Daily Health Policy Report

Monday, August 18, 2014

Last updated: Mon, Aug 18

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicare

Health Care Marketplace

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospitals Reconsider Charity For Patients Who Decline Health Coverage

Kaiser Health News staff writer Julie Appleby reports: “As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t. The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage” (Appleby, 8/18). Read the story, which also appeared in The Washington Post.

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In Study, Questions About Who Should Perform In-Office Surgeries

Kaiser Health News staff writer Shefali Luthra reports: “One of the hopes embedded in the health law was to expand the role of nurse practitioners and physician assistants in addressing the nation’s shortage of primary care providers. But a new study questions whether that’s actually happening in doctors’ offices. Of the more than 4 million procedures office-based nurse practitioners and physician assistants independently billed more than 5,000 times in a year to Medicare – a list including radiological exams, setting casts and injecting anesthetic agents – more than half were for dermatological surgeries” (Luthra, 8/18). Read the story

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Searching For 'Big Ideas'; Patients Soliciting Bids For Care Online; Training Doctors

Read this Kaiser Health News regular feature in which readers respond to KHN original stories (8/15). Check out the comments

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Political Cartoon: 'A Three Hour Tour?'

Kaiser Health News provides a fresh take on health policy developments with "A Three Hour Tour?" by Larry Lambert.

Meanwhile, here's today's haiku:

THIS JUST IN

Congressional noise
Obscuring the benefits
misleading the pack.
-Dan Schulte 

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

Consumer Groups: Chronically Ill Still Face Insurer Discrimination

Patient advocacy groups are complaining to federal officials that some insurers' policies, such as the high prices charged for certain drugs, "are highly discriminatory against people with chronic health conditions." Other stories look at whether the health law has helped young people get mental health treatment and how hospitals are rethinking their charity policies.

The Associated Press: Have Insurers Found New Ways To Avoid The Sick?
Ending insurance discrimination against the sick was a central goal of the nation's health care overhaul, but leading patient groups say that promise is being undermined by new barriers from insurers. The insurance industry responds that critics are confusing legitimate cost-control with bias. Some state regulators, however, say there's reason to be concerned about policies that shift costs to patients and narrow their choices of hospitals and doctors. ... Coverage of expensive drugs tops [the patients'] concerns. (Alonso-Zaldivar, 8/17).

Kaiser Health News: Hospitals Reconsider Charity For Patients Who Decline Health Coverage
As more Americans gain insurance under the federal health law, hospitals are rethinking their charity programs, with some scaling back help for those who could have signed up for coverage but didn’t. The move is prompted by concerns that offering free or discounted care to low-income uninsured patients might dissuade them from getting government-subsidized coverage (Appleby, 8/18).

The Fiscal Times: Insurers Say Obama's 'Fix' Is Driving Up Premiums
President Obama buckled under political pressure last fall and exempted a wave of plans that would have otherwise been cancelled under the Affordable Care Act. He made the decision after critics blasted him for his famously flawed promise, "If you like your plan, you can keep it." While the new rule to grandfather in these non-compliant plans may have been beneficial for some people who didn’t have to find new policies this year, it could ultimately mean higher premiums for 2015. That’s what some insurers are saying (Ehley, 8/18).

NPR: Has Health Law Helped Young People Get Mental Health Treatment? Maybe
A popular provision of the Affordable Care Act that took effect in 2010 aimed to make it easier for young adults to get access to health care, by allowing them to stay on their parents' insurance until they turn 26. So, are more young adults getting help with mental health issues because of the provision? Maybe, suggests a study published in the September issue of Health Affairs. Before 2010, just over 30 percent of young adults with mental health issues said they were getting treatment. And that went up by about 2 percent in the two years after the ACA provision took effect (Singh, 8/15).

