Daily Health Policy Report

Thursday, August 21, 2014

Last updated: Thu, Aug 21

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Health Care Marketplace

Health Information Technology

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Californians Favor Tougher Rules On Health Insurance Rates, Survey Says

Reporting for Kaiser Health News, Helen Shen writes: “California voters are showing strong early support for a ballot initiative that would expand the state's authority to regulate health insurance rates. Nearly 7 of every 10 respondents indicated that they would vote in favor of Proposition 45, while 16 percent would vote against it, according to an independent poll released Wednesday by the Field Research Corp. in San Francisco” (Shen, 8/20). Read the story.

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Are Your Medical Records Vulnerable To Theft?

Reporting for Kaiser Health News, Eric Whitney writes: “A decade ago almost all doctors kept paper charts on every patient. That is changing quickly as laptops become as common as stethoscopes in exam rooms. Recent hacking attacks have raised questions about how safe that data may be. Here are some frequently asked questions about this evolution underway in American medicine and the government programs sparking the change” (Whitney, 8/21). Read the story, which also ran in CNN Money.

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Political Cartoon: 'Spin Doctor?'

Kaiser Health News provides a fresh take on health policy developments with "Spin Doctor?" by Rina Piccolo.

Meanwhile, here's today's haiku:


San Antonio:
Bringing a new kind of hope
by mental health squad.
-J. Cantone 

And a bonus:


A ballot question
about rate regulation?
Voters polled say yes!

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

Texas Faces Barriers To Signing Immigrants Up For Coverage

Outreach is also proving a big barrier to signing Latinos up for health insurance in California, many say.

Texas Tribune: Glitches Threaten ACA Coverage For Some Immigrants
Health advocates helping the state’s minority population say they’ve been working to overcome language barriers, technical issues and low awareness of who is eligible to obtain coverage under the federal health law. With the first enrollment period closed, enrollees are now dealing with inconsistencies in their applications, which are detected when the marketplace website finds a data matching issue between the reported citizenship information and the information the government has on file for an individual (Ura, 8/21).

The California Health Report: Hurdles Remain to Signing Up More Latinos For Health Coverage
As a college-prep consultant, Marina Grijalva heard about the Affordable Care Act and how it would enable her to sign up for health insurance. But the enrollment campaigns -- which the state poured tens of millions of dollars into -- didn't reach her sister or many other Latinos. Had Grijalva not informed her sister of the new health law and walked her through the enrollment process, the 53-year-old woman may have remained uninsured this year. She would not have been alone (Kritz, 8/20).

Elsewhere, salary and benefits are cutting into hospital profits --

Modern Healthcare: Hospitals See More Paying Patients, But There’s a Hitch
Insurance expansion under health care reform is starting to yield patient volume for hospitals, but the costs of staffing up for more patients are eclipsing the additional revenue. Earnings reports for not-for-profit systems in the first half of the year show that many providers are seeing rising salary and benefit expenses cut into revenue gains, leading to smaller operating surpluses (Kutscher, 8/20).

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Handicapping How 'Obamacare,' Other Health Issues Play Into Campaigns

The New York Times examines how the outcome of midterm elections and subsequent efforts to replace parts of the health law could factor into the presidential campaign landscape. Meanwhile, a recent poll notes that small business owners are less concerned about the health law than previously.

The New York Times: Loss For Democrats In Midterm Elections Could Be Boon For Clinton
“A Republican Congress will present an inviting contrast and easily understood negative for whoever runs for president as a Democrat,” said Anita Dunn, a former White House communications director for Mr. Obama. At the same time, she added, “The president will have two more years to get things done, and clearly, a Democratic Senate would be better for that.” As little as Congress is doing now, losing the Senate beachhead poses numerous dangers to Mr. Obama’s agenda. Republicans would control which of his appointees receive confirmation votes, and how quickly. They could, as their House counterparts have done, initiate investigations of the administration. They could make him use his veto pen to fend off legislation impeding his climate-change initiative or repealing parts of the health care law. They could seek smaller compromises on trade, infrastructure or business taxation on terms that force Mr. Obama to choose between alienating his Democratic base or accomplishing nothing further before leaving office (Harwood, 8/20).

