Daily Health Policy Report

Thursday, August 2, 2012

Last updated: Thu, Aug 2

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch


Campaign 2012

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Group Health Teams With Hospital System In Pacific Northwest

Reporting for Kaiser Health News, Harris Meyer writes: "In an unusual partnership, a nonprofit health plan that employs its own doctors is joining with a major Catholic hospital system in the Pacific Northwest to provide more efficient health care services to members of all health plans in the Spokane, Wash., area" (Meyer, 8/1). Read the story.

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Mitt Romney On Health Care

Kaiser Health News reporters Matthew Fleming and David Schultz assembled this resource to provide details on Mitt Romney’s health policy record and positions (Fleming and Schultz, 8/1). Read the resource page.

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Capsules: Doctors Will Have To Figure Out Who Gets 'No-Cost' Birth Control; Experts Release 11-Point Plan To Reduce Health Spending; Israel's Health Care In The Spotlight After Romney Cost Comments

Now on Kaiser Health News' blog, Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports on the birth control coverage mandate: "The new provision of the federal health law that waives cost sharing for women's preventive health services may be a mandate on insurance companies, but it's providers who are complaining about its burden" (Whitney, 8/2).

Also on the blog, Julie Appleby reports on a new plan to reduce health spending: "The proposals include state spending targets; competitive bidding for medical devices, laboratory tests and other Medicare services; and a dramatic move away from the traditional way doctors and hospitals are paid" (Appleby, 8/1).

In addition, Sarah Barr offers details on Israel's health system after GOP presidential hopeful Mitt Romney's comments about it: "Mitt Romney caused quite a stir earlier this week when he applauded Israel for spending far less on health care than the United States but neglected to mention that the Israeli system depends on the kind of government regulation he has decried at home" (Barr, 8/1). Check out what else is on the blog.

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Analysis: App-Happy Health Care Full Of Optimism, Money

In this Kaiser Health News analysis, Michael L. Millenson writes: "There is a corner of the health care industry where rancor is rare, the chance to banish illness beckons just a few mouse clicks away and talk revolves around venture deals, not voluminous budget deficits. Welcome to the realm of Internet-enabled health apps" (Millenson, 8/1). Read the analysis.

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Political Cartoon: 'Fringe Benefits'

Kaiser Health News provides a fresh take on health policy developments with "Fringe Benefits" by John Deering.

Meanwhile, here's today's health policy haiku:

If Only We Could Control Costs Like Israel...

Israel knows best
about state-run health systems... 
Just ask Mitt Romney.  

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

Doctors, Women, Religious Groups Feel Impact Of Birth Control Coverage Mandate

Physicians say they -- rather than insurers -- will feel the burden of the rule. Meanwhile, Republicans in Congress stay relatively quiet on the requirement, but tensions continue among Catholics and evangelical Protestants.

Kaiser Health News: Capsules: Doctors Will Have to Figure Out Who Gets 'No-Cost' Birth Control
The new provision of the federal health law that waives cost sharing for women's preventive health services may be a mandate on insurance companies, but it's providers who are complaining about its burden (Whitney, 8/2).

The Washington Post: Five Facts About The Health Law's Contraceptive Mandate
Remember that part of the health reform law, that requires insurance companies to provide contraceptives at no cost to subscribers? After surviving a heated debate earlier this year, the regulation went into effect. … Here are five things to know about it (Kliff, 8/1).

Newshour (Video): Affordable Care Act Benefits Begin Roll Out, Including Women's Preventative Care
Some benefits outlined in the Affordable Care Act begin this week, including preventive services for women. Covered benefits include OB-GYN visits, HIV and other STD testing and birth control. Margaret Warner talks to NPR's Julie Rovner about the latest updates regarding health care reform.

Reuters: U.S. Rule Highlights Catholic Tensions Over Contraception
New rules requiring free access to prescription birth control for women with health insurance go into effect on Wednesday, but controversy lingers at some Catholic institutions struggling to balance the requirement with their opposition to contraception. At Georgetown University, the nation's oldest Catholic university, students and administration officials are still wrestling with the requirement to cover contraceptives as part of larger effort to expand no-cost preventive care for women (Heavey, 8/1).

National Journal: As Contraception Rule Goes Into Effect, Unusual Silence From Republicans
Religious freedom from government regulations was once seen as a winning talking point for Republicans. But on the day that a contraception regulation takes effect that several religious groups are challenging in court, Republicans are barely mentioning the topic. That is a stark contrast to what happened in February, when House Speaker John Boehner, R-Ohio, took to the floor for a rare one-minute speech promising to overturn a rule from the Obama administration requiring employers to pay for birth control for their workers (McCarthy, 8/1).