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Rocky Rollout Of ACA Benefits For Oregon's Developmentally Disabled

Many developmentally disabled Oregonians qualify for more money to cover services at home under the Affordable Care Act, but families say there aren't enough providers to go around. Meanwhile, consumer advocacy groups in North Carolina look for people who qualify for Obamacare and don't know it. And Connecticut reports a 55 percent increase in the size of its individual insurance market.

The Oregonian: Affordable Care Act Benefits Soar For Oregonians With Developmental Disabilities, Potentially Costing State Millions
But while some families are rejoicing [about the law's increased benefits], others worry that a change in how services are calculated and funded could cost the state millions of dollars. Under a provision of the Affordable Care Act, many of the 9,000 Oregonians with developmental disabilities who live at home are now eligible for three times or more in the amount of money to cover services – or tens of thousands of dollars each. In addition, the rollout has been rocky, requiring wholesale changes to the system without disrupting services (Zheng, 8/15).

Charlotte Observer: Fired, Freed Or Married? Health Insurance Aid Might Help
In bridal shops and jails, moms’ groups and charities, the search is on for people who qualify for low-cost health insurance and don’t know it. When open enrollment for subsidized insurance ended this spring, the spotlight on the Affordable Care Act dimmed. But advocates in Charlotte and around the country are working to let people know that life changes that range from losing a job to saying “I do” can trigger an opportunity to sign up before the 2015 enrollment period starts in November. “A lot of these folks aren’t looking for this information because they don’t know it’s there,” said Mark Van Arnam, who is leading Charlotte-area efforts for the nonprofit Enroll America (Helms, 8/17).

The CT Mirror: CT’s Individual Insurance Market Grew 55 Percent Under Obamacare
The number of Connecticut residents covered by health insurance purchased through the state’s individual market rose by nearly 60,000 since last year, a 55 percent increase since the implementation of major provisions of Obamacare, according to figures released by the Connecticut Insurance Department. The data also show that more than half the people who bought their own health insurance last year have maintained their old policies or other plans purchased late in 2013. But more than 50,000 of them won’t be able to keep their health plans beyond this year, potentially setting up a repeat of last fall’s turmoil and frustration among people whose policies were discontinued (Becker, 8/18).

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Three Southern Governors Tout Medicaid Expansion Benefits

Also, a report says Wisconsin is leaving more than $206 million on the table by not fully expanding its Medicaid program, BadgerCare.

The Associated Press: Governors Tout Benefits Of Medicaid Expansion
Three governors who expanded Medicaid under the federal health care overhaul said Saturday there are economic and moral arguments for embracing a key part of the law, despite strong political opposition in their southern states. The Democratic governors of Arkansas, Kentucky and Maryland touted the success their states have seen in cutting the number of uninsured residents during a panel discussion at the Southern Governors' Association annual meeting in downtown Little Rock. Arkansas and Kentucky had the highest drop in the number of uninsured residents in a Gallup poll released earlier this month (DeMillo, 8/16).

Milwaukee Journal Sentinel: Wisconsin Loses $206M By Not Fully Expanding BadgerCare
Wisconsin taxpayers would have saved $206 million over two years -- 73 percent more than estimated -- if officials had fully expanded its main health care program for the poor under the federal Affordable Care Act, a new nonpartisan report shows. If officials decide to change course and expand the program in the next state budget, state taxpayers would save another $261 million to $315 million through June 2017, according to the Legislative Fiscal Bureau. The bureau serves the Legislature and is widely respected by lawmakers from both sides of the aisle. In all, the state could have saved more than $500 million over 3-1/2 years, the report shows. That would have allowed Gov. Scott Walker and legislators to put more money toward schools or roads or cut taxes more deeply than they did over the last year (Marley, 8/17).

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Capitol Hill Watch

House GOP Focuses On Administration Official's Instruction To Delete Email

House Republicans are pointing fingers at Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner's direction to delete an email related to the health law's troubled launch.  

