Daily Health Policy Report

Tuesday, August 26, 2014

Last updated: Tue, Aug 26

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Veterans Health Care

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

New Birth Control Rules Appear To Track Supreme Court Suggestion

Kaiser Health News staff writer Julie Rovner reports: “Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month” (Rovner, 8/25). Read the story.

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FAQ: Administration’s New Contraception Rules Explained

Kaiser Health News staff writer Mary Agnes Carey reports: "The Obama administration has released new rules they say will give employees of religiously affiliated organizations a way to obtain contraceptive services as part of their health insurance coverage while respecting the religious beliefs of their employers. The announcement follows a controversy that has dogged the administration as religiously affiliated employers objected to efforts to expand contraceptive options for women under the health law. The latest regulations seek to satisfy complaints about earlier guidance on contraception coverage that instructed these employers to notify their insurers or third-party administrators if they did not want to comply with the law’s contraception coverage based on religious objections" Carey, 8/26). Read the article.

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Insuring Your Health: Federal Officials Order Medicaid To Cover Autism Services

Kaiser Health News consumer columnist Michelle Andrews writes: "When Yuri Maldonado's 6-year-old son was diagnosed with autism four years ago, she learned that getting him the therapy he needed from California’s Medicaid plan for low-income children was going to be tough. Medi-Cal, as California's plan is called, does provide coverage of autism services for some children who are severely disabled by the disorder, in contrast to many states which offer no autism coverage. But Maldonado’s son was approved for 30 hours a week of applied behavioral analysis (ABA), a type of behavior modification therapy that has been shown to be effective with autistic children, and she was worried that wasn’t enough" (Andrews, 8/26). Read the column.

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With Coverage Through Obamacare, Transgender Woman Opts For Surgery

Kaiser Health News staff writer Anna Gorman reports: “Among the less-talked-about implications of the Affordable Care Act is the relief it is providing to many transgender people, many of whom are low-income and who have struggled to obtain health coverage. Getting jobs that offer insurance often has been difficult for transgender people and the cost of purchasing plans on the private market can be prohibitive. Some have been denied policies altogether after being diagnosed with 'gender identity disorder,' often considered a pre-existing condition. Without insurance, many people were unable to afford the hormones, surgeries and counseling needed to complete their transition. Nor would they have been covered in the event of surgical complications, which can include infections" (Gorman, 8/25). Read the story or watch the related video by Heidi de Marco.

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Political Cartoon: 'Game Of Groans?'

Kaiser Health News provides a fresh take on health policy developments with "Game Of Groans?" by Darrin Bell.


House health law challenge
plus high-priced lawyers equal
billable hours.

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

Report Tallies Funds Committed To Federal Insurance Exchange

The federal government has committed nearly $800 million to the project, according the Health and Human Services' inspector general. Also in the news, Washington state will have a special limited enrollment period for people who want to shop for coverage outside the marketplace as a result of continuing exchange problems. Meanwhile, Idaho is setting up its own marketplace.

Politico Pro: First IG Report Coming Tuesday On Federal Exchange Contracts
The HHS Inspector General’s Office will release a report Tuesday that CMS spent $500 million on the federal Obamacare exchange through February and committed nearly $800 million to the project. The total cost is in line with other recent estimates. Last month, the Government Accountability Office reported that CMS had obligated about $840 million to the exchange through March (Norman, 8/25).

Seattle Times: Health Exchange Problems Prompt Special Enrollment Period
Responding to ongoing problems at the Washington Healthplanfinder insurance exchange, state Insurance Commissioner Mike Kreidler on Monday instituted a limited special enrollment period for consumers who want to obtain coverage outside the exchange. From Aug. 27 to Nov. 14, those who have had problems with enrolling or making payments through Healthplanfinder can enroll in coverage outside the exchange either by selecting a different plan with the same carrier or by changing carriers. “This is a problem that has been around since the end of December,” Kreidler said in an interview (Marshall, 8/25).

McClatchy: Idaho Preps For Obamacare Re-Enrollment
As federal officials wrestle over whether HealthCare.gov will withstand the weight of millions of new customers and re-enrollees this fall, state brass with Your Health Idaho are looking to detach from the federal health insurance portal. But they’re going to need help from Idahoans. The state-run insurance marketplace has begun setting up state-based accounts through its own technology for the 76,000 residents who signed up for health care last year, said spokeswoman Jody Olson (Smith, 8/25).

