Daily Health Policy Report

Thursday, August 28, 2014

Last updated: Thu, Aug 28

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Veterans Health Care

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Law Spurs Focus On Faster Drug Development

Kaiser Health News staff writer Daniela Hernandez reports: “Imagine if scientists could recreate you---or at least part of you---on a chip. That might help doctors identify drugs that would help you heal faster, bypassing the sometimes painful trial-and-error process and hefty health care costs that accompany arriving at the right treatment. Right now, at the University of California, Berkeley, researchers in bioengineer Kevin Healy's lab are working to make that happen. Funded under a provision of the health law, they're trying to grow human organ tissue, like heart and liver, on tiny chips” (Hernandez, 8/28). Read the story, which also ran in Wired.

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Capsules: CBO Projects Lower Medicare and Medicaid Costs; Urgent Care Centers Opening For People With Mental lllness

Now on Kaiser Health News blog, Mary Agnes Carey reports on the CBO’s latest projections for Medicare and Medicaid: “Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday. Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast” (Carey, 8/27). 

Also on Capsules, Anna Gorman reports on how urgent care centers are opening to treat people with mental illness: “Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned. L.A. County’s mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are 'more humane' and a smarter approach” (Gorman, 8/28). Check out what else is on the blog.

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Political Cartoon: 'Cootie Catcher?'

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

CBO'S LONG-TERM VIEW

The bargain price tag
On a permanent doc fix
won't last forever
-Anonymous 

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 Provision Seeks To Rein In Executive Compensation At Insurance Companies

News outlets report that this little-noticed provision puts in place stricter limits regarding the amount companies can deduct from their federal tax bills. Also in the news, The Associated Press reports on ways health plans discourage sick people from enrolling and The New York Times examines the health law's efforts to expand mental health coverage.   

The Washington Post’s Wonkblog: The Obscure Part Of Obamacare That Takes On Executive Pay
We all know Obamacare is a pretty big law, with plenty of obscure provisions that don't get much attention. For one, the law targets big executive pay packages at health insurance companies -- and based on data released Wednesday, the provision is already going a long way. Companies have long been able to deduct salaries to top executives from their federal tax bills, although since the early 1990s -- in an effort to reduce excessive pay -- the government has limited the amount to $1 million (Millman, 8/27).

Marketplace: Affordable Care Act Provision Targets Some Exec Pay
A little-known provision in the Affordable Care Act (ACA) could help rein in executive compensation at health insurance companies, according to The Institute for Policy Studies. Corporations can deduct the costs of doing business from their tax bills, including the compensation of a firm’s top four executives. The deductions are capped at $1 million for each of those executives. The Affordable Care Act made the limits stricter for health insurance companies, which stood to gain business as more Americans became insured under the law (Baxter, 8/27).

Related KHN coverage: Report: Health Law Ups Taxes On Insurers With Big Pay Packages (Appleby, 8/27)

The Associated Press: 3 Ways Insurers Can Discourage Sick From Enrolling
Insurers can no longer reject customers with expensive medical conditions thanks to the health care overhaul. But consumer advocates warn that companies are still using wiggle room to discourage the sickest — and costliest — patients from enrolling. Some insurers are excluding well-known cancer centers from the list of providers they cover under a plan; requiring patients to make large, initial payments for HIV medications; or delaying participation in public insurance exchanges created by the overhaul (8/27).

The New York Times: Expansion Of Mental Health Care Hits Obstacles
The Affordable Care Act has paved the way for a vast expansion of mental health coverage in America, providing access for millions of people who were previously uninsured or whose policies did not include such coverage before. Under the law, mental health treatment is an “essential” benefit that must be covered by Medicaid and every private plan sold through the new online insurance marketplaces (Goodnough, 8/28).

Meanwhile, Arkansas' governor touts lower insurance premiums --

The Washington Post: Health-Care Premiums Fall In Arkansas
Arkansas Gov. Mike Beebe's office said Wednesday that most health-care customers will pay less for their plans next year, a relief to state residents — and to the Democratic senator trying to hold onto his seat in one of the country's most expensive elections. Health-care premiums will decline about 2 percent next year, Beebe (D) wrote in a statement Wednesday. Beebe helped lead an at-times reluctant Republican legislature to expand Medicaid. In his statement, he said insurance costs nationwide "historically rise by six-to-ten percent annually." The state used federal funds to launch a private Medicaid option that has been described as a potential model for conservative-leaning states (Ferris, 8/27).

