Daily Health Policy Report

Wednesday, August 20, 2014

Last updated: Wed, Aug 20

KHN Original Reporting & Guest Opinion

Health Reform

Health Information Technology


Health Care Marketplace

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Wrestling With A Texas County’s Mental Health System

Kaiser Health News staff writer Jenny Gold reports: "Evans is the director of the Center for Health Care Services, the community mental health system in San Antonio and Bexar County. Texas ranks 49th out of 50 states in how much funding it commits to mental health. But under Evans’ leadership, Bexar County has built a mental health system considered a model for other cities across the country -- one that has saved $50 million over the past five years" (Gold, 8/20). Read the story, which also ran on NPR.

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Political Cartoon: 'Admission Against Interest?'

Kaiser Health News provides a fresh take on health policy developments with "Admission Against Interest?" by Ron Morgan.

Meanwhile, here's today's haiku:


Opioid treatment?
Check. But we will not help you
with your HCV.
-Paige Kulie 

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

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Health Reform

Health Law's Medical Device Tax Falls Short Of Revenue Target

An IG report concludes that the Internal Revenue Service continues to face problems implementing this tax, including difficulties in identifying the companies that owe it.

The Hill: Report: Medical Device Tax Missing Revenue Mark
A tax imposed on medical devices included in the Affordable Care Act is raising roughly three-quarters of the revenue originally expected, according to a new government report. The watchdog for the Internal Revenue Service reported Tuesday that the tax collection agency was still facing problems implementing the medical device tax included in the 2010 healthcare reform law. The Treasury Inspector General for Tax Administration (TIGTA) said the IRS needs to continue to tweak its compliance rules for the tax, identifying several mistakes when it came to collecting money owed the government (Schroeder, 8/19).

The Associated Press: Audit: Obamacare Medical-Device Tax Not Meeting Revenue Target
An Obamacare tax on medical devices is falling short of its revenue target because thousands of companies aren't paying it, according to a government audit released Tuesday. The audit by the Treasury inspector general for tax administration says the IRS needs to do a better job policing the tax. The tax agency, however, doesn't have adequate tools to identify which companies owe it, the audit said. The report could add fuel to efforts to repeal the tax, which is opposed by Republicans and many Democrats (Ohlemacher, 8/19).

Politico Pro: TIGTA: IRS Fumbles Medical Device Tax
The IRS needs to beef up its enforcement of a medical device tax imposed as part of Obamacare, an IRS watchdog said on Tuesday. The agency doesn't know how many companies are subject to the 2.3 percent levy, and those that are sometimes either pay too much or too little, according to a report by the Treasury Inspector General for Tax Administration. What's more, the IRS wrongly issued hundreds of penalties for companies failing to pay, the report said (Weinger and Faler, 8/19).

The Fiscal Times: How the IRS Is Botching Obamacare Tax Collection
The Internal Revenue Service is struggling to collect a new tax that's critical to financing the president's health care law – and auditors say the IRS's flawed collecting process is allowing it to raise only three-quarters or so of the revenue that was originally expected. A new report from the Treasury Inspector General for Tax Administration (TIGTA) flags the enforcement of the medical device excise tax, one of a handful of new taxes imposed under the Affordable Care Act. The Affordable Care Act's excise tax – equal to 2.3 percent of the sales price of medical devices – took effect in January and is estimated to bring in about $20 billion through 2019, the Joint Committee on Taxation has said (Ehley, 8/20). 

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Md. Officials Vow To Have Marketplace Working In November

The online insurance website was plagued with problems during last year's enrollment season, but state officials say they are confident the $40 million reconstruction of the site will work.

The Washington Post: Md. Health Officials: Rebuilt Health Insurance Online Site Will Be Fixed By Nov.
Maryland Gov. Martin O'Malley's administration is confident that its rapid rebuilding of the state's health insurance Web site is progressing as planned and will be ready before the next enrollment period begins in November. The state's first attempt at launching a site was riddled with technical problems that made it much more difficult for residents to sign up for health insurance made possible by the Affordable Care Act. Maryland is now rebuilding the site using technology developed by Connecticut. The fix is estimated to cost at least $40 million, if not much more (Johnson, 8/19).