Meanwhile, coverage continues about Oregon's lawsuit against Oracle, and The New York Times reports on Todd Park's expected departure as the White House's top technology adviser -   

Oregonian: Court Filings Show Oracle America Stymied Oregon DOJ Demand For Documents
The Oregon Department of Justice jousted for nearly two months with Oracle America over the state's demand for documents from the California software giant relating to the health exchange debacle. In fact, Oracle flouted state law and stymied the demand, according to DOJ. The state filed papers in federal court Friday that provide a glimpse into high-stakes jockeying that for months took place largely out of public view (Budnick 8/25).

Oregonian: Feds Back Down From Directive That Undermined Oregon Health Plan Reforms
The federal government says that executives of organizations serving the Oregon Health Plan should not overreact to a recent letter from the Centers for Medicare and Medicaid Services that demanded changes in how the state accounts for its payments to provider organizations under recent reforms. On Aug. 7, the federal agency that holds the purse strings for care of nearly 1 million low-income Oregon Health Plan members harshly criticized the state's system for distributing money to regional coordinated care organizations set up by state changes. The groups, which act like insurance plans, are known as CCOs. The Aug. 7 letter from CMS said the state is employing "high-risk practices" in setting its payment rates, and using projections that "differ greatly" from those used by the care organizations themselves (Budnick, 8/25).

The Washington Post: Oregon Files Suit Against Oracle, Developer Of Faulty Health Exchange
The Oregon Department of Justice on Friday filed suit against the developer of its catastrophically broken health-care exchange, accusing Oracle America Inc. of false statements, fraud and racketeering, among other misdeeds. In a 126-page filing, Oregon Attorney General Ellen Rosenblum (D) in a Marion County court, says Oracle fraudulently induced Oregon and its health-care exchange, Cover Oregon, into contracts worth hundreds of millions of dollars. In total, the state spent more than $240 million on Oracle; Cover Oregon, a disaster from the start, failed to sign up a single person for health-care coverage through its Web site (Wilson, 8/25).

The New York Times: Technology Adviser Expected To Leave White House Post
Todd Park, President Obama’s top technology adviser and an important figure in the emergency effort last year to fix the federal government’s online health care marketplace after a disastrous beginning, is leaving the White House, a person familiar with the matter said Monday (Joachim, 8/25).

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Who Is Exempt From Health Law's Mandate To Have Insurance?

The Miami Herald looks at the religious groups that pool their money to pay medical expenses and whose members are therefore exempt from the law's requirement to carry insurance. Other stories look at the "drafting error" that is the basis of a legal challenge to the law's subsidies and the administration's latest accommodation on the contraceptive mandate.

Miami Herald: Affordable Care Act Exemptions Mean Millions Don’t Have To Sign Up
Although as many as 30 million Americans will remain without health insurance by 2016, despite the best efforts of the ACA’s proponents, all but about seven million of them will be spared having to join the new system because of exemptions created by the act itself, according to an analysis by the Congressional Budget Office and the staff of the Joint Committee on Taxation. The exempted religious organizations generally pool their members’ money to pay the medical expenses of anyone in the group who gets sick, injured or becomes pregnant. Also exempted from the law are members of federally recognized religious sects who have religious objections to insurance or to such systems as Social Security or Medicare (Madigan, 8/25).

Los Angeles Times: Could A Wording 'Glitch' Doom Obama's Healthcare Law?
In 2009, they had spent months piecing together a compromise that sought to create a national system of subsidized insurance -- but one run by the states. Now, they fear their work could be undone by what some call a "drafting error" and others portray as a political miscalculation. The judges from the U.S. Court of Appeals for the District of Columbia Circuit based their ruling on language saying that subsidies would be offered for health policies bought through an "exchange established by the state." That wording meant only marketplaces established by 14 states, including California, would qualify, the three-judge panel ruled; 5 million people in 36 states where consumers used the federal government's exchange should not get subsidies (Savage, 8/25).

Kaiser Health News: New Birth Control Rules Appear To Track Supreme Court Suggestion
Those who favor women being guaranteed no-cost birth control coverage under their health insurance say the new rules for nonprofit religious organizations issued by the Obama administration simply put into force what the Supreme Court suggested last month (Rovner, 8/25).