The Washington Post: Small Business Owners Aiming To Unseat Incumbents In Midterms, Poll Shows 
“It’s important for politicians to hear their voice and focus on issues relevant to this community,” John Swanciger, Manta’s chief executive, said in the company’s report. So, what issues are those? Not surprisingly, a third of the respondents said the economy still represents the country’s greatest challenge, more than any other issue presented in the survey. Manta polled more than 1,500 owners and reported a margin of error of just below 3 percent. Conversely, health care, which has been one of the most controversial political issues for small firms in recent years, has fallen to fourth on that list, now behind immigration issues and income inequality (Harrison, 8/20).

Meanwhile, Planned Parenthood steps onto the Alaska Senate campaign trail --

The Hill: Planned Parenthood Attacks Alaska Republican Senate Candidate
Planned Parenthood's political arm is launching its largest ad buy so far this cycle against Alaska's freshly minted Republican Senate candidate. Planned Parenthood Action Fund debuted its digital ad campaign against Dan Sullivan less than 12 hours after the GOP establishment pick won his primary to challenge Sen. Mark Begich (D-Alaska) in November. The effort seeks to highlight Sullivan's opposition to abortion, government funding for Planned Parenthood and ObamaCare's birth control coverage mandate (Viebeck, 8/20).

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Special Election Secures GOP Control Of Va. Legislature

The results are expected to hamper efforts by Democratic Gov. Terry McAuliffe to expand Medicaid.

The Washington Post: GOP Win In Southwest Virginia Senate Race Secures Republican Control Of Legislature
Republican A. Benton Chafin Jr. won a state Senate seat Tuesday that secured GOP control of the General Assembly, , dimming Gov. Terry McAuliffe’s legislative prospects .... The Senate election was the most important of the day given its impact on Richmond's upper chamber. Republicans already dominate the House, so the GOP victory in the Senate put the General Assembly fully in the hands of a party that opposes the Democratic governor’s top policy aims (Vozzella and Robinson, 8/19).

The Associated Press: Republican Wins Special Va. State Senate Race
The seat was previously held by conservative Democrat Phil Puckett. His abrupt resignation in June gave control of the Senate to Republicans, who used their new leverage to prevail against McAuliffe in a monthslong showdown over whether the state budget should include Medicaid expansion. A possible job offer to Puckett by the GOP-controlled Virginia tobacco commission at the time of his resignation is the subject of an FBI investigation (8/19).

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Capitol Hill Watch

Sen. Pryor Debuts Campaign Ad Embracing Health Law Provisions

The Arkansas Democrat, who is in a tough reelection fight, talked about his own struggle with cancer and how the health law provisions that prohibit insurance companies from denying coverage to people with medical problems could have helped him.

The Associated Press: Pryor's 'Obamacare' Ad Highlights His Cancer Fight
U.S. Sen. Mark Pryor reached into his own medical history Tuesday to explain his vote on the nation's new health care law, telling Arkansans his battle with a rare cancer 18 years ago influenced him. The two-term Democrat, who is in a tough re-election battle, fought a clear-cell sarcoma discovered after a pickup basketball game. He had five weeks of chemotherapy and a 13-hour surgery that his campaign called experimental (8/20).

The Wall Street Journal's Washington Wire: Democrat Pryor Embraces Obama Health-Care Law In Ad
Mr. Pryor discusses his own battle with cancer and appears for the first time in a campaign ad with his father, former Sen. and Gov. David Pryor, one of the state’s most popular Democrats. Although the senator does not mention the Affordable Care Act by name, he touts his support for the law proudly after his father mentions that his son's insurance company didn't want to pay for treatment after he was diagnosed with a rare form of cancer in 1996 (Hook, 8/20).

The Hill: Pryor Touts Vote For O-Care In New Ad
"When Mark was diagnosed with cancer, we thought we might lose him," David Pryor says in the ad. "Mark's insurance company didn't want to pay for the treatment that ultimately saved his life." The younger Pryor then cites ObamaCare regulations that force insurance companies to provide coverage for pre-existing conditions (Joseph, 8/20).

Bloomberg/Businessweek: Democrat Runs On Obamacare Without Mentioning Obamacare
A Democratic politician fighting for reelection is using a strategy few would have imagined six months ago: Arkansas Senator Mark Pryor just released a new ad boasting about his yea vote for Obamacare. Well, sort of. The ad never mentions the Affordable Care Act by name. Instead, it begins with Pryor and his father talking about the senator’s own cancer treatment and fighting with his insurer to get it covered (Tozzi, 8/20).

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Health Care Marketplace

Lawsuit Challenges Employer Wellness Program

The U.S. Equal Employment Opportunity Commission brought a lawsuit on behalf of a former employee of Orion Energy Systems, based in Manitowoc, Wis., saying she was punished and then fired for refusing to participate in a company wellness program. Another story looks at how companies are buying or subsidizing fitness-tracking devices to encourage employees to be more fit. 