Baltimore Sun: Health Exchange Seeks To Re-Enroll All Who Bought Insurance Plans
Maryland health exchange officials plan to contact every person who bought one of their insurance plans last year to get them to re-enroll in November. Most of the nearly 79,000 people who gained private coverage in the state under the Affordable Care Act were subsidized, and they will lose that benefit if they don't sign back up manually. Most people who do nothing will be automatically re-enrolled in the same or equivalent plans, according to Dr. Joshua M. Sharfstein, state health secretary and chairman of the exchange board. Evergreen Health Co-op, one of four insurers on the exchange, changed its plans too significantly to roll anyone over, he said (Cohn, 8/19).

In other exchange news -

Dallas Morning News: Group: Nearly 400,000 Texas Adults Have 'Life Events' And Qualify To Sign Up For Obamacare Before November
Round two of Obamacare enrollment starts Nov. 15. But a group promoting signups wants Texas' 5 million uninsured adults between the ages of 18 and 64 to know that as many as 365,000 of them are eligible today to go online and enroll in the federally run health insurance marketplace. ... if you move to another county, get married, have or adopt a child or gain citizenship, you have had what the Affordable Care Act deems a life-changing event that triggers a special enrollment period — right now. On Tuesday, the group Enroll America and its Get Covered America campaign, which operates in Texas and 10 other states, released a report estimating that 365,691 uninsured adult Texans will experience one or more of those qualifying events in the 7 1/2 months between enrollment periods (Garrett, 8/19).

Los Angeles Times: Anthem Blue Cross Sued Again Over Narrow-Network Health Plans
Health insurance giant Anthem Blue Cross faces another lawsuit over switching consumers to narrow-network health plans — with limited selections of doctors — during the rollout of Obamacare. These types of complaints have already sparked an ongoing investigation by California regulators and other lawsuits seeking class-action status against Anthem and rival Blue Shield of California (Terhune, 8/19).

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In Arkansas' Private-Plan Medicaid Expansion Model, Enrollees May Have To Contribute To HSAs

Meanwhile, in Wisconsin, Gov. Scott Walker defended his Medicaid policy and decision not to pursue the health law's expansion.

Modern Healthcare: Arkansas May Make Medicaid Enrollees Fund HSAs
Arkansas, the first state to establish the conservative private-plan model for expanding Medicaid under the Patient Protection and Affordable Care Act, now is looking to join several other conservative-leaning states in requiring low-income beneficiaries to make monthly contributions to their health coverage in the form of a health savings account. The state has proposed to the CMS that, beginning in 2015, its Medicaid beneficiaries would have to contribute to Health Independence Accounts (PDF). Beneficiaries with annual incomes between 50% and 99% of the federal poverty level would contribute $5 a month to their accounts, while those earning between 100% and 138% of poverty would pay between $10 and $25. The state would provide a matching contribution of $15 into their accounts (Johnson, 8/19).

Related KHN coverage: Arkansas Weighs Plan To Make Some Medicaid Enrollees Fund Savings Accounts (Andrews, 7/22).

Green Bay Press-Gazette: Walker On Medicaid: Dems 'Living In Alternate Universe'
Gov. Scott Walker countered attacks against his Medicaid policy saying Wisconsin has a "very unique" approach that provides health coverage for all poor people without taking on additional financial risk. Walker came under fire this week by Democrats who solicited a report from the nonpartisan Legislative Fiscal Bureau that found the state could have saved $206 million in its current biennial budget and another $315 million in its 2015-17 budget if Walker accepted federal money to expand Medicaid. ... At a campaign stop in De Pere on Tuesday, Walker said the reports are based on hypothetical circumstances and assume the federal government will follow through with the full funding amount (Rodewald, 8/19).

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Health Information Technology

Internet Security Is Growing Concern At Health Care Sites

The recent hacker attack against Community Health Systems highlights concerns about patient privacy as hospitals, doctors and other providers move to use more electronic records.