Kaiser Health News: FAQ: Administration’s New Contraception Rules Explained
The regulations unveiled Friday would allow religiously affiliated employers to notify the government -- rather than their insurer -- of their objections to the law’s coverage of birth control. The government will then notify the insurer to provide the contraception coverage. A second rule suggests the administration will allow the same mechanism for some businesses that object to contraception on religious grounds but seeks public comment on how to identify businesses to be included (Carey, 8/26).

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Vermont GOP Candidates For Governor Blast State's Move Toward Single Payer System

The criticism of Gov. Peter Shumlin's push for a publicly funded health care system came during a debate on the eve of the primary. Also, in Virginia, Republican Senate candidate Ed Gillespie unveils a tax plan that would repeal taxes in the health law.

The Associated Press: Health Care Focus As Vermont Governor Candidates Debate
Three Republicans and one Libertarian vying for the GOP gubernatorial nomination ... faced each other in a primary-eve debate Monday with the main fireworks coming over health policy. All four voiced disagreement with incumbent Democrat Gov. Peter Shumlin's push for a universal, publicly funded health care system, though GOP businessman Scott Milne was more muted in his criticism than the others. The debate, during a class led by Johnson State College Professor William Doyle -- a state senator and political historian -- included strong criticism of the universal health plan from Republican Steve Berry of Wolcott and from Dan Feliciano, a Libertarian who is seeking enough write-in votes in Tuesday's primary to garner the Republican nomination. (Gram, 8/26).

Richmond Times-Dispatch: Gillespie Introduces Tax Reform Plan
Republican U.S. Senate candidate Ed Gillespie on Monday introduced his tax reform plan, pushing to lower the corporate tax rate to 25 percent, do away with sales taxes on health insurance under the Affordable Care Act and replace the Earned Income Tax Credit with one that encourages people to stay employed (Schmidt, 8/25).

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Capitol Hill Watch

House Hires $500-An-Hour Lawyers To Sue Obama

House Republicans revealed they will pay law firm Baker & Hostetler LLP to sue President Barack Obama for allegedly overstepping his legal authority in implementing the Affordable Care Act by giving large employers a one-year extension to offer coverage.

Politico: House To Spend $350K On Barack Obama Lawsuit
The House of Representatives will not spend more than $350,000 to sue President Barack Obama, according to a contract released Monday by a congressional committee. BakerHostetler’s David Rivkin will represent the House as it seeks to show that Obama has misused executive authority. The contract expires in January 2015 and the House is paying $500 per hour (Sherman, 8/25).

The Wall Street Journal’s Washington Wire: House GOP Hires $500-An-Hour Lawyers For Suit Against Obama
House Republicans revealed Monday they will pay an outside law firm $500 an hour to pursue their lawsuit against President Barack Obama, a disclosure that served to ratchet up the political controversy surrounding the GOP’s legal effort. House Republicans said they had hired law firm Baker & Hostetler LLP and partner David Rivkin to make the legal case that Mr. Obama overstepped his legal authority in implementing the Affordable Care Act. The lawsuit, which was authorized by House Republicans last month, is expected to focus on the White House’s decision last year to give employers a one-year reprieve from a requirement they offer health coverage or pay a penalty (Crittenden, 8/25).

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Veterans Health Care

Obama To Outline More Veterans Health Care Fixes

In a speech to the American Legion today, the president will announce new steps to improve veterans' access to mental health care and the transition in getting care from the Department of Defense to VA systems.

The Associated Press: Obama Addresses Vets In Trip Laden With Politics
Three months after a veterans' health care scandal rocked his administration, President Barack Obama is taking executive action to improve the mental well-being of veterans. The president was to announce his initiatives during an appearance before the American Legion National Convention that is fraught with midterm politics. ... The White House says Obama will announce administration steps to strengthen access to mental health care by members of the military, to improve the transition for those leaving the military from care administered by the Defense Department to that run by Veterans Affairs, and to foster suicide prevention and better treatments for post-traumatic stress syndrome (Kuhnhenn, 8/26).

The New York Times: Obama Plans More Measures To Improve Health Care For Veterans
The president is set to fly to Charlotte, N.C., where he will address the national convention of the American Legion just three months after a scandal over long waiting periods for medical appointments, falsified records and poor care forced the resignation of his secretary of veterans affairs, Eric K. Shinseki (Baker, 8/26).