Bloomberg: First Wellness Program Firing Suit Filed By U.S. Agency
Orion Energy Systems Inc. (OESX) was sued by the U.S. Equal Employment Opportunity Commission for allegedly punishing, then firing, a worker who refused to participate in a company wellness program. The complaint filed today in Green Bay, Wisconsin, federal court is the first to challenge a wellness program under the Americans with Disabilities Act, the EEOC said in a statement. Orion, a maker of energy-efficient lighting systems, is based in Manitowoc, Wisconsin. While most Americans approve of programs offered by employers to promote healthy behavior, a majority says it’s not appropriate for employers to require people who don’t participate to pay higher premiums, according to results of a June survey by the Kaiser Family Foundation, a non-profit health-care research organization (Harris, 8/20).

Herald Times Reporter: Lawsuit Challenges Orion Wellness Program
Manitowoc-based Orion Energy Systems violated federal law by requiring an employee to submit to medical exams and inquiries that were not job-related as part of a so-called “wellness program,” which was not voluntary, and then by firing the employee when she objected to the program, the U.S. Equal Employment Opportunity Commission charged in a lawsuit it filed Wednesday in U.S. District Court, Green Bay (8/20). 

Bloomberg: Wear This Device So The Boss Knows You’re Losing Weight
To fight rising medical costs, oil company BP Plc (BP) last year offered Cory Slagle -- a 260-pound former football lineman -- an unusual way to trim $1,200 from his annual insurance bill. One option was to wear a fitness-tracking bracelet from FitBit Inc. to earn points toward cheaper health insurance. With the gadget, the 51-year-old walked more than 1 million steps over several months, wirelessly logging the activity on the device. Twelve months later, Slagle has added to his new exercise regimen by trading burgers for salads and soda for water, dropping 70 pounds (31.8 kilograms) and 10 pant sizes in the process (Satariano, 8/21).

Earlier related KHN coverage: Employers Tie Financial Rewards, Penalties to Health Tests, Lifestyle Choices (Appleby, 4/2/2012).

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Health Information Technology

How Chinese Hackers Stole Patient Data

The hackers exploited 'Heartbleed' -- a hole in widely used data-protection technology -- to steal data on 4.5 million patients of Community Health Systems, according to Bloomberg News. Another report looks at why your medical information might be vulnerable.

Bloomberg: Heartbleed Flaw Said Used By Chinese In Hospital Hacking
Chinese hackers exploited the Heartbleed Web-security flaw to steal data on 4.5 million patients of Community Health Systems Inc. (CYH), the first known breach of a company by use of the vulnerability, said a person involved in the investigation. Community Health, the second-biggest for-profit U.S. hospital chain, said Aug. 18 that thieves stole patients’ Social Security numbers, names and addresses, without revealing how the hackers got in. The person involved with the probe wasn’t authorized to comment publicly and requested anonymity. The group suspected of being responsible for the attack has a history of stealing intellectual property from health-care companies, and security specialists said it’s unusual for such thieves to turn to personal data (Strohm, 8/20).

Kaiser Health News: Are Your Medical Records Vulnerable To Theft?
A decade ago almost all doctors kept paper charts on every patient. That is changing quickly as laptops become as common as stethoscopes in exam rooms. Recent hacking attacks have raised questions about how safe that data may be. Here are some frequently asked questions about this evolution underway in American medicine and the government programs sparking the change (Whitney, 8/21).

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State Watch

Poll: Californians Support Stronger Regulation Of Insurance Rates

The ballot initiative, which will likely be the subject of a costly campaign battle, is championed by consumer groups but opposed by many in the medical and insurance industries.

Los Angeles Times: Poll: 69% Favor Prop. 45 Measure On Regulating Health Insurance Rates
A new poll shows 69 percent of California voters back Proposition 45, a November ballot measure giving the insurance commissioner the power to stop excessive health-insurance rate increases. The Field Poll released Wednesday indicates broad support statewide for Proposition 45 ahead of what's expected to be a costly and contentious battle between consumer groups and health insurers (Terhune, 8/20).

Kaiser Health News: Californians Favor Tougher Rules On Health Insurance Rates, Survey Says
California voters are showing strong early support for a ballot initiative that would expand the state's authority to regulate health insurance rates. Nearly 7 of every 10 respondents indicated that they would vote in favor of Proposition 45, while 16 percent would vote against it, according to an independent poll released Wednesday by the Field Research Corp. in San Francisco (Shen, 8/20).