Marketplace: Health Records Are An Easy Target For Identity Thieves
Community Health Systems, a large hospital operator, got hacked. The word is Chinese hackers stole some 4.5 million health records from the company.  The files included everything from patient Social Security numbers to birth dates and addresses, a veritable goldmine of information for identity theft. Healthcare providers have been digitizing our records to make everything from treating patients to filing for insurance more efficient. But in their rush towards efficiency, cyber security has gotten lost, says Stephen Cobb, a security researcher at ESET (Kim, 8/19).

The Washington Post's Wonkblog: Health Care Data Breaches Have Hit 30M Patients And Counting
In this latest incident, hackers reportedly stole personal data from Community Health Systems patients, including their Social Security numbers, which is an especially coveted piece of information if you want to steal someone's identity. But it appears that patients' medical data and credit card numbers were not stolen in this case. Thanks to some tougher federal reporting requirements for health-care data breaches in recent years, we have a better sense of when patient information goes missing or might have been inappropriately accessed by someone (Millman, 8/19).

The Wall Street Journal’s CIO Journal: Health Care CIOs Boosting Security In The Wake Of Breaches
A recent string of high-profile data breaches is leading some health-care CIOs to modify their approach [to]cybersecurity. The new approach is partly influenced by executive boards demanding more communication from IT on security efforts. CIOs say they are implementing new security software and processes, hiring staff and meeting with their boards more regularly. But the industry may need to up its security spending to get results. Health-care providers generally have smaller IT budgets than private-sector companies (Boulton, 8/19).

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Some States Angered About Lack Of Authority Over Medicare Advantage Plans

Elsewhere, Medicare officials consider offering HIV tests for all Medicare beneficiaries.

Center For Public Integrity: Medicare Advantage Patients Find Themselves In Regulatory Limbo
[Minnesota Attorney General Lori] Swanson turned to CMS because state regulators lack the legal authority to impose sanctions on Medicare Advantage carriers. When Congress created the Medicare Advantage option in 2003, it gave CMS that power, thus preempting state laws and oversight. Minnesota officials don't believe CMS should have a "monopoly" on oversight. "We think states should have authority over improper determinations by Medicare Advantage plans," [Minnesota attorney general’s office spokesman Benjamin] Wogsland said. "If they (CMS officials) don't take action, there's no other remedy." Other state officials also have been frustrated by the limits on their authority (Schulte, 8/19).

Modern Healthcare: CMS Considers Covering HIV Screening For All Medicare Beneficiaries
The CMS has accepted a request from HIV/AIDS advocates to consider paying for HIV screening of all Medicare beneficiaries without regard to perceived risk behavior rather than only for pregnant women and those at high risk for the virus. The change would bring the policy in line with a 2013 U.S. Preventive Services Task Force recommendation, although that recommendation applies to people between ages 15 and 65. HIV/AIDS advocates, however, argue that seniors should be screened as well even though it's estimated that only 3 percent of those living with HIV are 65 or older. They point to a recent CDC estimate that by 2017, more than half of those living with HIV will be 50 and older, approaching Medicare eligibility (Dickson, 8/19).

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Health Care Marketplace

Walgreens' Billion-Dollar Medicare-Biz Forecasting Mistake

Also, the Wall Street Journal examines the collapse of the Vascular Biogenics initial public offering.

The Wall Street Journal: Walgreen Shakeup Followed Bad Projection
A billion-dollar forecasting error in Walgreen Co.'s Medicare-related business has cost the jobs of two top executives and alarmed big investors. At an April board meeting, Chief Financial Officer Wade Miquelon forecast $8.5 billion in fiscal 2016 pharmacy-unit earnings, based partly on contracts to sell drugs under Medicare (Siconolfi, 8/19).

The Wall Street Journal: Broken Commitment Ruined Vascular Biogenics IPO
The events that led to the collapse of the IPO haven't been previously reported. The highly unusual event -- many traders and investors struggled to recall another IPO being canceled in such a manner -- was a major setback for a company seeking money to pay for clinical trials to complete its work on treatments for cancer and other diseases. For executives, it also raised questions about the role of underwriters in an offering (Demos, 8/19).

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Capitol Hill Watch

GOP Candidates Make Late-Term Abortions Campaign Trail Issue

Republicans who see potential on the Senate political map are turning to this issue as a counter-attack to Democrats' messaging on birth control and personhood.