The Hill: GOP Says Obama Health Official Instructed Staff To Delete Email
House Republicans on Friday accused a top Obama administration health official of telling staff to delete an email related to the healthcare law’s rollout last fall. In a letter to Centers for Medicare and Medicaid Administrator Marilyn Tavenner, the Republicans point to an Oct. 5 email from Tavenner to staff about how to handle calls from people applying for ObamaCare. In the first line of the email, Tavenner writes "please delete this email but see if we can work on call script" (Al-Faruque, 8/15).

Fox News: Republicans Question HHS Official's Instruction To 'Delete' Internal Obamacare Email
A key official overseeing the ObamaCare launch last fall asked a subordinate to "delete" an email exchange on the matter, according to newly released records, fueling Republican concerns that the administration may be hiding internal discussions from Congress. "Time and again, the self-proclaimed 'most transparent administration' has been anything but," House Energy and Commerce Committee Chairman Fred Upton, R-Mich., said in a statement. "And now we know that when HealthCare.gov was crashing, those in charge were hitting the delete button behind the scenes." Upton and other GOP committee leaders on Friday released an email exchange from Oct. 5, 2013, shortly after HealthCare.gov launched to widespread problems. It showed Marilyn Tavenner, administrator for the Centers for Medicare and Medicaid Services, telling an employee in the public affairs office to "please delete this email" (Berger, 8/15).

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GOP Senate Candidate Seeks Wider Birth Control Access And End To Charges Of War On Women

Rep. Cory Gardner is the first Republican candidate to talk up a new Republican idea of making birth control available over the counter.

The Hill: Can Over-The-Counter Birth Control Push Pay Off For Republicans?
Republicans want to beat Democrats at their own game this November by proposing a new way to widen access to birth control. GOP candidates around the country are saying they want to make the pill available over-the-counter without a doctor's prescription for the first time since it was approved in 1960. The party hopes its stance, widely shared by healthcare providers, will help neutralize tough debates over birth control coverage and cut into Democrats' traditional advantage among women voters. "Cory's proposal puts women in control," said Alex Siciliano, spokesman for Rep. Cory Gardner (R-Colo.), the first 2014 Senate candidate to talk up the idea (Viebeck, 8/18).

Denver Post: Renamed 'War on Women' Strategy Forges Ahead In Colorado Senate Race
The playbook is no secret. Four years ago, U.S. Sen. Michael Bennet successfully defined his Republican opponent as a man waging a war on women. The political maneuver is still viewed as a cautionary tale by Colorado Republicans who saw Bennet take the office with a 16-point edge among women voters during a year in which the Tea Party enjoyed strong gains. They watched as similar plans were replicated by Democrats across the country, helping President Barack Obama win his 2012 re-election bid against Mitt Romney. Now, U.S. Sen. Mark Udall is employing the campaign narrative against Republican Cory Gardner in an effort to appeal to women voters as the November election draws near (Torres, 8/17).

Politico Pro: NARAL Poll: Most Voters Against Abortion Access Limits
Nearly 70 percent of registered voters say the government should not restrict access to abortion, according to a new national poll that a prominent abortion-rights group says should discourage politicians from trying to limit access to the procedure. In a poll that NARAL Pro-Choice America plans to release Monday, more than one in five voters — 23 percent — said they believe abortion is morally acceptable and should be legal. Forty-five percent said that while they are personally against abortion, they don’t believe the government should put limits on a woman’s access (Haberkorn, 8/18).

The intense congressional campaign season is keeping lawmakers out of Washington for much of the rest of the fall, raising questions about some of the work that awaits.

Modern Healthcare: Political Season Injects A Lot Of Variables Into Health Care Agenda
The dynamics of healthcare reform may wildly change in the weeks ahead. The congressional calendar calls for a short legislative session followed by nonstop campaigning, a November election followed by a lame-duck session, and then finally the seating of a new Congress that could feature a shift in power in the Senate. While healthcare stakeholders have their own interests and priorities, reaching an agreement to fund the government beginning Oct. 1 will top the legislative agenda, said Tom Nickels, the American Hospital Association's senior vice president for government relations (Robeznieks, 8/15).

