread the word and clear up any confusion about how the ACA affects people (Hart, 8/14).

The Oregonian: Oregon Insurance Officials Looking Into Feds' Delay Of Health Coverage Limit
On Tuesday The New York Times broke the news that some insurers will be given an extra year to comply with new federal health coverage rules that limit people’s spending on medical bills. In Oregon officials aren't sure whether anyone will be affected by the newly disclosed exception to the federal rules for 2014 (Budnick, 8/14).

CT Mirror: Health Insurance Coverage Is Expanding. So Are Free Clinics
Karen Gottlieb says she shares a dream with everyone else who runs a free clinic. … People who work in free clinics -- "the safety net below the safety net," Gottlieb calls them -- take it as a given that many of their patients will still be without insurance after Jan. 1, when, as part of Obamacare, Medicaid eligibility will be expanded, coverage sold through a new private insurance marketplace will take effect, and nearly all Americans will be legally required to have health care coverage (Becker, 8/14).

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Health Law Promises To Be A Boon For Advertisers

Already, TV executives expect insurers alone to spend as much as $1 billion. Meanwhile, the pro-health law group Organizing for Action released its latest spot.

The Wall Street Journal: Health Ads Stream In
The television industry is anticipating an advertising bonanza related to the rollout of the federal health overhaul, with as much as $1 billion expected to be spent on ads by insurers alone, according to TV executives and a broadcasters' trade group (Sharma, 8/14).

Politico: OFA Releases New Obamacare Ad
A new ad promoting Obamacare was released Thursday, promoting insurance rebates families receive under the new health care law, according to reports. The ad by Organizing for Action will run on national cable channels, specifically Bravo and Lifetime, and is the third spot in support of the health care law running this summer, an OFA official told CNN (Gold, 8/15).

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GOP Operatives Struggle To Find Message On Health Care, Other Major Issues

As the Republican National Committee holds its summer meeting, leaders like former presidential hopeful Newt Gingrich and Ohio Gov. John Kasich highlight the need to advance solutions to the nation's health care challenges, rather than being the party that only says "no" to Obamacare.

The Associated Press/Washington Post: Republican Officials Push Rising Stars Amid Calls For Solutions On Major Issues
While there is little sign of GOP unity on solutions for immigration, health care or a looming budget standoff, RNC officials are launching a program to highlight a new generation of Republican leaders -- largely younger and more ethnically diverse -- to help broaden the party's appeal among women and minorities, groups that overwhelmingly supported President Barack Obama in the last election. The program supplements an ongoing effort to expand Republican outreach among minority communities across the country (8/15).

Politico: Newt Gingrich: No GOP Health Care Plan
Former House Speaker Newt Gingrich on Wednesday told party chairs and operatives at the Republican National Committee summer meeting that the GOP has "zero" ideas for replacing Obamacare, according to a report. … Gingrich said the party has a "very deep problem" with a culture that promotes negativity (Kopan, 8/14).

The Wall Street Journal: An Ohio Prescription For GOP: Lower Taxes, More Aid For Poor
On the one hand, he tamed a deficit by slashing funding to local governments and overhauling the state's Medicaid rules, among things. He has eliminated the state's estate tax and wants to phase out all state income taxes, a step aimed at stimulating growth. A budget he signed in June included a range of new abortion restrictions that drew sharp criticism from Democrats. At the same time, Mr. Kasich has stirred strong opposition from tea-party leaders -- and won surprised approval from liberals -- by pushing to expand Medicaid coverage to nearly 300,000 additional Ohioans, adopting a provision of the Obama health care overhaul that he has taken to defending with an openly religious fervor (King, 8/14).

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Capitol Hill Watch

Mulling The Pros And Cons Of A Govt. Shutdown

Congressioinal Republicans are at odds about whether they should try to block all funding for the health law's implementation -- even if it triggers a government shutdown. Some say it wouldn't work anyway and might bring with it a high political cost. But a new poll shows blame would likely be split evenly between Democrats and the GOP.

NPR: GOP Debate: Is Obamacare Fight Worth A Government Shutdown?
Congressional Republicans agree that the new federal health care program should be ended. But they are finding themselves bitterly divided over how. They have tried dozens of times to repeal it. Now, some GOP lawmakers want to block all money for Obamacare in a stopgap spending bill that must be approved next month to prevent the government from shutting down on Oct. 1. But other Republicans say that won't work and may well backfire (Welna, 8/14).