The Hill: GOP Plots Late Term Abortion Counterattack
Republicans are working to strike a blow against abortion rights and the Senate incumbents who support them by emphasizing late-term abortion on the campaign trail. With the political map favoring the GOP, anti-abortion-rights groups are rallying their supporters for a coordinated ground game meant to counterbalance Democratic attacks over birth control and personhood. At the heart of the activists' message is a legislative proposal from Sen. Lindsey Graham (R-S.C.) that would prevent women from terminating pregnancies after 20 weeks (Viebeck, 8/20).

In other news from Capitol Hill --

The Associated Press: Analysis: Congress Can Still Do Deals When It Must
The must-do bills included $16 billion to improve veterans’ access to health care and a short-term $11 billion measure to prevent federal funding for highway projects and transit systems from drying up this month. Voting against either effort could have cost lawmakers in November’s elections. The veterans bill came together when Democrats agreed to lower the price tag and Republicans accepted adding the additional cost to the national debt. On the highway bill, Senate Democrats bowed to House Republicans on financing it through anticipated revenues the government might or might not reap a decade from now (8/18).

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State Watch

Big Support For Insurance Rate Regulation Measure In California

A proposal to randomly drug test doctors and increase the limit on medical malpractice lawsuit awards also has a strong show of support in the poll. 

The Sacramento Bee: Field Poll: Strong Support For California Health Insurance Rate-Regulation Measure
A California initiative on the fall ballot requiring that health insurance rate changes be approved by the elected insurance commissioner is receiving strong support from voters statewide, according to the latest Field Poll. Nearly 70 percent of registered voters back Proposition 45, while 16 percent say they would oppose it and 15 percent remain undecided ahead of the Nov. 4 election. Support came from 75 percent of Democrats, 73 percent of independents and 58 percent of Republicans. Meanwhile, a separate initiative mandating random drug testing of doctors and quadrupling the state’s $250,000 limit on medical malpractice awards was out ahead by a smaller majority. Proposition 46, which also would compel doctors to consult a state drug history database before issuing certain prescriptions, is supported by 58 percent, opposed by 30 percent and has 12 percent undecided (Cadelago, 8/20).

And California voter approval of the federal health care law grows --

The San Francisco Chronicle: Voter Approval Of Health Care Law Climbing, Poll Shows
Most California voters gave the state's rollout of the federal health law high marks and overall support of the Affordable Care Act is on the rise, according to a Field Poll released Tuesday. The survey of more than 1,500 registered voters between June 26 and July 19 found that by a 2-to-1 margin -- 60 percent to 30 percent - respondents thought the state was successful in implementing the law, results that contrasted with the federal effort. Less than half described the federal rollout, which was plagued with high-profile technical glitches, as successful. Moreover, statewide support of the Affordable Care Act is at its highest level since its introduction in 2010, with the Bay Area recording the highest rates of support of any region, the poll found (Colliver, 8/19).

The San Jose Mercury News: Obamacare Poll: Californians Of All Political Stripes Show Increased Support Of Health Care Law
The nation's new health care law is surging in popularity in the Golden State, according to a Field Poll, which finds more Californians today -- of all political stripes -- support the Affordable Care Act than at any time since it was signed into law four years ago. And by a 2-1 margin, they praise the successful way it's been rolled out in the state, compared to the federal government's glitch-ridden system. Still more now say they're satisfied with the way the health care system is working in the state, compared to a year ago (Seipel, 8/19).

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Advocates Decry Closing Of Mental Health Clinics In Chicago

But officials say the closings, which planned to shutter six of the city's 12 mental health clinics, actually expanded care for those with mental illnesses.

Chicago Tribune: Chicago Mental Health Clinic Closings Spark Opposing Views
Mayor Rahm Emanuel’s mental health care policies went on trial at City Hall Tuesday, with critics saying many patients ended up homeless, jailed or dead after the mayor closed half of the city’s clinics, while city officials maintained that care for the mentally ill actually has been expanded. Those opposing views were aired during nearly five hours of testimony before the City Council Health Committee, where advocates for reopening the closed clinics got the hearing they’ve been seeking for years. There was no clear verdict on what needs to be done, although all parties agreed on the need for expanded and improved mental health care for low-income city residents after years of local, state and federal cuts (Dardick, 8/19).