Local coverage of this health law provision -

Kansas Health Institute News: New Coverage Rules Expected To Have Big Impact In Kansas
The U.S. Department of Health and Human Services estimates that 450,000 Kansas women will benefit from federal rules that take effect today requiring health insurance companies to cover certain preventive and contraceptive services. The new rules in the Affordable Care Act prohibit charging co-payments and deductibles for specific preventive services, including well-woman visits, breast-feeding support and supplies, and testing for HIV, gestational diabetes and human papillomavirus. Screening for domestic violence and counseling for victims are also among the preventive services required. "This is an historic moment for Kansas women and their families," said Anna Lambertson, executive director of the Kansas Health Consumer Coalition (McLean, 8/1).

Milwaukee Journal Sentinel: Affordable Health Care Act Takes Effect
Basic preventive care on eight services, including a birth control benefit, for women insured under new health care plans went into effect Wednesday under the Affordable Health Care Act. About 967,000 women between the ages of 15 and 64 from Wisconsin enrolled in new health care plans are guaranteed access to preventive care under the Affordable Care Act guidelines, according to a U.S. Department of Health and Human Services brief released last month. Nationally, 47 million women are estimated to receive preventive health services for policies renewing on or after Aug. 1 (Qidwae, 8/2).

In related news -

CQ HealthBeat: Wheaton College Seeks Injunction Against Contraceptive Requirement
Lawyers for Wheaton College asked a federal court to grant a preliminary injunction Wednesday against enforcement of a Department of Health and Human Services requirement that the college offer free contraceptive coverage in its employee health insurance policies. Wheaton, an evangelical Christian liberal arts college in Wheaton, Ill., said in its filing in U.S. District Court for the District of Columbia that the requirement would apply to its health coverage because the HHS rule goes into effect for non-grandfathered plans that begin their open enrollment on Wednesday or later. The college said covering the so-called "morning after" emergency contraceptives known as Ella and Plan B would violate its religious beliefs (Norman, 8/1).

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Some Small Businesses Brace For Health Law Hardships

The Wall Street Journal reports on the impact the health law could have on restaurants and retailers, while other news outlets explore reverberations of the Supreme Court decision making the expansion of Medicaid effectively optional.

The Wall Street Journal: Small Firms See Pain In Health Law
Restaurants and retailers face some of the toughest changes now that the Supreme Court has kept the overhaul in place. These industries historically are among the least likely to provide insurance to workers. Many franchisees of big chains hover around the threshold at which they will be required to start insuring workers or pay the penalty. With high turnover and a large percentage of part-time and seasonal workers, restaurant and retail operators must juggle several variables in figuring out whether they will cross the threshold (Radnofsky, 8/1).

Medscape:  Medicaid Expansion?  Expand Pay Too, Physicians Say
In the wake of last month's Supreme Court decision on the Affordable Care Act, some governors have announced that their states will opt out of a dramatic expansion of Medicaid and the massive influx of federal dollars that comes with it.  That negative stance has provoked opposition, guarded agreement, and, more than anything, mixed feelings among leaders of affected state medical societies. Even physician supporters of Medicaid expansion acknowledge the dilemma that it poses — more people will gain coverage, but not necessarily a clinician who is willing to treat them, given the program's notoriously stingy rates (Lowes, 8/1).

Stateline:  Health Care Ruling Casts Doubts On Billions In State-Federal Funding
In striking down the federal health care law's mandatory Medicaid expansion, the U.S. Supreme Court's ruling last month limited a key component of the federal government's power over the states for the first time in decades, unsettling state-federal relations for years to come.  With the new limit in place, worries that countless other programs, regulations and mandates that impose federal requirements on states could face a similar fate are now beginning to reverberate around the country (Grovum, 8/1).

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Capitol Hill Watch

Medicare Seeks More Time To Estimate Cost Of Fixing Card Security Issues

A Centers for Medicare & Medicaid Services official, testifying before the House Ways and Means Committee, said it would take six more months to figure out this cost and that he could not yet provide a timetable for removing Social Security numbers from Medicare cards.  

The Associated Press/New York Times: Medicare Wants More Time To Study Cost Of Security Fix
Five years after being told to look at taking Social Security numbers off Medicare cards, Medicare officials say they need six more months to figure out how much it will cost. At a tense House hearing on Wednesday, Medicare's chief information officer, Tony Trenkle, said that he could not offer a timetable for making the change. Congressional auditors said that an earlier estimate of $800 million to $845 million was faulty, partly because of insufficient and inconsistent data (8/1).

CQ HealthBeat: Cost Estimates For Removing Numbers From Medicare Cards Expected In 6 Months
A Medicare official agreed to give Congress new cost estimates in six months for a proposal to remove Social Security numbers from beneficiaries' Medicare cards. Lawmakers of both parties at a House Ways and Means joint subcommittee hearing Wednesday agreed that displaying the full number on Medicare cards puts seniors at risk for identity theft. Beneficiaries are instructed to always have their cards on them, but that makes the sensitive number easy for someone else to obtain. Despite congressional pressure, lawmakers said, the Centers for Medicare & Medicaid Services has not come up with a plan for removing the Social Security numbers (Ethridge, 8/1).