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Medicare

Combating Medicare Fraud Proves To Be A Difficult Proposition

The New York Times reports that, despite stepped-up enforcement and investments in anti-fraud efforts, the administration's push has so far not made much progress. Meanwhile, The Washington Post examines a classic Medicare scam.

The New York Times: Pervasive Medicare Fraud Proves Hard To Stop
The Obama administration’s declared war on health care fraud, costing some $600 million a year, has a remarkable new look in places like Baltimore and Miami. But even with the fancy computers and expert teams, the government is not close to defeating the fraudsters. And even the effort designed to combat the fraud may be in large part to blame. An array of outside contractors used by the government is poorly managed, rife with conflicts of interest and vulnerable to political winds (Abelson and Lichtblau, 8/15).

The Washington Post: A Medicare Scam That Just Kept Rolling
The wheelchair scam was designed to exploit blind spots in Medicare, which often pays insurance claims without checking them first. Criminals disguised themselves as medical-supply companies. They ginned up bogus bills, saying they’d provided expensive wheelchairs to Medicare patients — who, in reality, didn’t need wheelchairs at all. Then the scammers asked Medicare to pay them back, so they could pocket the huge markup that the government paid on each chair. A lot of the time, Medicare was fooled. The government paid (Fahrenthold, 8/16).

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Medicare To Begin Paying Physicians To Coordinate Care For Patients With Chronic Illnesses

The New York Times: Medicare To Start Paying Doctors Who Coordinate Needs Of Chronically Ill Patients 
In a policy change, the Obama administration is planning to pay doctors to coordinate the care of Medicare beneficiaries, amid growing evidence that patients with chronic illnesses suffer from disjointed, fragmented care. Although doctors have often performed such work between office visits by patients, they have historically not been paid for it. Starting in January, Medicare will pay monthly fees to doctors who manage care for patients with two or more chronic conditions like heart disease, diabetes and depression (Pear, 8/16).

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Health Care Marketplace

Feds To Withhold Some Doctor Payment Data After Inconsistencies

The Centers For Medicare & Medicaid Services said Friday that, because of data inconsistencies, a third of the records in a database showing drug and device-maker contributions to doctors will be withheld next month when the website goes live.

ProPublica: Government Will Withhold One-Third Records From Physician Payment Database
Next month, when the federal government releases data about payments to physicians from pharmaceutical and medical device makers, one-third of the records will be withheld because of data inconsistencies, an official told ProPublica. The issue is the latest hurdle for the federal government as it seeks to launch the already-delayed Open Payments database mandated under the Physician Payment Sunshine Act, a provision of the 2010 Affordable Care Act. Making this information public is a crucial step in promoting greater transparency about conflicts of interest in medicine (Ornstein, 8/15).

The Hill: CMS Delays Release Of Some Doctor Records On Transparency Website
The Centers for Medicare and Medicaid Services said Friday that a third of the records in a database showing physician ties with the drug and medical industry have errors and will not be made public in September. “CMS is returning about one-third of submitted records to the manufacturers and [group purchasing organizations] because of intermingled data, and will include these records in the next reporting cycle,” said agency spokesman Aaron Albright (Al-Faruque, 8/15).

Meanwhile, the Alabama Supreme Court holds that Pfizer is liable for harm caused by a generic version of its drug --

The Wall Street Journal: Pfizer Is Liable For Harm Caused By A Generic Version Of Its Drug: Court
Should brand-name drug makers be held liable if consumers are harmed by a medicine made by a generic rival? The Alabama Supreme Court believes the answer is yes. And the court has upheld its own controversial ruling that Pfizer can be sued by an Alabama man who claimed he was injured by a generic version of its Reglan heartburn medicine. Why? The brand-name drug maker purportedly failed to warn his physician about the risks. The decision is potentially significant, because this is one of the few cases in which a court has found that a brand-name drug maker can be sued, even though a consumer had taken only the generic version (Silverman, 8/15).