The Sacramento Bee: Field Poll: Strong Support For California Health Insurance Rate-Regulation Measure
The survey comes ahead of what are expected to be two of the most expensive and hard-fought statewide campaigns of the election cycle. Proponents of the measures include the politically influential trial attorneys and consumer groups who argue more must be done to prevent steep health insurance rate increases and to deter negligence by making doctors accountable for their medical errors. Opponents from the powerful medical and insurance industries argue the measures concentrate too much power under one politician and stand to financially benefit supporters at great expense to taxpayers (Cadelago, 8/20).

Contra Costa Times: Poll: Californians Strongly Support Measure Regulating Health Insurance Rates
The measure is being championed by Consumer Watchdog, the same group that pushed through a landmark 1988 proposition that created an elected California insurance commissioner and required insurers to publicly justify auto and homeowner's insurance rate changes and get the commissioner's approval before they go into effect. Proposition 45 would extend that requirement to include health insurance (Seipel, 8/20).

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State Highlights: Ill. Plans Medicaid Contraception Boost; Minn. Union Vote

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

Los Angeles Times: State Audits Find Prison, Hospital Payroll Abuses
Audits of a state prison and psychiatric hospital detail hundreds of thousands of dollars in improper payments and financial problems, including outright payroll fraud, and medical staff and guards receiving questionable bonuses and holiday pay, according to reports released Wednesday (St. John, 8/20).

Chicago Tribune: State Plans To Boost Medicaid Funding For Contraception 
Medicaid patients in Illinois could gain increased access to contraception under policy changes proposed Wednesday by the Department of Healthcare and Family Services. Health care providers would receive more money for providing vasectomies to men and birth control to women under the proposal, which also includes a possible new referral requirement for Roman Catholic providers and others that object to contraception. The department expects to implement most of the proposed changes this fall, but department Director Julie Hamos said Medicaid will immediately start paying more toward the cost of long-term contraception at walk-in providers such as Planned Parenthood clinics (Venteicher, 8/20).

The Star Tribune: Judge Won't Block Union Vote By 27,000 Minnesota Home Health Care Workers
U.S. District Chief Judge Michael Davis ruled Wednesday that he will not stop the union election for thousands of Minnesota home health care workers, and the national group that tried to block the vote said it will not appeal the decision. However, the National Right to Work Foundation, which sought a temporary injunction, said that it will continue to argue in court that the unionization effort is illegal if the Service Employees International Union (SEIU) wins the election. Ballots will be counted next Tuesday to determine whether the union will represent nearly 27,000 personal health care workers, the largest unit in Minnesota to seek union certification since the Wagner Act was passed in 1935 (Furst, 8/20).

Georgia Health News: A County’s Difficult Question: How To Save Its Local Hospital
Elbert Memorial Hospital has served its northeast Georgia county for more than 60 years. But the future of the hospital is now unclear. Its fate will hinge on the coming days and weeks. Elbert County commissioners are holding public hearings this week and next on a proposed one-mill property tax increase for one year to raise about $500,000 to offset the Elberton hospital’s costs for indigent care. Without the money, the 52-bed hospital will close, officials warn (Miller, 8/20).

Philadelphia Inquirer: Pa. Law Mandates Information With Down Syndrome Diagnosis 
Pennsylvania has joined a small but growing number of states requiring that a Down syndrome diagnosis be accompanied by useful, accurate information about the genetic disorder. The Down Syndrome Prenatal and Postnatal Education Act, effective Oct. 1, mandates that medical practitioners give expectant or new parents "informational publications," to be provided online by the state health department. The Down syndrome advocates behind such state laws -- five in the last two years, including in Delaware and Maryland -- promote them as a way to give unbiased information to pregnant women at a momentous, stressful juncture (McCullough, 8/19).

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Weekend Reading

Longer Looks: The Right To Pain Relief; Limiting Access To Sovaldi

KHN's Shefali Luthra finds interesting reads from around the Web.

Aeon Magazine: How New Orleans Became America's Ground Zero For HIV
An infectious disease doctor at Tulane University, [MarkAlain] Dery treats people living with HIV in New Orleans and Baton Rouge, the two largest cities in the southern state of Louisiana, which itself has the fourth-highest rate of HIV in the United States, just behind New York, Florida and Maryland. In the cities, it's worse. Baton Rouge ranks number one among US metropolitan regions for AIDS ... Louisiana’s HIV epidemic is a direct consequence of its severe social conditions (Jessica Wapner, 8/15).