Politico: Obama Orders Aimed At VA Delays
President Barack Obama will announce a number of executive actions on Tuesday tackling the scandal-plagued Department of Veterans Affairs, including providing better access to health care for veterans. The White House has reached out to over a quarter of a million veterans to get them off of wait-lists and into appointments, according to an administration fact sheet released Tuesday. Acknowledging what it called "inexcusable delays" that ultimately led to the deaths of dozens of veterans who were on waitlists, the White House said these steps will "ensure that this never happens again, and we will keep at it as long as it takes" (McCalmont, 8/26).

Bloomberg: Obama To Promise Improvements For U.S. Veterans In Speech
President Barack Obama will pledge improved mental-health care for U.S. military veterans and that fewer former service members will be homeless as he seeks to restore confidence in the scandal-scarred Veterans Affairs Department (Runningen and Keane, 8/26).

Also, VA officials announced some results of their investigation of the system -

The Associated Press: Probe: No Proof VA Delays Caused Phoenix Veterans To Die
The Veterans Affairs Department says investigators have found no proof that delays in care caused any deaths at a VA hospital in Phoenix, deflating an explosive allegation that helped expose a troubled health care system in which veterans waited months for appointments while employees falsified records to cover up the delays (Ohlemacher, 8/26).

Modern Healthcare: VA Preparing RFP For New Scheduling System
The Veterans Affairs Department is planning to launch a search for a contractor to create a new medical appointment scheduling system for the agency. The federal department plans to release an RFP for the work by the end of September. ... The agency currently uses the scheduling module of its VistA electronic health-record system. While a department audit released in June laid relatively little of the blame for recent veteran healthcare problems at the feet of the system, the department has been moving ahead to replace it (Dickson, 8/25).

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State Watch

State Highlights: Minn. Vaccine Requirements; Sovaldi in Calif. Prisons; Ga. Rural ERs

A selection of health policy stories from Minnesota, California, Georgia, Kansas, Arkansas and Maryland.

Minneapolis Star-Tribune: New Minnesota Vaccine Requirement Inspires Pro-Vaccination Effort
For the first time in a decade, Minnesota schoolchildren are required to receive additional vaccines this fall. Seventh-graders now must get the meningococcal vaccination and an additional pertussis (whooping cough) booster. And younger children in day care and early-childhood programs must get hepatitis A and B shots. For most parents, complying is not a problem. Vaccination rates in Minnesota top 90 percent for almost all immunizations required by law, according to the state Department of Health. Less than 2 percent of the state’s more than 70,000 kindergartners enter school unvaccinated under Minnesota’s conscientious-objection exemption, the agency says (Prather, 8/25).

California Healthline: High-Priced Drug Makes Its Way Into California Prisons
While lawmakers in Congress and policymakers in Sacramento grapple with how to pay for -- and perhaps regulate the cost of -- high priced new drugs, an effective and expensive new treatment for hepatitis C continues to make inroads in California. California Correctional Health Care Services, which oversees clinical care and drug prescriptions for 125,000 inmates at 34 prisons, began using Sovaldi last month. Made by Gilead Sciences of Foster City, Sovaldi has become part of the "community standard" for medical professionals treating patients with hepatitis C, according to prison officials. The high cost of the drug -- $1,000 per pill, about $84,000 for a full course of treatment -- sparked a congressional investigation after objections from several corners of the health care industry (Lauer, 8/25).

Georgia Health News: Freestanding ERs Target Suburbs, Rural Panel Told
Freestanding emergency departments have been proposed in Georgia as a potential solution for struggling rural hospitals, or newly closed ones, that want to remain operational in downsized form to help patients in need. But the trend toward such standalone emergency rooms nationally is totally different from that picture, members of the Georgia Rural Hospital Stabilization Committee were told Monday. Freestanding EDs are actually proliferating in suburban areas, targeting high-income patients who have private insurance, said Charles Horne of accounting firm Draffin & Tucker. The prevailing emphasis is on patient convenience, not need, he told committee members at a meeting in Cordele (Miller, 8/25).

Kansas Health Institute News Service: Overuse Of Antipsychotic Drugs In Some Kansas Nursing Homes Endangering Patients
Experts say powerful antipsychotic drugs -- sometimes given in combination -- are used too much and often inappropriately as “chemical restraints” or sedatives to control the behavior of Kansas nursing home residents suffering from Alzheimer’s or other dementias, and that efforts to curb the practice so far are showing weak results compared with other states (Shields, 8/25).