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Why Didn't Your Health Insurance Cover Your Bill?

Also, blood test pricing variation in California is examined.

USA Today: 5 Reasons Health Insurance Didn't Pay Your Bill
How many times have you gotten a medical bill for more than you were expecting? Chances are, it's happened before, and you're not the only one who's been shocked at the price tag on a service that your insurance should have covered. Here are five possible reasons ... 1. Your insurance company made an error. ... 2. Your provider "accepts your insurance" -- but isn't in your plan's network. ... 3. Your free annual examination wasn't billed as a free exam. ... 4. Your insurance company practices "bundling." .... 5. There's missing information (Flynn, 8/17).

The Washington Post: A $10,000 Blood Test?!? Yes, Really.
Imagine walking into a hospital and being charged more than $10,000 for a blood test to check your cholesterol level. And going to another hospital in the same state and being charged $10 for the exact same blood test. That’s what a team led by a University of California San Francisco researcher found when it looked at the prices California hospitals charge for 10 common blood tests (Sun, 8/15).

Related KHN story: Wide Variation In Hospital Charges For Blood Tests Called 'Irrational' (Rabin, 8/15).

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State Watch

After Rejection Of Increases, Conn. Premiums Set To Decrease

Elsewhere, Missouri regulators have less authority to review insurance rates than other states do. And Massachusetts' health insurance premiums are set to rise.

The CT Mirror: After Rate Hike Rejected, Anthem To Decrease Premiums Next Year
Anthem Blue Cross and Blue Shield’s individual-market customers will, on average, see a slight decrease in their premiums next year under new rates approved by the Connecticut Insurance Department. Anthem, the state’s largest insurer, initially requested approval to raise rates by an average of 12.5 percent. But the insurance department rejected the proposal and asked the company to resubmit its plan using different calculations. The result: An average premium decrease of 0.1 percent for Anthem customers (Becker, 8/15).

St. Louis Post-Dispatch: Missouri Lags Behind In Insurance Pricing Transparency
Connecticut, Kansas and Illinois are among a long list of states and the District of Columbia that have some sort of authority to review insurance rates, meaning pricing, before plans are sold. But that type of authority does not exist in Missouri. The Show-Me State is one of the only states that does not have the ability to review health insurance rates. Wyoming is close behind; it has only the ability to review rates for health maintenance organizations, or HMOs. Advocates say it’s time for a change in Missouri (Liss, 8/17).

WBUR: Mass. Health Insurers Report Losses; Many Premiums To Rise By 3 Percent
Premiums for Massachusetts small businesses and residents who buy insurance on their own are going up. The average increase for Jan. 1 is 3.1 percent. But this is just the base rate. Your rates could be higher or lower, depending on how much you or your fellow employees have spent on health care this year. Insurers say premiums are going up because residents are using more care. What’s known as “utilization” in the insurance world dropped during the recession, but appears to be creeping up again (Bebinger, 8/15).

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State Highlights: Calif. Hospital Bid Draws Scrutiny; Hospital House Calls

A selection of health policy stories from California, Pennsylvania, Washington and Minnesota.

Los Angeles Times: Health Care Chain's Bid For 6 Hospitals Draws Protest
Prime Healthcare Services Inc., a hospital chain that has come under fire for billing and patient privacy issues, is facing opposition over its potential acquisition of six California hospitals, including two medical centers in Los Angeles County. On Friday, hospital workers, union representatives and elected officials protested against Prime outside St. Vincent Medical Center near downtown Los Angeles, one of the six hospitals put up for sale this year by the Daughters of Charity Health System (Garland, 8/15).