The Hill: GOP Lawmakers: New Medicare Cards Would Help Prevent Identity Theft
The current Medicare card puts seniors at risk for identity theft and must be changed, two GOP subcommittee chairmen charged Wednesday. Reps. Wally Herger, R-Calif., and Sam Johnson, R-Texas, called on the Medicare agency to redesign its insurance card without beneficiaries' Social Security number. Most Americans do not carry their Social Security cards for fear of theft, but seniors face a dilemma because their Medicare cards prominently feature the number (Viebeck, 8/1).

The Associated Press/Boston Globe: Medicare Card ID Protections Overdue
Despite deep ideological divisions, Democrats and Republicans in Congress still can find common ground on one thing: their frustration with Medicare. Five years after being told to look at taking Social Security numbers off Medicare cards, Medicare officials told lawmakers at a sometimes-tense House hearing Wednesday that they still need six more months to figure out how much it will cost (Parnass, 8/1).

Meanwhile, a Government Accountability Office report is expected out today that highlights a legal glitch that makes it more difficult for the Internal Revenue Service to collect taxes from Medicaid providers -

The Associated Press: Gov't Report: Tax Cheats Getting Paid By Medicaid
Thousands of Medicaid health care service providers still got paid by the government even though they owed hundreds of millions of dollars in federal taxes, congressional investigators say. A legal technicality is making it harder for the IRS to collect. In a report being released Thursday, the Government Accountability Office says Medicaid payments to doctors, hospitals and other providers aren't technically considered federal funds, since they're funneled through state health care programs (Alonso-Zaldivar, 8/2).

And in other Capitol Hill news related to the IRS -

Marketplace:  How The IRS Will Enforce Health Care 'Tax' Penalty (Audio)
On Capitol Hill today, a House committee is looking into the effects of the Supreme Court's ruling on health care, specifically just how the IRS will assess a tax on people who don't carry health insurance. Opponents of the health care overhaul say the IRS isn't authorized to collect and share the personal information that's required (Hartman, 8/2).

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CBO Sets Price Tag For Delaying Scheduled Medicare Physician Payment Cuts: $271 Billion

Medpage Today: CBO: Delays In SGR Cuts To Cost $271 Billion
The Congressional Budget Office (CBO) has released updated figures on the cost of repealing -- or continuing to override -- the cuts doctors are scheduled to receive under Medicare's Sustainable Growth Rate (SGR) reimbursement formula. The fresh numbers give Washington lawmakers a better idea of the effect of changes they could make later this year to the SGR cuts. Physician reimbursements are scheduled to drop by 27% next year unless Congress acts, the CBO noted in the report. Every year since 2003, Congress has acted to override the SGR cuts by either maintaining or increasing payments when they were scheduled to drop. The CBO estimates that if cuts are blocked and payments sustained at current rates from now through 2022, it would cost an additional $271 billion from 2013 to 2022. Resetting payments to 2011 levels, only to increase them annually at 2% plus however much the gross domestic product (GDP) grows, would cost an additional $376.6 billion (Pittman, 8/1).

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Campaign 2012

Romney's Record On Health Care Examined

News outlets look at presumptive GOP presidential candidate Mitt Romney's style and positions on health care before and after he was governor of Massachusetts.

The Associated Press/Boston Globe: Romney's CEO Style Rankled Mass. lawmakers
What worked for Mitt Romney in the corporate boardroom didn't fly in the more raucous corridors of the Massachusetts Legislature. … A notable exception was Romney's work with Democratic leaders to craft a landmark health care bill, which then launched his 2008 presidential bid. Romney's signature legislative success got a big boost from Sen. Edward M. Kennedy, then the state's most powerful Democrat and a passionate advocate for universal health care (Miga and LeBlanc, 8/2).

Kaiser Health News: Mitt Romney On Health Care
KHN has assembled an overview of Mitt Romney's record as governor of Massachusetts and the positions he has taken on the campaign trail (Fleming and Schultz, 8/1).

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Health Care Marketplace

Experts Offer Disparate Views On Controlling Health Care Costs

Dueling articles in the New England Journal of Medicine Wednesday propose sharply different ways to curb medical spending. The proposals offer a glimpse of the rival approaches that could emerge in 2013, when Congress will have to tackle the budget deficit and the future of the Medicare program for the elderly and disabled.

Reuters: Democrats, Republicans Offer Rival Views To Control Health Costs
Democrats and Republicans agree that the next U.S. president will have to contend with rising health care costs that pose a growing, destabilizing burden for families, employers and government budgets. But two articles published in the New England Journal of Medicine on Wednesday show how far apart each side stands on the question of what to do, ahead of a November election showdown between President Barack Obama and presumptive Republican nominee Mitt Romney (Morgan, 8/1).