Politico: Poll: Shutdown Blame Would Be Split
House members shouldn’t worry about losing their seats if they oppose spending bills that contain Obamacare funding, conservatives said Wednesday. The blame for a potential government shutdown when the current spending bill expires Sept. 30 over the issue of stripping out funding for the Affordable Care Act would be spread among congressional Republicans, Democrats and President Barack Obama, according to a poll by GOP-leaning Basswood Research commissioned by Heritage Action for America (Everett, 8/14).

In other news -

Health News Florida: Obamacare Controls Prices: McCarty
Florida Insurance Commissioner Kevin McCarty says there's no need for the state to regulate health premiums because the Affordable Care Act has a rule that keeps them under control. In a discussion with the Orlando Sentinel editorial board, McCarty said the ACA contains a "self-regulator" that limits the amount of the premium that companies can keep for administrative expenses and profits (Gentry, 8/14).

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Critical-Access Hospitals Would Face Funding Trims Under New Plan

The proposal, advanced as part of a report from the Department of Health and Human Services Office of the Inspector General, would curb enhanced payments to as many as two-thirds of these facilities.

Modern Healthcare: OIG Proposal Threatens Enhanced Payments To Two-Thirds Of Critical-Access Hospitals
More than 800 small hospitals that dot the American countryside would lose enhanced Medicare funding for providing healthcare access in remote settings under a proposal put forward in a report today from HHS' Office of the Inspector General. Opponents say the proposal could put hundreds of hospitals out of business and roll back years of progress on access to healthcare. Critical-access hospitals, which have 25 or fewer beds, are already facing reductions in Medicare reimbursements under President Barack Obama's proposed 2014 budget (Carlson, 8/15).

Kaiser Health News: Capsules: HHS Watchdog Says Rural Hospital Program Needs A Trim
The critical access hospital program was intended to financially stabilize small, rural institutions by providing them with higher Medicare reimbursement rates. The hospitals in the program are supposed to have 25 or fewer beds and be at least 35 miles away from another facility (15 miles across mountainous terrain) in communities that would otherwise have limited access to health care services. The effort was a response to a spate of 360 rural hospital closures in the 1980s and 1990s (Gold, 8/15).

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Medicare Changes Appear To Be Driving Reduced Used Of Dialysis Drugs

The Washington Post reports on a new study, which finds Food and Drug Administration warnings did not cause a sharp drop in the use of these drugs.

The Washington Post: Medicare Changes, Not FDA Warning, Seem To Have Curtailed Use Of Dialysis Drugs, Study Finds
In March 2007, the Food and Drug Administration issued a stern "black box" warning regarding the anemia drugs commonly prescribed to dialysis patients: The popular drugs, known as ESAs, could increase the risk of heart attacks, stroke, blood clots and death. But according to a new paper by researchers who studied the use of the drugs for months before and after the warning, the FDA's black box "did not appear to influence ESA prescribing among the overall dialysis population." Instead, the use of the drugs continued a slow, steady decline rather than taking a sharp drop, according to the paper (Whoriskey, 8/14).

Meanwhile, Medicare also just celebrated another anniversary -

The Lund Report: Medicare, Medicaid Anniversary Raises Fears, Hopes For Future
The end of July marked the 48th anniversary of the signing of the Social Security Act which turned Medicare and Medicaid into law. Now – with talk of Medicare becoming a voucher program, and threats to Medicaid, Social Security and other entitlements – local activists (in Portland, Ore.) are fighting to protect the program and potentially to expand it (McCurdy, 8/14).

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Analysis: Physicians Worried About Lawsuits Tend To Order Extra Diagnostic Tests

Reuters: Fearful Doctors May Order Too Many Tests
Doctors who are the most worried about malpractice suits are more likely than less fearful colleagues to order extra diagnostic tests and refer patients to emergency rooms, even if the real threat of a lawsuit is low, according to a new U.S. study. The practice of so-called defensive medicine "is one of those things that everyone knows goes on, but doesn't know how to control," said Michelle Mello, senior author of the new analysis and a professor of law and public health at the Harvard School of Public Health in Boston (Kulkarni, 8/14).