Pittsburgh Tribune-Review: Hospital Makes House Calls To High-Risk Patients
The doctor sat in Valerie Robinson's apartment and marveled at the number of pill bottles she kept in a zippered bag. "Holy schmoley, girl!" Dr. Rick Fogle said as he sorted through the medications in Robinson's Harrison high-rise. Checking the drugs against a list, Fogle concluded that more than half were not part of her official medical record. Within two hours, he found that Robinson's doctor had moved offices and she needed a new doctor. Without this rare home visit, Robinson, 65, likely would have ended up hospitalized, Fogle said. To avoid this, hospitals target patients such as Robinson and send doctors to their homes, hoping to prevent readmissions (Fabregas, 8/16).

The Star Tribune: Care Aides Get Little To No Training For Life-And-Death Tasks
Each day, thousands of home-based caregivers such as Sernett are thrust into similar life-and-death situations with little training and virtually no direct supervision. They perform a dizzying array of complex medical tasks -- from inserting feeding tubes and cleaning infections to monitoring intravenous fluids -- that once were provided only in hospitals or nursing homes by medical professionals. Many say they feel overwhelmed and unqualified as they struggle to help patients with serious illnesses and disabilities. In Minnesota, where more than 100,000 care assistants serve some 36,000 vulnerable patients, all it takes to be certified as a home caregiver is a brief online quiz with questions such as, “When talking to a 911 operator, do not hang up. True or false?” (Serres, 8/17).

Seattle Times: Premera And LifeWise Will Include Children’s In Coverage
Premera Blue Cross and its subsidiary, LifeWise Health Plan of Washington, will include Seattle Children’s hospital and its specialists in its individual and small-group health insurance-plan networks for 2014 and 2015. The moves put an end to the insurer’s part in a long-running legal dispute with widespread implications. The issue -- whether the state insurance office violated state and federal laws in approving plans that didn’t include Children’s -- sparked a yearlong battle that pitted various insurers against a medical system whose patients include children with difficult, often deadly, conditions (Ostrom, 8/17).

MinnPost: Midwest Leads In Increase Of Hospitalizations For Prescription Painkiller Overdoses
Hospitalizations resulting from the overuse of prescription opioid painkillers have risen more than 150 percent during the last two decades, according to a new national report. That stunning increase was greatest among Midwesterners, women and people aged 45 or older. Much recent media attention on drug overdoses has focused on deaths from illegal drugs, particularly heroin. But, as the findings from this new report underscore, deaths from prescription opioids -- a class of drugs that includes oxycodone, hydrocodone, fentanyl and morphine -- is an even bigger problem. Some 60 percent of drug overdose deaths in the U.S. involve prescription drugs, and three out of four of those deaths -- more than 16,600 each year -- are caused by prescription opioids, according to the Centers for Disease Control and Prevention (Perry, 8/15).

Minnesota Public Radio: New Immunization Requirements Coming
Thousands of Minnesota children will be subject to new vaccination rules next month. Beginning Sept. 1, children enrolled in childcare and early childhood programs will be required to get vaccinated against Hepatitis A and B. Those requirements already applied to some programs, but the rule change extends the requirement to every early childhood program. "If you weren't caught up this is the reminder that you need to make sure that your kids are getting caught up," said Kris Ehresmann, director of the infectious disease division at the Minnesota Department of Health (8/16).

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Editorials and Opinions

Viewpoints: Va. GOP's 'Medicaid Charade'; Paul Ryan's Health Rx For Poverty; Giving The Sick Unapproved Drugs

The Washington Post: Republicans' Medicaid Charade In Virginia
Virginia lawmakers will convene in a special session next month to address the question of expanding Medicaid and, more broadly, the fact that hundreds of thousands of poor and disabled people in the state have no health insurance coverage. Democrats and some moderate Republicans have advanced a variety of ideas to tackle that problem. Conservative Republicans, who control the legislature in Richmond, have rejected those solutions while proposing no alternative. Does the GOP intend for the special session to be anything more than a charade at taxpayers’ expense? (8/15).