Modern Healthcare: Another Rural Hospital Succumbs To Mounting Financial Pressures
Rural hospitals are about to lose another comrade. Crittenden Regional Hospital, a 142-bed facility in West Memphis, Ark., said Monday that it has stopped admitting patients and will permanently shut down by Sept. 7. The hospital has been facing a host of financial and operational challenges. It lost almost $3 million on $55 million in revenue in 2012, according to Crittenden Regional's latest Form 990. That came one year after the hospital lost $1.3 million on $57 million in revenue. Reimbursement cuts and sharp declines in patient volumes led to those troubles. Also, hospital officials said outgoing physicians and two fires negatively affected its outlook. Most recently, a fire kept the hospital closed for more than six weeks (Herman, 8/25).

Baltimore Sun: Agency Strips Shuttered Health Clinic Group Of Funding
Nearly two months after People's Community Health Centers shut the doors to five low-income health clinics in Baltimore city and Anne Arundel County, a federal agency confirmed it is no longer providing critical grant money to the nonprofit group. People's had received $2.4 million a year from the Health Services Resources Administration to treat uninsured patients -- its largest source of revenue. That loss comes as the organization faces a new federal tax lien nearly that doubled the amount it owes the Internal Revenue Service and mounting claims from employees seeking backpay (Wood, 8/25).

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Editorials and Opinions

Viewpoints: Check Out Those Nursing Home Stars; Rove A 'Bleeding Heart Liberal' On Medicare?

The New York Times: When Five-Star Care Is Substandard
Medicare has devised a rating system for nursing homes that portrays many of them as much better than they really are. Consumers should be aware that a top five-star rating from Medicare, achieved by a fifth of the more than 15,000 nursing homes nationwide, may mask serious and potentially dangerous deficiencies (8/25). 

The Washington Post’s Plum Line: Bleeding Heart Liberal Karl Rove Attacks Senate Dems From The Left
The other day, I noted that Karl Rove’s Crossroads GPS is up with a new ad that slices and dices Dem Senator Mark Pryor’s quotes to create the impression he supports raising the Social Security retirement age in ways that should frighten today's seniors. Just as they have in the last two cycles — in which Republicans have built national campaigns around dishonest attacks on Obamacare’s provider-side cuts to Medicare — this ad shows Republicans once again hitting Dems from the left on entitlements (Greg Sargent, 8/25). 

Los Angeles Times: Another GOP State May Be Signing Up For Medicaid, And The Reason Is Obvious
Reports out of Cheyenne say that Wyoming is finally talking to federal officials about expanding Medicaid. That would make Wyoming the 12th state with a Republican governor to expand Medicaid under the Affordable Care Act, leaving 16 with GOP leadership still in the "no expansion" column. The reason for Wyoming's wavering is clear: It's money (Michael Hiltzik, 8/25).

Bloomberg: Loving And Hating Obamacare With One Muddled Mind
For those of us who pay close attention, it may seem weird that someone could hate Obamacare while loving almost every part of it. There must be one overriding opinion hidden in there -- pro or con -- that good research can isolate, no? Well, no. Sometimes, incoherence in the polls simply reflects incoherence among voters. We just have to live with that (Jonathan Bernstein, 8/25). 

Los Angeles Times: A Women's Rights Victory As California Nixes An Attack On Abortion Coverage
With minimal fanfare, California state officials have nixed an underhanded effort by two Catholic-affiliated universities and their insurers to deprive the universities' employees of insurance coverage for abortions. The move by the Department of Managed Health Care is one of the strongest statements in favor of women's reproductive health rights you're likely to hear from officials of any state, at a time when those rights are under systematic attack. So it's proper to pay attention (Michael Hiltzik, 8/25). 

Los Angeles Times: Trying To Save The Contraception Mandate By Changing Its Address
Here's a prediction: The next legal battle over the Obama administration’s contraception mandate will be over who has to write what kind of letter to whom. The administration announced Friday the latest tweaks to the requirement that all new employer-sponsored health plans include coverage for female contraception with no out-of-pocket costs. The changes, which respond to a pair of Supreme Court rulings, are designed to keep the coverage in place for female employees while allowing more religious-affiliated nonprofits and some privately held for-profits to distance themselves further from the transaction (Jon Healey, 8/25).

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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.