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Coverage & Access

DOD Says Same-Sex Spouses To Get Benefits In Early September

By early September, gay spouses of military members will get full benefits, including health care coverage. The Department of Defense said the benefits will be retroactive to the Supreme Court decision striking down the Defense of Marriage Act in June.

The New York Times: Gay Spouses Of Members Of Military Get Benefits
Under the plan, spousal and family benefits -- including health care coverage, housing allowances and survivor benefits -- will be available to all legally married military spouses. The same-sex spouses of service members and civilian Defense Department employees can claim the entitlements retroactively, starting with the date of the decision (Huetteman, 8/14).

Politico: DOD: Benefits For Same-Sex Couples Available By Sept. 3
Enrollments in DoD's health care coverage, as well as requests for housing benefits or separation allowances, are retroactive to the Supreme Court's June ruling that struck down the federal Defense of Marriage Act, the announcement said. "For those members married after June 26, 2013, entitlements begin at the date of marriage" (Ewing, 8/14).

The Associated Press: Same-Sex Spouses Of US Military Members Eligible For Identical Health-Care, Housing, Other Benefits
Same-sex spouses of U.S. military members will be eligible for the same health care, housing and other benefits enjoyed by opposite-sex spouses starting Sept. 3, the Defense Department said Wednesday. The decision follows the Supreme Court's ruling in June that struck down part of the Defense of Marriage Act, which had been used to deny married gay couples such benefits (8/14).

And Fox News reports that nontraditional families may soon see changes to their household health coverage --

Fox News: Health Coverage For The Extended Family, Coming Soon?
The trend of multiple generations living under one roof is changing the idea of the traditional family household, but the health insurance industry hasn't been keeping up with the new living situation. The economic environment has forced many families to live together, often with adult children taking care of their live-in elderly parents in addition to their children’s needs (Fuscaldo, 8/14).

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Women's Health

Mo. Lawmaker Readies Challenge To State Coverage For Sterilization, Contraceptives

A lawmaker in Missouri prepares to challenge the state government's insurance coverage that includes sterilization and contraceptives. In the meantime, a group prepares to appeal a ruling upholding the health law's contraception coverage mandate to the Supreme Court.

St. Louis Beacon: Missouri Legislator Challenges State Insurance Coverage For Contraception, Sterilization
State Rep. Paul Wieland could be starting a legislative trend in Missouri with his suit that challenges the Missouri government's new group insurance coverage that covers sterilization and contraceptives, including some birth-control drugs or devices that he says induce abortion (Mannies, 8/15).

The Hill: Critics Of Contraception Mandate Vow Supreme Court Appeal
Critics of the contraception mandate in President Obama's health care law said they will appeal to the Supreme Court after a federal appeals court declined to re-hear their case Wednesday. Alliance for Defending Freedom, one of the organizations challenging the contraception mandate in the courts, said it will ask the Supreme Court to consider whether the mandate is unconstitutional (Baker, 8/14).

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State Watch

State Highlights: Ga. Waits For Fed Approval On Provider Fee

A selection of health policy stories from Missouri, Georgia, Massachusetts, California, Virginia, West Virginia, New York and Minnesota.

Georgia Health News: Wait On Provider Fee Makes Industry Officials Uneasy
The wait continues for federal approval of the Georgia hospital provider fee -- a delay that's increasingly worrisome to some in the hospital industry. The financing mechanism is designed to fill a nearly $500 million hole in the state's Medicaid program. Legislation to ease the renewal of the current hospital fee sailed through the General Assembly early this year, with a push from Gov. Nathan Deal (Miller, 8/14).

Modern Healthcare: Reform Update:  Mass. Contracts Require Providers To Absorb Financial Losses, Study Finds
In Massachusetts, the state's health care giants are heavily involved in contracts that require hospitals and doctors to absorb financial losses when health care spending exceeds spending targets, according to a new report. Blue Cross and Blue Shield of Massachusetts, which dominates the state's health insurance sector with 45 percent of the market, made half of its payments to providers under global budget contracts last year, a newly released snapshot of the state market done by the Massachusetts Center for Health Information and Analysis (Evans, 8/14).