Raleigh News & Observer: Blocking NC's Medicaid Expansion Takes A Heavy Toll
The Republican-led General Assembly plans to address ways to reform Medicaid in its next session, but there's one thing it won’t do to the program: expand it. This resistance is a scandal and a growing one. It’s well past time for responsible and influential forces in North Carolina – the universities, banks, high-tech businesses, hospitals, clergy and others – to make expanding Medicaid the state’s No. 1 priority (8/16).

Milwaukee Journal-Sentinel: More Fuel On The Fire For Medicaid Expansion
[In] recent months, the cases for Medicaid expansion has become even more compelling in our state. ... Our state's refusal to accept Medicaid expansion resulted in nearly 63,000 Wisconsinites being dropped from BadgerCare. Now, reports are showing that around 38,000 of those people don't have insurance through the federal health care exchange, as intended. Accepting the federal expansion funds would have insured 84,700 more people, saved Wisconsin taxpayers millions of dollars (at least $100 million in the current biennium), and brought money into our economy (Drs. Richard E. Rieselbach, Ian H. Gilson And Thomas C. Jackson, 8/15).

The Wall Street Journal: Senate Democrats Vs. The Middle Class
ObamaCare, which gave government control of the health-care system, was vigorously supported, promoted and defended by every Senate Democrat. It became law in March 2010 without a single Republican vote in either house of Congress. Every Democratic senator cast the deciding vote for ObamaCare. … It is impossible for any Democratic senator running for re-election this year to credibly argue that he or she did not support the president's program or provide a critical vote to enact it. No Democratic candidate can argue that by electing him or her and sustaining the Democratic majority in the Senate, voters can hope to alter the president's program (Phil Gramm and Michael Solon, 8/17). 

The Wall Street Journal: A Better Way Up From Poverty
[T]he Founders' vision, ... puts individuals, their families and their communities—not government—at the center of American life. What does this vision look like in action? For starters, it favors choice and competition over government-run solutions. It would make health care a true market with transparent prices and more choices. It would empower Americans to make their own health decisions. Instead of top-down price controls imposed by bureaucrats, we'd have bottom-up competition driven by millions of consumers. That won't just lower health-care costs; it will improve the quality of care (Rep. Paul Ryan, R-Ill., 8/16).

The New York Times’ The Upshot: Medicare Advantage Is More Expensive, But It May Be Worth It
Medicare Advantage plans — private plans that serve as alternatives to the traditional, public program for those that qualify for it — underperform traditional Medicare in one respect: They cost 6 percent more. But they outperform traditional Medicare in another way: They offer higher quality (Austin Frakt, 8/18). 

Los Angeles Times: New Data: How The Attack On Contraceptive Services Targets The Poor
The political attack on contraceptive services and family planning is often depicted as an attack on all women. So it is, but new data show how it's become a particular burden on low-income women. The data come from the Guttmacher Institute, one of our leading advocacy organizations for women's reproductive health (Michael Hiltzik, 8/15). 

The Washington Post: Stop Calling Abortion A 'Difficult Decision'
Planned Parenthood calls abortion "a difficult decision" in many of its consent forms and fact sheets. When NARAL launched a film on the 40th anniversary of Roe v. Wade in 2013, the president of the pro-choice organization called abortion "a difficult decision" women and couples face. ... However, when the pro-choice community frames abortion as a difficult decision, it implies that women need help deciding, which opens the door to paternalistic and demeaning "informed consent" laws. It also stigmatizes abortion and the women who need it (Janet Harris, 7/15). 

USA Today: FDA Vs. Right To Try: Our View
The deadly Ebola outbreak spreading through Africa is so extreme, it is driving health officials to do something that they would instinctively resist in normal circumstances: Subject patients to unproven experimental drugs. The drugs are risky. Some have not even been tested on humans. Even so, a World Health Organization ethics committee just declared such use ethical, and its reasoning is hard to dispute, at least for patients who would otherwise die. Some chance is better than none, even with unknown side effects. Too bad American patients suffering from terminal illnesses have so much trouble getting the same chance (8/17). 