And, on the political front --

The Washington Post: Why That One Democratic Obamacare Ad Didn’t Signal A New Trend
When Sen. Mark Pryor of Arkansas went up with a television ad last week alluding to some benefits of Obamacare, partisans on both the left and the right saw the spot as a sign that vulnerable Democrats might finally be embracing the polarizing health-care overhaul in their campaigns. But in the days since, it's become clear: there's little evidence that the hotly debated law is on its way to becoming a central Democratic talking point heading into the fall campaign (Gold, 8/27).

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Consumers Unable To Update Healthcare.gov Data With Deadline Looming

Hundreds of thousands of people risk losing subsidized health insurance if they don't resubmit immigration information by the end of next week, but many have been unable to comply because of glitches with healthcare.gov. Other stories look at the millions spent on healthcare.gov and at exchange developments in Connecticut, Oregon and Washington.

USA Today: Consumers Deal With Insurance Deadline, Site Glitches
Hundreds of thousands of people risk losing their new health insurance policies if they don't resubmit citizenship or immigration information to the government by the end of next week -- but the federal Healthcare.gov site remains so glitchy that they are having a tough time complying. Consumers are being forced to send their information multiple times, and many can't access their accounts at all, immigration law experts and insurance agents say (O’Donnell, 8/28).

The Washington Post: How You End Up Spending $800 Million On Healthcare.Gov
Signed into law by President Obama on March 23, 2010, the Affordable Care Act has proven to be its own kind of jobs act, especially when it comes to the Washington-area IT community. When, in several places, the bill called for the creation of an "Internet website" to allow Americans to find and sign up for new health insurance coverage, it opened the tap on hundreds of millions of dollars that would eventually go to creating healthcare.gov's front end and back end, as well as a small universe of accompanying digital sites. On Wednesday, the office of Daniel Levinson, the inspector general of the Department of Health and Human Services, put out a report detailing the dozens of contracts that went into building out the Federal Marketplace project. And a look at each in the disaggregate paints a picture of an effort far more sweeping than even that suggested by the half-billion dollars the federal government has already paid out to implement the digital side of the health insurance law (Scola, 8/27).

Connecticut Mirror: Access Health CT’s IT Chief To Lead Agency As Interim Boss
Jim Wadleigh, the top information technology official at Connecticut’s health insurance exchange, will lead the agency on an interim basis after chief executive Kevin Counihan leaves for a top federal job next week. The exchange’'s board plans to conduct a national search to replace Counihan, but it's anticipated to take months. That means Wadleigh will be leading the agency, Access Health CT, at the start of the next open enrollment period for private health insurance, which begins Nov. 15 (Levin Becker, 8/27).

The Seattle Times: State To Offer More Health-Insurance Choices Next Year
Ninety individual health plans sold by 10 insurers will likely make their way into Washington's exchange marketplace for 2015, if the Washington Health Benefit Exchange board approves them Thursday, as expected. The Office of the Insurance Commissioner (OIC) also approved two insurers' exchange plans for small businesses, including the first to sell small-business plans statewide in Washington: Moda Health Plan (Ostrom, 8/27).

Oregonian: Cover Oregon Needs Oracle's Help To Avoid Delays In Federal Health Exchange Transition
A key portion of the work under way on the troubled Cover Oregon health exchange project -- that affecting people enrolling for the state's Medicaid program -- may not be ready as planned when the new federally-assisted exchange "goes live" in November, The Oregonian has learned. And it appears that Oregon's legal dispute with Oracle America over the exchange is not helping the matter. The new obstacles involve Oracle, which highlights an uneasy reality. Despite having accused the California software giant of lies, poor work and fraud in court, the state still needs Oracle's help (Budnick, 8/28).

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Pennsylvania Officials Say Medicaid Expansion Talks Are In Final Stage

But the state offered few details about where the negotiations with the federal government are heading. Also in news about changes from the health law in the states, the Arizona Supreme Court agreed to hear an appeal of a case that could unravel that state's Medicaid expansion.

The Associated Press: Talks On Pennsylvania Medicaid Plan Said To Be Nearing End
An announcement could be made soon on Pennsylvania Gov. Tom Corbett's plan to use billions of federal Medicaid expansion dollars under the 2010 healthcare law to subsidize private health insurance policies, a spokeswoman said Wednesday. Kait Gillis, a state Department of Public Welfare spokeswoman, said negotiations with the federal government are in the final stages, but details remain under wraps (8/27).