Kaiser Health News: Capsules: Report: Mass. Residents Paying More, Getting Less From Health Insurance
If Massachusetts residents have the feeling they're getting less coverage from their health insurance even though it's costing more, there's now evidence that they're right. A state report says Bay State premiums rose 9.7 percent between 2009 and 2011, while the value of that coverage shrank 5.1 percent (Bebinger, 8/14).

The Wall Street Journal: Nurse Practitioners Seek Right To Treat Patients On Their Own
Nurse practitioners in five states are fighting for the right to treat patients without oversight from doctors, as they can in many parts of the country. The battle is particularly pitched in California, where a bill that would let some nurse practitioners do their work independently passed a key legislative committee this week. California doctors strenuously oppose the idea, arguing that it could jeopardize patient safety (Beck, 8/14).

The Associated Press/Washington Post: 2 Southwest Va. Prosecutor Offices Receive $1.3M From National Medicaid Fraud Settlement
The money comes from the $1.5 billion Abbott Laboratories agreed to pay to settle allegations that it promoted the drug Depakote for uses not approved by the Food and Drug Administration. The federal, state and local law enforcement agencies that participated in the investigation shared $200 million in forfeited funds (8/14).

The Associated Press: WV CHIP Eliminates Enrollment Waiting Period
A waiting period for enrollment in West Virginia's Children's Health Insurance Program has been eliminated. The Children's Health Insurance Agency board voted Wednesday to eliminate the 90-day waiting period prior for enrollment in the program for West Virginia children who are uninsured. The changes are effective Oct. 1 (Raby, 8/14).

ProPublica: New York Promised Help For Mentally Ill Inmates -- But Still Sticks Many In Solitary
When Amir Hall entered New York state prison for a parole violation in November 2009, he came with a long list of psychological problems. … Multiple studies have shown that isolation can damage inmates' minds, particularly those already struggling with mental illness. In recent years, New York state has led the way in implementing policies to protect troubled inmates from the trauma of solitary confinement (Thompson, 8/15).

MPR: Survey: Patients Satisfied With Medical Providers, But Want Easier Access
Minnesota patients are satisfied with the way their medical providers interact with them, but many would like easier access to their doctor, according to a patient experience survey released today. The independent ratings group Minnesota Community Measurement announced the findings after compiling data from 230,000 patient surveys completed at 651 Minnesota clinics from Sept. 1 to Nov. 30 of last year (Benson, 8/14).

Richmond Times Dispatch: Pediatricians Weigh In On Plan For VCU Children’s Hospital
Twenty years ago, when pediatrician Gayle Smith began her medical career in Richmond, she said there was the promise of a children's hospital in the near future. … About 200 people attended the meeting, held at the Richmond Marriott, the second of a series of public meetings being held to get feedback on the VCU proposal announced in June. VCU's plan calls for building a children's hospital with its own governing board and open to community doctors but still part of the VCU Health System (Smith, 8/15).

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Weekend Reading

Longer Looks: Fight Against Meth Labs Faces Drug Makers' Opposition

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Fresno Bee: Locked In Terror
The Fresno County Jail has been a place of terror and despair for mentally ill inmates who spiral deeper into madness because jail officials withhold their medication. About one in six jail inmates is sick enough to need antipsychotic drugs to control schizophrenia, bipolar disorders and other psychiatric conditions, but many sit for weeks in cells without medication previously prescribed by private doctors, say family members, lawyers and psychiatrists. If the inmates do get medication, it's often at a lower dose or is a cheaper generic substitute that doesn't work as well, they say. … But the drug policy has raised costs significantly in other areas. Taxpayers spend millions of dollars each year on the inmates — above and beyond the cost of caring for them in the jail (Marc Benjamin, Barbara Anderson et al, August 2013).

Health Affairs: In The Safety Net: A Tale Of Ticking Clocks And Tricky Diagnoses
The tempo had been building since our clinic session began. It was a typical Thursday afternoon in February, and the din was rising in the clinic's conference room as our internal medicine residents traded patient stories and plans for dinner, waiting for their turn to present their patients to the attending physicians. … That afternoon, the most essential thing we managed to provide to one particular patient was a bit of extra time. Today I still think of what the consequences could have been if we had not taken that time. We would have missed the opportunity to intervene at a critical moment—and to save our patient's life (Dr. Maria Madonado, 8/2013).