Chicago Tribune: Chicago Council To Hold Hearing On Closing Of Mental Health Clinics
More than two years after Mayor Rahm Emanuel closed six of the city’s mental health clinics, patients, unions and other critics that continue to oppose the move are getting a hearing on the matter. They contend many patients “fell into severe depression, addiction, psychosis, incarceration and general crisis due to losing their clinics and/or therapists,” according to a news release issued this morning. City officials, meanwhile, maintain that they worked to help all displaced patients find other options, either at clinics that remained open or at other nonprofit clinics that receive federal funding (Dardick, 8/19).

The Chicago Sun-Times: Mental Health Advocates Blast Emanuel’s Clinic Closings
Mayor Rahm Emanuel’s two-year-old plan to close six of the city’s 12 mental health clinics came under withering attack Tuesday, with advocates accusing the mayor of throwing Chicago’s most vulnerable residents to the wolves. Cut off from familiar therapists and forced to travel longer for treatment, thousands of patients fell through the cracks, sometimes tearful mental health advocates claimed. Some [dissolved] into depression or returned to past addictions. Others were arrested, turning Cook County Jail into, what Sheriff Tom Dart has called the “largest mental health hospital” where patients are “criminalized” instead of being given the care they desperately need (Spielman, 8/19).

Elsewhere, mental health care in San Antonio, Texas, is examined, and rural states use a different kind of counselor to deliver mental health care --

Kaiser Health News: Wrestling With A Texas County’s Mental Health System
Evans is the director of the Center for Health Care Services, the community mental health system in San Antonio and Bexar County. Texas ranks 49th out of 50 states in how much funding it commits to mental health. But under Evans’ leadership, Bexar County has built a mental health system considered a model for other cities across the country -- one that has saved $50 million over the past five years (Gold, 8/20).

Stateline: In Rural States 'Pastoral Counselors' Help Fill Mental Health Gap
Kentucky recently became the sixth state (joining Arkansas, Maine, New Hampshire, North Carolina and Tennessee) to allow pastoral counselors to become licensed mental health counselors. As of now, Kentucky only has 20 licensed pastoral counselors. But the hope is that licensing will increase those numbers by making it easier for pastoral counselors to receive health insurance reimbursement and by adding luster to the field (Ollove, 8/20).

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Iowa Telemedicine Abortion Ban Stands After Ruling

Planned Parenthood of the Heartland had claimed the ban was meant to limit abortions for women who live in rural areas.

Des Moines Register/USA Today: Judge Rules Against Use Of Telemed Abortion System
Iowa regulators were within their authority when they voted to ban a first-in-the-nation videoconferencing system that allows doctors here to dispense abortion drugs to women in rural clinics, a Polk County District Court judge ruled Tuesday. Planned Parenthood of the Heartland had sued the Iowa Board of Medicine, contending that the board's decision to ban doctors from using its system was a blatant attempt to limit rural women's access to abortions (Leys, 8/19). 

Bloomberg: Planned Parenthood Loses ‘Telemedicine Abortion’ Ban Suit
An Iowa law barring doctors from remotely dispensing pregnancy-ending drugs withstood Planned Parenthood’s claim that it would impose a hardship on women living far from abortion providers. The decision by Polk County District Judge Jeffrey Farrell in Des Moines upholds an Iowa Board of Medicine rule requiring physicians to be present and to perform a physical examination before drugs are dispensed. Planned Parenthood of the Heartland Inc. claimed the restriction would compel women to travel farther to obtain abortions, leading to delays and a potential increase in illegal abortions. Farrell said the board had a legitimate basis for its measure (Harris, 8/19).

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State Highlights: Mass. Insurers Press On Medicaid Pay

A selection of health policy stories from the District of Columbia, California, Massachusetts and Minnesota.

Los Angeles Times: Auditor Says $93 Million In Medi-Cal Payments Could Be Fraudulent
The audit released Tuesday reviewed billing data from July 2008 to December 2013 for Medi-Cal's Drug Treatment program, which reimburses rehabilitation clinics. The audit found the state's Department of Health Care Services and the Department of Alcohol and Drug Programs failed to administer the program "and created opportunities for fraud" (Karlamangla, 8/19).