Kaiser Health News: Capsules: Experts Release Plan To Reduce Health Spending
The proposals include state spending targets; competitive bidding for medical devices, laboratory tests and other Medicare services; and a dramatic move away from the traditional way doctors and hospitals are paid (Appleby, 8/1).

Politico Pro: Advocates Unveil Cost Control Blueprint
A group of health experts, led by the left-leaning Center for American Progress, unveiled a slate of reforms Wednesday it says will reemphasize the "affordable" part of the ACA, in part by using a government hammer to move providers and insurers away from fee-for-service waste. Advocates for the new approach -- headlined by former CMS chief Don Berwick, former OMB Director Peter Orszag and Center for American Progress President Neera Tanden -- say their proposal represents "the next generation" of reforms intended to prevent health care costs from consuming a greater share of the national economy (Cheney, 8/1).

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Group Health, Providence Health Care Team Up In Pacific Northwest

The Group Health Cooperative and Providence Health Care are joining forces in a new limited liability corporation with the goal of providing more efficient health services.

Kaiser Health News: Group Health Teams With Hospital System In Pacific Northwest
In an unusual partnership, a nonprofit health plan that employs its own doctors is joining with a major Catholic hospital system in the Pacific Northwest to provide more efficient health care services to members of all health plans in the Spokane, Wash., area (Meyer, 8/1).

Modern Healthcare: New Doc Organization Forming In Wash.
Two not-for-profit healthcare organizations in the Spokane, Wash., area are forming a new company with more than 300 physicians—but they're stressing that this is not a merger or acquisition deal. The Group Health Cooperative and Providence Health Care are forming a new limited liability corporation under which "both organizations will work together in innovative ways to improve the overall delivery of healthcare services in Spokane," according to a joint news release (Robeznieks, 8/1).

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Super-Bug Technology Draws High-Tech Attention

The Wall Street Journal's Venture Capital Dispatch: Hospitals Investigate Start-Up Technologies For Superbug Disinfection
The Centers for Medicare & Medicaid Services has said 2012 will be the year that hospitals should start paying to treat infections contracted on their premises. Many investors have the issue pegged as a janitorial concern, and not necessarily the purview of high-tech gadgets. But others see an enormous unmet need, where several small companies are vying to unseat giants like Johnson & Johnson in a potentially lucrative field. Hospitals are now turning to esoteric technologies–including robots that use xenon ultraviolet light technology–to combat the germs (Hay, 8/1).

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State Watch

Most States Expect Higher Costs After Medicaid Expansion

A new report from the Government Accountability Office found that most state budget directors expect an increase in their costs if they expand Medicaid, even when the federal government picks up 100 percent of the expanded enrollment tab.

Modern Healthcare: States See Increased Costs In Medicaid Expansion: Survey
Most states expect the Medicaid eligibility expansion to increase their costs, even during the three years that the federal government provides a 100 percent reimbursement for the expanded enrollment, a government survey found. Ancillary activities to the Medicaid expansion included in the 2010 federal health care overhaul that are expected to increase costs for most states include the need to upgrade information technology for eligibility determinations, according to a Government Accountability Office survey of state budget directors released Wednesday (Daly, 8/1).

CQ HealthBeat: Health Care Law's Medicaid Expansion Costs Worry State Officials, GAO Finds
State budget directors are concerned about the cost and complexity of the Medicaid expansion included in the health care law, according to a Government Accountability Office report released Wednesday. The GAO, in response to a request from Sen. Charles E. Grassley, R-Iowa, surveyed states on how, by Jan. 1, 2014, they plan to implement the expansion of the joint federal-state Medicaid program to childless adults earning less than 138 percent of the federal poverty level (Norman, 8/2).

In Maine, officials are seeking to cut 30,000 from the Medicaid rolls --

The Wall Street Journal: Maine Seeks To Make Medicaid Cuts
Maine moved to strip about 30,000 low-income Medicaid patients from the state-run health program Wednesday, formally challenging federal officials on a key provision of the health law (Weaver, 8/1).

Politico Pro: Maine May Challenge Medicaid Rule In Court
Maine has formally asked the Obama administration to let the state pare back its Medicaid rolls, setting the stage for what could be another ugly legal fight over the president's health care law. Looking to reduce Medicaid eligibility rules in three areas, Maine argues that the Supreme Court's decision on the Medicaid expansion invalidated the Affordable Care Act's maintenance of effort provisions -- a claim that the administration has disputed (Millman, 8/1).

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Missouri Supreme Court Strikes Down Cap On Medical Malpractice Damages

Missouri's Supreme Court has ruled that a 20-year-old, $350,000 cap on noneconomic medical malpractice damages -- pain and suffering -- takes away a citizen's right to trial by jury and is unconstitutional.