The Atlantic: Why Doctors Are Reluctant To Take Responsibility For Rising Medical Costs
Medical costs are skyrocketing and a survey published last month in JAMA has us doctors pointing fingers in every direction but at ourselves. The more than 2500 physicians surveyed rested most of the blame on malpractice lawyers, insurance companies, healthcare conglomerates, and drug/device companies. Patients came next. Trailing the lot were the doctors themselves. Doctors' enthusiasm for cost-containment strategies that affected their compensation—eliminating fee-for-service reimbursement, "bundling" payments for the total care of patients, penalizing physicians when patients were re-admitted to the hospital—was notably lukewarm (Danielle Ofri, 8/14).

Mother Jones: Merchants Of Meth: How Big Pharma Keeps The Cooks In Business
The first time she saw her mother passed out on the living room floor, Amanda thought she was dead. …The empty packages of cold medicine, the canisters of Coleman fuel, the smell, her parents' strange behavior all pointed to one thing. They were meth cooks. Amanda (last name withheld to protect her privacy) told her grandparents, who lived next door. Eventually, they called police. … As law enforcement agencies scramble to clean up and dispose of toxic labs, prosecute cooks, and find foster homes for their children, they are waging two battles: one against destitute, strung-out addicts, the other against some of the world's wealthiest and most politically connected drug manufacturers. In the past several years, lawmakers in 25 states have sought to make pseudoephedrine—the one irreplaceable ingredient in a shake-and-bake lab—a prescription drug. In all but two—Oregon and Mississippi—they have failed as the industry, which sells an estimated $605 million worth of pseudoephedrine-based drugs a year, has deployed all-star lobbying teams and campaign-trail tactics such as robocalls and advertising blitzes (Jonah Engle, 8/2013). 

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Editorials and Opinions

Viewpoints: George Will Assails 'Illegal' Delay Of Employer Mandate; Cohn Reminds Conservatives That Subsidies Will Be Important

The Washington Post: Obama's Unconstitutional Steps Worse Than Nixon's
Barack Obama's increasingly grandiose claims for presidential power are inversely proportional to his shriveling presidency. Desperation fuels arrogance as, barely 200 days into the 1,462 days of his second term, his pantry of excuses for failure is bare, his domestic agenda is nonexistent and his foreign policy of empty rhetorical deadlines and redlines is floundering. And at last week's news conference he offered inconvenience as a justification for illegality. Explaining his decision to unilaterally rewrite the Affordable Care Act (ACA), he said: "I didn't simply choose to" ignore the statutory requirement for beginning in 2014 the employer mandate to provide employees with health care. No, "this was in consultation with businesses" (George Will, 8/14).

The Fiscal Times: Did Obama Flout The Law By Delaying Obamacare?
The Obama administration suffered a telling and potentially far-reaching defeat in the D.C. Circuit Court of Appeals this week on the need for the executive branch to abide by statutory law. While the issue at the center of the case involved an old and somewhat arcane controversy over nuclear waste, the implications may well alter the political calculus on immigration, drug policy and especially the rollout of Obamacare (Edward Morrissey, 8/15).

Atlanta Journal-Constitution: ObamaCare With A Human Face, And A Human Story
With all the controversy about ObamaCare, it's important to remember why the legislation was passed in the first place. Health-insurance premiums were soaring. People who had pre-existing conditions could not get coverage, particularly if you were buying insurance individually or through a small business. Health-caused bankruptcies were soaring (Jay Bookman, 8/14).

National Review Online: What Obama Can't Admit
President Barack Obama continues to insist that under the law, as he said in his pre-vacation press conference, people are going to be able to "sign up for affordable quality health insurance at a significantly cheaper rate than what they can get right now on the individual market." This has been his sales pitch for his health-care law from the beginning, and it's never been true. But admitting that Obamacare will mean higher rates for many people is too painful a concession to make, so the president simply doesn't make it, despite all the evidence contradicting his rote assurances of lower premiums (Rich Lowry, 8/13).