Reuters: California May Have Paid Millions For Fraudulent Drug Treatments
A California program that covers addiction treatments for the poor may have paid $93.7 million in fraudulent claims, a state audit showed. The report released Tuesday by the California State Auditor showed that the state's Drug Medi-Cal program may have paid more than $3 million in claims for patients who were actually dead, and found serious deficiencies in the agency's records for 30 drug treatment program providers. The audit was spurred by a 2013 investigation by The Center For Investigative Reporting and CNN, which found questionable billing practices at drug-treatment clinics in Southern California. The program is a division of the state's healthcare program for the poor, known as Medi-Cal (Mendelson, 8/19).

The Boston Globe: Medicaid Insurers Prod State On Funds
Buckling from more than $140 million in losses since the start of the year, companies that insure Medicaid patients are pressing the Patrick administration to increase payments they receive from the state for serving low-income residents. The health insurers say the deficits are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members -- many with serious medical issues -- assigned to the companies by MassHealth, the state Medicaid program. Insurers say the state did not budget enough money this year to cover the added costs (8/20).

The Associated Press: Medicaid Insurers Seek More From Massachusetts
Companies that insure Medicaid patients in Massachusetts are pressing for an increase in the payments they receive from the state for serving low-income residents. The health insurers say $140 million in losses since the start of the year are the result of an expensive new hepatitis C drug and a surge of nearly 190,000 new members assigned to the companies by MassHealth, the state Medicaid program. Insurers say the state did not budget enough money to cover added costs (8/20).

The Washington Post: Rare D.C. House-Call Doctor Straddles Two Washingtons
[Dr. Ernest] Brown is a rarity: a family medicine doctor who performs house calls. Working mostly in the District, he’s fully independent and unaffiliated with insurance programs. His work straddles two Washingtons. His paying patients are foreign and domestic travelers, including foreign dignitaries, staying at the city’s hotels. Treating those clients allows him to serve as the primary care doctor -- pro bono -- for more than a dozen elderly homebound residents in poorer neighborhoods (Najarro, 8/19).

The Star Tribune: National Group Tries To Halt Union Election Of Personal Home Care Providers In Minnesota
U.S. District Judge Michael Davis is expected to decide Wednesday whether to stop the biggest unionization election in Minnesota history. Davis said at a hearing Tuesday that he’ll decide by noon whether to issue a temporary injunction that would halt an election, now in progress, to determine if nearly 27,000 personal home health care workers will be represented by the Service Employees International Union (SEIU). The injunction is being sought by the National Right to Work Foundation, a Florida-based organization that has fought unionization. It sued on behalf of some home care providers who oppose the union (Furst, 8/19). 8/19).

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Editorials and Opinions

Viewpoints: Threat To Drug Development; GOP's Obamacare Criticism Tempered; Finding Doctors For Seniors

The Wall Street Journal: The Medical Innovation Threat
An invasive species has been introduced into the U.S. health innovation ecosystem, with a growing danger of permanent damage to the development of specialty drugs. The relentless assault on the price of Sovaldi is becoming a threat to the 30-year political balance that has energized the biomedical revolution (8/19).

Bloomberg: Obamacare Fades Right On Schedule
Obamacare is fading as a campaign issue. It hasn't disappeared entirely. But after totally dominating the ad landscape in the spring, Obamacare has dropped to just another issue in Republican ads. Health-care has also plummeted in polling on issues important to voters in this cycle. And as Greg Sargent has been documenting, Republican candidates have shifted to a more nuanced position -- they still almost all say they support repeal, but they weasel around the idea that various ACA programs and benefits will be included in that supposed repeal (Jonathan Bernstein, 8/19). 

The New York Times' The Conscience Of A Liberal: Beyond The Lies
The reason is fairly obvious, although it's not considered nice to state it bluntly: the attack on Obamacare depended almost entirely on lies, and those lies are becoming unsustainable now that the law is actually working. No, there aren't any death panels; no, huge numbers of Americans aren't losing coverage or finding their health costs soaring; no, jobs aren't being killed in vast numbers. A few relatively affluent, healthy people are paying more for coverage; a few high-income taxpayers are paying more in taxes; a much larger number of Americans are getting coverage that was previously unavailable and/or unaffordable; and most people are seeing no difference at all, except that they no longer have to fear what happens if they lose their current coverage (Paul Krugman, 8/19). 