Modern Healthcare: Missouri Supreme Court Overturns Malpractice Caps
Overturning decades of prior legal rulings, the Missouri Supreme Court ruled Tuesday that the state Legislature's $350,000 cap on noneconomic medical malpractice damages is an illegal violation of residents' constitutional right to a trial by jury. A divided court ruled  that "while this court always is hesitant to overturn precedent, it nonetheless has followed its obligation to do so where necessary to protect the constitutional rights of Missouri's citizens" (Carlson, 8/1).

Medscape: Missouri Supreme Court Strikes Down Malpractice Cap
The Missouri Supreme Court yesterday struck down a state law that caps non-economic damages in medical malpractice cases at $350,000. It declared that the law infringed on a person's right to trial by jury, which includes the right to have a jury set damages. The ruling, one of several recent setbacks for proponents of tough tort reform measures, illustrates the risk inherent in passing a federal law that would limit what a victorious plaintiff can receive in non-economic damages. Such a law, supported by organized medicine and congressional Republicans to curb supposedly frivolous suits and extravagant jury awards, theoretically could be overturned by the U.S. Supreme Court (Lowes, 8/1).

Kansas Health Institute News: Missouri Justices Overturn Cap On 'Pain And Suffering'
The Missouri Supreme Court has struck down that state's cap on non-economic damages that can be awarded by a jury in a medical malpractice case. The Kansas Supreme Court has had the same issue before it for more than three years in the case of Miller v. Johnson. In a 4-3 decision released Tuesday, the Missouri court ruled that the state's limits on the amounts juries can award someone injured from medical malpractice violated the constitutional right to a jury trial (Ranney, 8/1).

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U.S. Appeals Court Blocks Arizona's 20-Week Abortion Ban

A federal appeals court on Wednesday blocked an Arizona law banning abortions after 20 weeks of pregnancy as it considers the case. The law was upheld by a trial judge Monday and was set to take effect Thursday.

Politico: Court Blocks Arizona 20-Week Abortion Ban From Taking Effect
The 9th Circuit Court of Appeals on Wednesday issued a preliminary injunction that will block an Arizona law banning abortion after 20 weeks from going into effect this week. Responding to an emergency appeal filed by the Center for Reproductive Rights and the ACLU after a federal district court judge upheld the law on Monday, the circuit court Wednesday temporarily blocked the law from being implemented on Aug. 2 while the court considers the case against it (Smith, 8/1).

The Associated Press: U.S. appeals court blocks Ariz. 20-week abortion ban
A federal appeals court on Wednesday temporarily prohibited Arizona from enforcing its new ban on most abortions starting at 20 weeks of pregnancy. A three-judge panel of the 9th U.S. Circuit Court of Appeals issued its order two days after a trial judge ruled that the ban could take effect Thursday as scheduled (Davenport, 8/1).

Reuters: U.S. Appeals Court Blocks Arizona's New Late-Term Abortion Ban
A federal appeals court blocked Arizona on Wednesday from enforcing a new state ban on most late-term abortions that opponents say is the toughest in the nation, and agreed to an expedited review of the controversial measure. A three-judge panel of the 9th U.S. Circuit Court of Appeals issued the injunction two days after a federal judge upheld the ban and threw out a lawsuit brought against the Republican-backed law, which was due to go into effect on Thursday (Schwartz, 8/1).

Arizona Republic: Appeals Court Blocks Arizona's 20-Week Abortion Ban
The Ninth Circuit U.S. Court of Appeals granted a preliminary injunction Wednesday blocking implementation of Arizona's new law that bans abortions after 20 weeks of pregnancy. The law was to take effect today. With the injunction in place, the restrictions in the Mother's Health and Safety Act cannot be enforced until the San Francisco-based appeals court hears the case, likely in late October or early November, and issues a ruling (Pitzl, 8/1).

Bloomberg: Arizona Law Criminalizing Some Abortions Blocked for Now
An Arizona law that makes it a crime for doctors to perform abortions after 20 weeks of pregnancy was blocked from taking effect today by the U.S. Court of Appeals in San Francisco while a lower-court order is appealed. The appeals court ruled on a so-called emergency request to halt the law from three doctors who lost a lawsuit alleging the rule was preempted by the U.S. Supreme Court’s 1973 Roe v. Wade decision. A federal judge in Phoenix upheld the statute July 30, ruling that Arizona showed credible evidence that an unborn child may feel pain during such procedures (Gullo and Harris, 8/2).

CNN: Federal Court Blocks Arizona Abortion Law
The law was scheduled to go into effect Thursday, and a federal judge in Phoenix earlier this week had allowed it to go into effect. That prompted an emergency request for "injunctive relief" to the appeals court by the American Civil Liberties Union and the Center for Reproductive Rights, on behalf of three patients and their physicians. Those groups said in their successful emergency appeal the ban would force doctors to wait until a woman with a high-risk pregnancy was close to death or would suffer major medical damage before terminating a high-risk pregnancy (Mears, 8/1).