Vox: The Mystery Of The Falling Teen Birth Rate
For five years now, America's teen birth rate has plummeted at an unprecedented rate, falling faster and faster. Between 2007 and 2013, the number of babies born to teens annually fell by 38.4 percent, according to research firm Demographics Intelligence. This drop occurred in tandem with steep declines in the abortion rate. That suggests that the drop isn't the product of more teenagers terminating pregnancies. More simply, fewer girls are getting pregnant (Sarah Kliff, 8/20).

The Atlantic: Who Has A Right To Pain Relief?
Physical pain is not merely a private struggle. Pain is also a problem of representation and trust, of rights and responsibilities, and a source of tension between individual and community. Perhaps not surprisingly, efforts to manage it give rise to a chronic American condition: an intimate, unknowable experience co-opted by special interests. Pain, in short, is political. That is the argument Keith Wailoo, a Princeton historian of medicine and public policy scholar, makes in Pain: A Political History, which sets out to show "how the powerful question of other people's pain became a recurring site for political battle" (Rebecca Davis O'Brien, 8/18).

NPR: Cardiologist Speaks From The Heart About America's Medical System
[Sandeep] Jauhar's new memoir, Doctored: The Disillusionment of an American Physician, is about how doctors are growing increasingly discontent with their profession. And they're facing more pressures: As the number of patients they're expected to see increases, so does the amount of paperwork. While some doctors who perform a lot of procedures may be paid too much, he writes, many doctors, such as primary care physicians, aren't paid enough (Terry Gross, 8/19).

Governing: The Risky Business Of Limiting Medicaid Access To Sovaldi
As states limit Medicaid coverage of an extremely expensive but potentially game-changing hepatitis C medication, it's becoming clear that their actions will have legal consequences. But what's less clear is which side will win. Since the drug Sovaldi got approval from the U.S. Food and Drug Administration (FDA) late last year, it's generated headlines and sparked Congressional inquiries into its high cost ($84,000 on average for a 12-week treatment) as well as its effectiveness ... States typically have to cover drugs from makers that participate in Medicaid’s drug rebate program, which includes Gilead Sciences, the company that sells Sovaldi. According to the company, 47 states are covering the drug for their Medicaid populations. But in order to limit its use, about half are enforcing "prior authorization" (Chris Kardish, 8/19).

Modern Healthcare: Without Medicaid Expansion, Some Hospitals Suffer
Across the country, hospitals in Medicaid expansion states are seeing deep reductions in their uninsured volume and the amount of uncompensated care they deliver. That's not happening in nonexpansion states, which is why hospital leaders in those states continue to push elected officials to accept federal Medicaid money to cover more of their residents. The contrasting approaches to expanding Medicaid are starting to produce two separate and unequal healthcare systems in America—one where a growing percentage of the population has insurance and providers are getting paid, and the other where the uninsured rate remains high and hospitals and doctors struggle with providing care for patients who have no way of paying their bills (Beth Kutscher, 8/16).

Politico Magazine: The Secret Committee Behind Our Soaring Health Care Costs
In 2012, national health care spending in the United States reached $2.8 trillion, or more than 17 percent of the country’s gross domestic product — more than any other industrialized country. And yet overall our citizens aren’t healthier than those in other industrialized countries. Of course, there are a million complicated reasons for this: Generally speaking, prices in the United States are just higher than those in other countries… Another explanation, debated by experts in health policy circles but less known to the public, lies with a secretive committee run by the American Medical Association (AMA) which, with the assent of the government, has enormous power to determine Medicare prices by assessing the relative value of the services that physicians perform (Katie Jennings, 8/20).

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Editorials and Opinions

Viewpoints: 'Raw Judicial Politics' On Health Law; Texas Abortion Trial; Suicide And Gender

The New York Times: By Any Means Necessary
The Affordable Care Act -- Obamacare -- has endured so many near-death experiences that digging into the details of still another effort to demolish it is admittedly not an inviting prospect. (My own reaction, I confess, to hearing some months back about the latest legal challenge -- this one aimed at the supposed effect of a single word in the 900-page statute -- was something along the lines of "wake me when it's over.") But stay with me, because this latest round, catapulted onto the Supreme Court's docket earlier this month by the same forces that brought us the failed Commerce Clause attack two years ago, opens a window on raw judicial politics so extreme that the saga so far would be funny if the potential consequences weren’t so serious (Linda Greenhouse, 8/20). 