The Fiscal Times: 6 Reasons Obamacare Can Win The Senate For The GOP
That ever happened to Obamacare -- the unpopular healthcare bill that was to be the Republicans big weapon as they battled for control of the Senate this fall? For sure, the Affordable Care Act has been pushed to the sidelines by the chaos in Iraq, Russia’s invasion of Ukraine, the surge in Central American minors across our border, the Veterans Administration scandal, the pestilential virus rampaging across the computers of the federal government, and so much more. … Now, the GOP should circle back (Liz Peek, 8/20).

Bangor Daily News: Maine Props Up 'Two Americas' With No Medicaid Expansion
The Affordable Care Act, as originally passed, holds tremendous promise to decrease health care costs and increase insurance coverage rates across rural states like Maine. But federal court opinions and repeated vetoes of Medicaid expansion are putting all that into jeopardy. Already, data is pointing to widening disparities between the states embracing health reform and those that have resisted — in the numbers of uninsured, in new health care jobs and in the finances of local hospitals (Christy Daggett, 8/19).

The Washington Post’s The Volokh Conspiracy: Constitutional Challenge To IPAB Dismissed, But Could Return
The U.S. Court of Appeals for the Ninth Circuit dismissed as unripe a challenge to the Independent Payment Advisory Board (IPAB). This Board was created by the PPACA to help control health care costs. Specifically, IPAB is authorized to develop self-executing recommendations for limits on Medicare reimbursement rates and other cost controls should the rate of Medicare spending growth exceed a specified target. In this case the plaintiffs argued that IPAB violates the non-delegation doctrine (Jonathan H. Adler, 8/19).

Bloomberg: Why Can't The Pentagon Stop Smoking?
Even the most oblivious member of Congress knows that smoking is bad for you. As it turns out, it's even worse for you if you happen to be a soldier. So why would Congress insist that the Pentagon sell cigarettes -- at a discount, no less? The rationale has long been that members of the military have to smoke because their jobs are so stressful (8/19).

Bloomberg: Wanted: More Doctors For Old People
One of the most glaring paradoxes in the U.S. health-care system is the persistent shortage of geriatricians. You've got a group of patients that is growing, and for whom the federal government guarantees health-care coverage. Yet slots in geriatrics programs go begging while people crowd into surgical specialties (Megan McArdle, 8/19).

JAMA Internal Medicine: Cancer Screening In Older Persons
Cancer screening in the 21st century ... is losing its luster. Increasing evidence suggests that many modalities of cancer screening may be far less beneficial than first thought. Screenings that used to be straightforwardly recommended, such as the prostate-specific antigen test, are now discouraged by many experts. Emerging mammography data show that we need to regularly reexamine even our most stalwart screening standards. Our sense of wonder has evolved into a sense of skepticism: Now we wonder whether screening tests are helping or hurting our patients. ... It is particularly important to question screening strategies for older persons (Dr. Cary P. Gross, 8/18).

JAMA Pediatrics: An Ethically Appropriate Strategy To Combat Obesity And Food Insecurity 
Doug Rauch, former president of Trader Joe’s grocery chain, announced his plans for the Urban Food Initiative (UFI). The goals are to address obesity, food insecurity, and food waste by opening nonprofit supermarkets in low-income neighborhoods and providing nutritious low-cost foods. To accomplish this, he proposed selling food gathered from the 11% of fresh produce and perishables that are discarded from other supermarkets, some of which is near or past the sell-by date. ... some have questioned whether the ethics of selling food that is near or past the sell-by date or best-by date to individuals living in low-income neighborhoods are objectionable. ... the UFI offers an innovative approach to combat obesity and food insecurity. ... The store's food will not be harmful, and the initiative is an ethically appropriate strategy to prevent obesity and food insecurity (Drs. Deepak Palakshappa, Genevieve Daftary and Chris Feudtner, 8/18).

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Stephanie Stapleton

Andrew Villegas

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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.