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State Roundup: N.Y. Law Requires Coverage For Partial Mastectomy

A selection of health policy stories from New York, Texas, Connecticut, Florida and Pennsylvania.

The Associated Press/Wall Street Journal: New Law Includes Coverage For Partial Mastectomy
New York's newest laws include one that will require health insurance to cover reconstructive surgery after partial mastectomies. Health insurers in New York must already cover the cost of reconstructive surgery after a full mastectomy (8/2).

Houston Chronicle: Texas Is Home To 40% Of Home Health Care Agencies With Suspicious Claims
The nation's top health care inspector is calling for a Medicare moratorium on new home health care agencies in Texas, where the largest number of companies are filing dubious claims, according to a report obtained by the Houston Chronicle. Nearly 40 percent of all home health care agencies or HHAs with suspicious billings came from Texas, according to the latest findings from the U.S. Health and Human Services Office of Inspector General. … "Florida and Texas each had a high number of (agencies) with questionable billings in 2010," states the report, scheduled to be released Thursday (Langford, 8/2).

CT Mirror: Budget Challenges Put Malloy, Urban Democrats At Odds
The plot revolves around Malloy's plan to curtail Medicaid benefits for single adults, a cut the governor needs to keep his new budget from slipping into an early deficit. Meanwhile, Democratic legislators from Connecticut's cities say this would leave more than 13,000 of the state's poorest residents -- most of whom are their constituents -- with no health coverage in a legislative election year. A better alternative, they say, would be to raise taxes on big business or the wealthy, neither of which are prevalent in their districts (Phaneuf, 8/1).

Medscape: Florida Appeals Defeat Of Gag Law On Physicians Gun Queries
The state is seeking to undo a permanent injunction that U.S. District Court Judge Marcia Cooke in Miami issued against the law in June. Cooke said the law, called the Firearm Owner's Privacy Act, violated the free speech rights of physicians. Individual Florida physicians and state chapters of the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Physicians had challenged the law in court, saying that physicians need to ask young parents about gun ownership for the sake of advising them about safe storage. The Florida law bans posing such questions, recording the responses in the patient's chart, and "unnecessarily harassing" or discriminating against gun owners (Lowes, 8/1).

Texas Tribune: Struggles Continue For Doctors Treating Elderly Poor
Months after Texas physicians treating the state's poorest seniors made a public plea for relief, there has been little movement to reverse a state policy that curbed their reimbursements for patients eligible for both Medicaid and Medicare. The policy change, made by budget-weary state lawmakers last session with an expectation that it would save an estimated $450 million over the next two years, has created unintended consequences for some doctors, who find themselves barely able to keep their doors open (Tan, 8/2).

AP/Miami Herald: Scott Promises Funding For Nursing Homes
Gov. Rick Scott promised adequate funding for nursing homes at a conference for providers of elderly care, but protesters criticized his opposition to President Obama's health care overhaul and his refusal to enforce some of its provisions. The Florida governor spoke for five minutes Wednesday to more than 700 attendees at the Florida Home Care Association's annual conference. Scott avoided about two dozen protesters who stood outside the Hilton Orlando in a downpour of rain (8/1).

MSNBC/Philly Burbs: Trio Indicted In $2.5 Million Medicare Fraud For Ambulance Rides
Three men, two of them from Bucks County, were indicted Wednesday in a $2.5 million scheme to defraud Medicare, according to the U.S. Attorney’s Office. MedEx Ambulance Inc. of Feasterville was indicted on 41 counts of health care fraud, false statements, wire fraud and conspiracy, said U.S. Attorney Zane David Memeger. The company, owned by Aleksandr N. Zagorodny of Holland and Sergey Zagorodny of Philadelphia, transported patients who could travel on their own and without an ambulance, according to the indictment (Mattar, 8/2).

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Weekend Reading

Longer Looks: Mississippi Learns From Iran's Health Care System

Every week, KHN reporter Shefali S. Kulkarni selects interesting reading from around the Web.

The New York Times: The Short Life And Lonely Death Of Sabrina Seelig
Sabrina Seeling seemed too young to die. ... One night she stayed up all night translating a Latin text into English for a college paper. ... During the all-nighter, Ms. Seelig took Ephedra, a stimulant diet drug that had been banned by the Food and Drug Administration three years earlier, and had a few beers. ... When she felt sick, she called Poison Control for help, and spoke very clearly, a recording of the call shows. She arrived by ambulance at Wyckoff Heights Medical Center, long regarded as one of the most troubled hospitals in the city, at 11:05 a.m. on May 30, 2007, conscious and alert but complaining of vomiting and dizziness. She was given a sedative that put her into a deep sleep, and her wrists were tied to the bed. None of her friends or relatives knew that she was there, and medical records show no measurements of her vital signs for hours that afternoon, suggesting that she was left unattended by the medical staff. By that evening she was brain damaged and on life support, with little hope of recovering (Anemona Hartocollis, 7/28).