USA Today: FDA Is Not The Main Problem: Opposing View
Suppose that you found out your son or daughter was dying of an untreatable brain tumor. Suppose you also found out that a pharmaceutical company was working on a drug to treat that disease but that it had only been tested in 10 adults. While all the patients came through unharmed, only two showed a little improvement. If your doctor said that drug was your child's only hope, but the Food and Drug Administration (FDA) might not let you get it, wouldn't you want something done? That is exactly what state "right to try" laws seek to do. The problem is that the FDA is not the main obstacle standing between desperately ill people and experimental drugs (Arthur L. Caplan, 8/17). 

The Washington Post: Time To Cut The Hype And Focus On The Real Dangers Of Ebola
The Ebola virus outbreak in West Africa has seized the world’s attention like a summer horror movie. The images of a terrible disease without a cure have surged across news and social media. Late last week, a spokesman for the World Health Organization (WHO) said the scope of the outbreak appears to have been "vastly underestimated." ... It is time to get sober, fast. The Ebola infections in four nations of West Africa may have been started by Mother Nature, but controlling them is now very much in the hand of humans. More than 1,000 people have died. Either the world gets this right or the outbreak will spread (8/17).

The Washington Post: When A Friend Asks You to Help Her Die
In July 1998, I received a call from an old friend. She was in intensive care in a New Hampshire hospital, where she lay, nearly quadriplegic, with a halo brace screwed into her skull to buttress her broken neck and shocked spinal cord. An avid horsewoman and competitive carriage racer in her mid-70s, she had been devastatingly injured when her horse spooked, flipping the carriage over on top of her. "The surgeon wants my permission to operate if I improve neurologically but the fracture does not heal. Will you promise me that if I remain a quadriplegic you will come and put me down?" I did not hesitate in my answer to her. "Yes," I said (Jerald Winakur, 8/17). 

The New York Times: To Know Suicide
It is often easier to account for a suicide by external causes like marital or work problems, physical illness, financial stress or trouble with the law than it is to attribute it to mental illness. ... Suicidal depression involves a kind of pain and hopelessness that is impossible to describe — and I have tried. I teach in psychiatry and have written about my bipolar illness, but words struggle to do justice to it. How can you say what it feels like to go from being someone who loves life to wishing only to die? (Kay Redfield Jamison, 8/15).

Seattle Times: Washington Can Do Better In Mental-Health System
But, for reasons ranging from the stigma associated with mental illness to insurance that does not cover mental health as it does physical health, as many as 40 percent never get treatment and struggle throughout their lives. ... The Affordable Care Act has opened a door to solutions, providing insurance to those who had none. Washington is ahead of many states because the Legislature embraced Medicaid expansion. But this state has also failed in some ways (Kate Riley, 8/16).

The New York Times: Cancer And The Secrets of Your Genes
Genetic testing has revolutionized how we think about cancer, allowing us to make some decent predictions about who might get certain cancers and who might benefit from preventive treatments. ... The problem is that many patients think genetic testing can tell us far more than it does. Despite the exaggerated claims of some entrepreneurs and lab owners, we can’t predict patients’ cancer risk and advise them appropriately just by sequencing their genome. At least not yet (Theodora Ross, 8/16).

The New York Times: The Verdict On A Troublesome Carcinogen
Formaldehyde, a substance widely used in consumer products and industrial processes, has been authoritatively judged a carcinogen despite the best efforts of the chemical industry to confuse the issue. A panel of experts convened by the National Academy of Sciences found sufficient evidence from human studies to declare formaldehyde "a known human carcinogen" that causes nasopharyngeal cancer, sinonasal cancer and myeloid leukemia. It also cited evidence from studies of animals and of carcinogenesis suggesting that formaldehyde may cause a much wider array of cancers than just those three (8/17).

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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.