The New Republic: The Big Savings Obamacare Critics Miss
Obamacare provides offers tax credits to offset the cost of insurance. If your income is less than four times the poverty line, and if you're buying through one of the new insurance exchanges, then the tax credit will operate like a discount. The less money you have, the bigger the discount. Nowadays, most Obamacare critics acknowledge that the subsidies exist. But they tend to dismiss them as trivial. "Some low-income people will get subsidies," Rich Lowry of the National Review wrote on Monday. "But that doesn’t change the essential facts." Actually, it does change the essential facts—by quite a lot (Jonathan Cohn, 8/14).

The New York Times: Taking Note: Mitch McConnell Tries Leadership, Then Backs Away
Yesterday Mitch McConnell, the Senate minority leader, appeared to attempt to act like a leader by throwing cold water on the government shutdown plan, which many Republicans have endorsed as a way to stop the implementation of the Affordable Care Act. … After sounding sensible for a second, Mr. McConnell told The Washington Post’s Greg Sargent that he did not mean to "take sides in the dispute over whether to stage a shutdown confrontation. He was merely stating a fact — that even if the government is shut down, it won't stop the funding of Obamacare." To recap: Mr. McConnell knows the shutdown won't work as intended, but he's not willing to actually come down against it (Juliet Lapidos, 8/14).

The Wall Street Journal: Government Shutdown Blame Game
Republican senators like Ted Cruz of Texas and Mike Lee of Utah are urging the GOP to reject any government spending plan that includes funding for ObamaCare, which could lead to a government shutdown when the current spending bill expires on Sept. 30. If that happens, will voters blame Republicans? A new poll commissioned by Heritage Action for America, which supports defunding the health-care law, suggests that Republican lawmakers shouldn't worry because there would be little political downside to a shutdown. ... Of course, the government did shut down partially in November 1995, when we also had a Democratic president and a Republican-controlled House. A Gallup poll taken the day after the shutdown showed that by almost 2-to-1, Americans blamed Republican leaders (49%) instead of President Clinton (26%). Republicans must decide whether past is prologue (Jason L. Riley, 8/14). 

JAMA: First, Do No (Financial) Harm
"First, do no harm" is a well-established mantra of the medical profession, but it may need to be reconceptualized in an era of unsustainable health care spending. Medical bills are now a leading cause of financial harm and physicians decide what goes on the bill. The possible consequential harm is substantial, often leading to lost homes and depleted savings (Drs. Christopher Moriates, Neel T. Shah and Vineet M. Arora, 8/14).

JAMA: The Critical Role Of Caregivers In Achieving Patient-Centered Care
Achieving high-quality, cost-effective medical care remains an elusive goal of the US health care system, but there is widespread agreement that patient-centered care will be a key ingredient. Yet for frail elders and patients with advanced illness, many of whom have multiple chronic diseases, patient-centered care is impossible without caregiver involvement. ... For caregivers to make patient-centered care a reality for frail elders and those with advanced illness, they will need unprecedented education and assistance. In addition to supporting policies designed to reimburse caregivers for some of their services—proposals unlikely to be enacted, given the current political climate—the medical establishment needs to incorporate caregivers at every step of patient care (Dr. Muriel R. Gillick, 8/14).

The New York Times: Opinionator: Beautiful Pathologies
At our medical school, we have something called the organ transplant observation program, which allows students to shadow the doctors who transfer functional organs from deceased or living donors into the bodies of dying patients. ... The program is wildly popular and often a highlight of the medical school experience. This year, over half of my class signed up as soon as the forms went online. ... In medicine, a lot of our training depends on the misfortune of others. Without sick people, we cannot learn to diagnose and treat. But we sometimes forget to manage our enthusiasm for the science of disease and, in doing so, ignore the human suffering that comes with the experience of disease (Nathaniel P. Morris, 8/14). 

National Review Online: After Newtown
Following [the shooting deaths at] Newtown, Obama promised to make "access to mental health care as easy as access to guns." Obama's first step was to set up a task force under Vice President Biden to make recommendations. Biden, in turn, asked the lead government agency on mental-health services for direction. That agency, the Substance Abuse and Mental Health Services Administration (SAMHSA), is a $3.1 billion component of the Department of Health and Human Services. SAMHSA's official mission is to reduce "the impact of substance abuse and mental illness on America's communities." The only problem is that SAMHSA knows nothing about severe mental illness and, indeed, is not even certain that it believes such illnesses exist. That was the beginning of President Obama's problems (E. Fuller Torrey & D. J. Jaffe, 8/15).

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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.