The New York Times Magazine: What Can Mississippi Learn From Iran?
Dr. Aaron Shirley ... three years ago found inspiration for health care reform in an unlikely place: the primary health care system created in the 1980s in the Islamic Republic of Iran. The main issue in Iran back then was "disparities in health between its urban and rural populations," he told me recently. "In the U.S., these disparities exist. The Iranian model eliminated the geographic disparities, so why couldn’t this same approach be used for racial and geographic disparities in the U.S.?" Shirley created HealthConnect in 2010 because — and, in part, to prove to others that — poor people in Mississippi still have health problems, even if they have Medicaid or health insurance, even if there are clinics in their communities, even if they get home health services. They don’t get better, and the diseases born of poverty and obesity are not prevented (Suzy Hansen, 7/27).

CNN: Dogs: A Medicine For Mental Health Problems?
His name is Valor. He's half Labrador retriever, half Great Dane, and goes everywhere with Sgt. Charles Hernandez. But Valor is more than a pet -- Hernandez considers the dog a personal physician. When Hernandez was having seizures, Valor would nibble on the side of Hernandez's leg before the veteran realized anything was wrong. And the dog pulls him away from conflicts and jumps on him during anxiety attacks to calm him down. In combination with medications, Hernandez says the dog has helped his symptoms of post-traumatic stress disorder. ... A growing number of Americans are getting dogs for mental health needs, experts say. In the case of psychiatric service animals, such as Valor, they are trained specifically to help people with mental illnesses, in much the way seeing-eye dogs are taught to help to blind people (Elizabeth Landau, 8/1).

The Washington Post: 'The World’s Most Important Bake Sale:' One Patient's Plan To Pay For Chemotherapy
Arijit Guha is a 31-year-old who lives in Phoenix, Ariz. He is pursuing a doctoral degree in sustainability at Arizona State University. He recently got married. And, since February, he has sold tee-shirts to pay for his own chemotherapy. Guha has Stage 4 colon cancer, a diagnosis that comes with an 8.1 percent survival rate. While he does have health insurance, a student plan through Arizona State, it has a lifetime limit of $300,000 in medical expenses. Guha has spent all of that, largely on chemotherapy sessions that cost $11,000 each (Sarah Kliff, 7/29).

The Economist: Teenage Pregnancy: Setting Aside Childish Things
Between 1990 and 2008, according to a June 2012 report from the Centres for Disease Control (CDC), the teenage-pregnancy rate dropped by 40% nationally. ... It is now nationally at its lowest recorded level in more than 40 years. If the birth rate had stayed where it was in 1991, an additional 3.4m babies would have been born to teenagers between 1992 and 2010. The progress has been national and thorough. Nearly every state has seen a decline, as has every ethnic group. The drop has been particularly precipitous among black teenagers, although black and Latina teenagers continue to have a much higher pregnancy rate than Anglos and Asians. It is also that rare phenomenon, a public-health victory for which no one is claiming credit (7/28).

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Editorials and Opinions

Viewpoints: Orszag On CAP Cost-Control Proposals; High-Tech And Health Costs

Bloomberg: Smart Ways To Keep The Brake On Health-Care Costs
The [Center for American Progress] proposals thus wisely recognize that there is no single strategy to continue the recent progress in slowing the growth in health-care costs. In contrast, the Republican budget plan put forward by Representative Paul Ryan of Wisconsin seems based on a belief that all that’s needed is to shift risks: from Medicare to beneficiaries through a premium-support program, and from the federal government to state governments by turning Medicaid into block grants. I wouldn’t bet on these steps solving the problem. The only certain outcome from them is the shifting of risk onto state governments and individuals (Peter Orszag, 8/1).

The Washington Post: Curbing The Costs Of High-Tech Health
Advances in medical technology are a double-edged sword. On the one hand, they have brought huge health gains to millions of Americans. Hip and knee replacements, heart operations, brain surgery, drugs — treating everything from high cholesterol to depression — have become routine when they were once considered exotic or unimaginable. The drawback is that these same breakthroughs have driven health spending upward, because they’re prone to misuse and overuse (Robert J. Samuelson, 8/1).

The Hill: Need For Affordable Care Cuts Across Party Lines
The United States currently has an expensive, uncoordinated and inefficient healthcare system. By 2020, healthcare spending will make up one-fifth of our national economy. Excessive and wasteful healthcare spending fuels our nation's exploding federal debt and imposes unsustainable burdens on our federal and state governments, employers, individuals and their families. This is a grave threat to our nation's future health, economic viability and ability to compete in an increasingly competitive global marketplace (Tom Daschle and Bill Frist, 8/1).