Bloomberg: Republicans Won't Have Obamacare Forever
[Arkansas Sen. Mark] Pryor doesn't say that he helped pass "Obamacare," or even that he helped pass the "Affordable Care Act." Instead, he simply touts provisions of the law that almost certainly sound good to most people, saying that he "helped pass a law that prevents insurance companies from canceling your policy if you get sick, or deny coverage for preexisting conditions." The wrong way to think about this is to imagine that the ACA is getting more popular. It isn’t .... But what this does get to is that individual provisions of the law (especially, naturally, the benefits) have always polled well, and the Republican solution -- repeal -- is even more unpopular than the law itself (Jonathan Bernstein, 8/20).

The New York Times: Quackery And Abortion Rights
The deception behind the wave of state-level abortion restrictions now threatening women’s access to safe and legal abortions was strikingly revealed during a trial that ended last week in Texas (8/20). 

The New York Times' Room For Debate: When Do Doctors Have The Right To Speak?
Two federal appellate court decisions, one allowing Florida to prevent doctors from discussing gun safety with patients, the other letting California ban "gay-conversion" therapy, raise questions about health professionals' First Amendment rights. Do occupational-licensing laws trump the First Amendment? What limits, if any, does the First Amendment impose on government's ability to restrict advice? (8/20). 

The Wall Street Journal: The Golden Age Of Neuroscience Has Arrived
More than a billion people were amazed this summer when a 29-year-old paraplegic man from Brazil raised his right leg and kicked a soccer ball to ceremonially begin the World Cup. The sight of a paralyzed person whose brain directly controlled a robotic exoskeleton (designed at Duke University) was thrilling. We are now entering the golden age of neuroscience. We have learned more about the thinking brain in the last 10-15 years than in all of previous human history (Michio Kaku, 8/20). 

The Wall Street Journal: FedEx's 'Money Laundering' Scheme
According to U.S. Attorney for the Northern District of California Melinda Haag's revised indictment, FedEx engaged in a "conspiracy to launder" more than $630,000 in payments from shipping drugs sold illegally by online pharmacies. Justice accuses FedEx of conspiring to launder money because it "requested payment for providing shipping services" to such fly-by-night pharmacies via wire transfers, checks, direct debits, credit card charges and telephone. But as we wrote last week, FedEx had no way of knowing which pharmacies were violating the law by filling orders without valid prescriptions, and Justice hasn't provided FedEx with a list. Even if employees ripped open packages, they wouldn't be able to finger the contraband (8/20). 

Bloomberg: Why Do More Men Commit Suicide?
Robin Williams's death has brought welcome attention to the very real problem of suicide in the U.S. From 2000 to 2011, suicides increased to 12.3 per 100,000 people from 10.4. Deaths by suicide now exceed those from motor-vehicle accidents. This is not, as you might think, a problem occurring disproportionately among teenagers or the very old. The people most prone to taking their own lives are those 45 to 59 years old .... What puzzles researchers even more is that men commit suicide more often than women do -- about four times as often -- even though most studies find that women are twice as likely to be depressed and also more likely to have suicidal thoughts (Peter R. Orszag, 8/20).

The New England Journal Of Medicine: The Impact And Evolution Of Medicare Part D
Many ACA provisions position Medicare for major payment and delivery-system changes that are designed to improve quality and reduce spending growth. These reforms include altering provider reimbursement to encourage efficiency and improving care coordination among providers. In some ways, the Part D program, which is run by stand-alone plans that don't carry risk for total medical spending and have no financial relationships with providers, is out of sync with such changes. ... [T]he long-term success of payment and delivery-system reforms will depend in part on integrating Part D policy with broader reforms (Julie M. Donohue, 8/21).

The New England Journal Of Medicine: Did Hospital Engagement Networks Actually Improve Care?
Everyone with a role in health care wants to improve the quality and safety of our delivery system. Recently, the Centers for Medicare and Medicaid Services (CMS) released results of its Partnership for Patients Program (PPP) and celebrated large improvements in patient outcomes. But the PPP's weak study design and methods, combined with a lack of transparency and rigor in evaluation, make it difficult to determine whether the program improved care. ... [T]he failure to generate valid, reliable information hampers our ability to improve future interventions, because we are no closer to understanding how to improve care than we were before the PPP (Drs. Peter Pronovost and Ashish K. Jha, 8/21).

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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.