JAMA: The Perverse Effects Of Corporate 'Speech' On The Health Reform Debate
Corporations are spending millions of dollars on ads attacking President Obama’s health care reform. Now that the Supreme Court has upheld the ACA, the next wave of political opposition is directed toward its repeal — by building up a groundswell of public opinion and removing from office elected officials who supported it. Political opposition to existing law and policy is well within the bounds of a liberal democracy that prizes the freedom of expression. But what makes this new wave of attack ads so perverse is that voters have no way of knowing who is behind the attacks (Lawrence O. Gostin, 8/1).

Market Watch: US View Of Health Care At Odds With Europe
Although it was pure coincidence, the timing could not have been better. A day after his visit to the U.K., Mitt Romney, opponent of health care reform (including, apparently, reforms even devised by himself) got to witness a whole section of the Olympics opening ceremony dedicated to that bastion of socialized health care, the British National Health Service, and all without a death panel in sight (Jason O’Mahony, 8/2).

Politico: ‘Obamacare’ Burdens Poor, Middle Class With Tax
Despite promises that the president’s health reforms would lower health care costs, “Obamacare” is saddled with new taxes, mandates and regulations that will increase the cost of care for families and job creators. New requirements force Americans to purchase a health plan deemed “essential” by Congress and bureaucrats at the Department of Health and Human Services. Price controls are to be imposed nationally — despite the fact that identical requirements enacted in several states dramatically increased premiums and eliminated consumer choice (Rep. Marsha Blackburn, 8/1).

MinnPost: Important Health-Care Milestone Begins To Roll Out
This week Planned Parenthood celebrates a critical early milestone for women’s preventive health under the Affordable Care Act (ACA). Specifically, the birth-control benefit that began going into effect on Wednesday will start making birth control available at no cost to millions of women, providing essential preventive care and easing the strain on Minnesota’s household budgets (Stoesz, 8/2).

Los Angeles Times: Health, Faith And Birth Control
Several Roman Catholic organizations have challenged Obama administration rules requiring religious colleges and hospitals (but not churches themselves) to offer preventive healthcare, including contraceptive coverage, with no deductibles or co-pays. Even though the Supreme Court has upheld the constitutionality of most of the Affordable Care Act ("Obamacare"), the courts still have to decide whether those institutions are exempt from the contraception requirement under a federal law called the Religious Freedom Restoration Act (7/31).

Detroit Free Press: The Endorsement That Dares Not Speak Its Name
I've never supported its mission to outlaw abortion, but there's no denying that Right to Life runs the smartest and most politically potent grassroots organization in Michigan. By recruiting anti-abortion-rights candidates for low-profile local races and mobilizing its members to participate in primary elections that most voters sit out, RTL has built a healthy farm team and secured an outsize role in Michigan's Legislature and its congressional delegation. But RTL is most effective when it keeps its electoral druthers close to the vest (Dickerson, 8/2).

The Washington Post: The Flawed Basis Behind Fetal-Pain Abortion Laws
On Thursday, Arizona’s new abortion law will take effect, outlawing the procedure after 20 weeks of pregnancy — a much earlier threshold than in any other law that has been upheld in court. Like-minded laws have been enacted in Nebraska, Alabama, Idaho, Indiana, Kansas, Oklahoma, Georgia and Louisiana, and a bill similarly limiting abortion in the District drew support Tuesday from a majority of the U.S. House, but not from enough members to pass (I. Glenn Cohen, 8/1).

Minneapolis Star Tribune: State Aims To Build A Better Medicaid
Called Reform 2020, it's a request for the feds to grant Minnesota the requisite authority to pursue an ambitious redesign of Medicaid, the $8 billion-a-year, state-federal health care program also called Medical Assistance. The effort deserves Minnesotans' notice and good wishes as it heads to the federal Centers for Medicare and Medicaid Services for approval…. The result is a map for the remainder of this decade for making Medicaid dollars stretch farther and serve elderly, needy and disabled people better (8/2).

The Washington Post: Kaine Embraces Bankrupt Entitlements
It’s a massive wealth transfer program from which there is no escape. But even with the fixes Tim Kaine urges — “like allowing for the negotiation of prescription drug prices — a measure that could save as much as $24 billion every year” — it will still go bust, and possibly as soon as 2014. Making the program solvent, then, will require more drastic action. But even the middling steps urged by Rep. Paul Ryan earn Kaine’s scorn (Norman Leahy, 8/1).

Denver Post: What's The Cost Of Freedom?
What's the cost of freedom for one Colorado family? Apparently, according to the Obama administration, it's nearly $10 million per year. That's how fines will stack up for members of the Newland family who run Hercules Industries in Denver if they do not prevail in their lawsuit against President Obama's abortion pill mandate and decide to abide by their consciences instead (Jane Norton, 8/1).

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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.