Arizona Republic: Arizona Medicaid Appeal To Be Heard By Court
The Arizona Supreme Court has agreed to hear Gov. Jan Brewer's appeal of an appeals-court decision that could unravel the Medicaid expansion she fought for last year. The high court has not yet set a date, but indicated it will hear Brewer's argument that about three dozen Republican lawmakers don't have the legal standing to challenge the controversial vote (Pitzl, 8/27).

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Capitol Hill Watch

CBO: Smaller Deficits Projected As Medicare And Medicaid Spending Declines Slightly

In the Congressional Budget Office's latest forecast, reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion.

The Wall Street Journal: Deficit Forecast Trimmed As Rates Stay Low
Smaller deficits are the result of a variety of factors, including higher tax revenue and economic growth, budget cuts and new limits on government spending. The agency forecast the government would spend slightly less on Medicare and Medicaid over the next decade than it estimated earlier this year. Still, the changes were relatively minor—less than 1% of total spending on the programs. CBO expects the deficit to shrink for several years before starting a steady expansion in 2018, driven by the aging U.S. population, higher health-care costs and increasing subsidies for certain federal programs (Paletta, 8/27).

Kaiser Health News: Capsules: CBO Projects Lower Medicare and Medicaid Costs
Reduced costs for medical services and labor have trimmed the 10-year projected cost of Medicare and Medicaid by $89 billion, the Congressional Budget Office said Wednesday. Medicare spending is projected to drop by $49 billion — or less than 1 percent — from 2015 and 2024, while Medicaid spending is expected to drop by $40 billion — or about 1 percent — over the next decade, CBO said in an update to its April forecast (Carey, 8/27). 

The Associated Press: US Economy Forecast To Grow By 1.5 Percent In 2014
The Congressional Budget Office on Wednesday forecast that the U.S. economy will grow by just 1.5 percent in 2014, undermined by a poor performance during the first three months of the year. The new assessment was considerably more pessimistic than the Obama administration’s, which predicted last month that the economy would expand by 2.6 percent this year even though it contracted by an annual rate of 2.1 percent in the first quarter (Taylor, 8/27).

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Veterans Health Care

Obama's Plans For Vets Include Development Of Computer Chips To Stop Pain

The novel effort will be spearheaded by the Defense Advanced Research Projects Agency. Also, Sen. Bernie Sanders, I-Vt., tells an American Legion convention that Congress will continue to revamp the VA.

The Washington Post: New Obama Plan Calls For Implanted Computer Chips To Help U.S. Troops Health
When President Obama on Tuesday highlighted 19 executive actions he says he is taking to improve the mental health of U.S. troops and veterans, one of them centered on a particularly novel effort: The development of new computer chips designed to modulate the nervous system to help with everything from arthritis to post-traumatic stress. The project is headed by the Defense Advanced Research Projects Agency, a Pentagon agency that develops a variety of high-tech equipment for the U.S. military (Lamothe, 8/27).

Arizona Republic: Congressional Leaders Say VA Reform To Continue
Months of disclosures about potentially criminal conduct at Department of Veterans Affairs facilities in Phoenix and elsewhere will help resuscitate the agency, according to two key congressional leaders who spoke to the nation's largest veterans organization Wednesday. "The problems within the VA were not created overnight, and they are not going to be solved overnight," Sen. Bernie Sanders, I-Vt., told thousands of veterans at the American Legion's national convention. "There is much left to do" (Giblin, 8/27).

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State Watch

State Highlights: Heroin Deaths Rise In N.Y.; TennCare Computer System Delay; Colo. Races To Win $87M To Integrate Care;

A selection of health policy stories from Colorado, Minnesota, Georgia, Virginia, California, New York, Michigan and Tennessee.

The New York Times: Heroin's Death Toll Rising In New York, Amid A Shift In Who Uses It
A heroin crisis gripping communities across the country deepened in New York last year, with more people in the city dying in overdoses from the drug than in any year since 2003. In all, 420 people fatally overdosed on heroin in 2013 out of a total of 782 drug overdoses, rising to a level not seen in a decade in both absolute numbers and as a population-adjusted rate, according to preliminary year-end data from the city’s health department (Goodman, 8/28).

McClatchy: TennCare Computer System Delay Draws Federal Criticism
Just days before TennCare leaders head to court over accusations that state failures have created months-long delays in coverage, the agency’s director faced questions from lawmakers about the unfinished computer system that led to those delays. TennCare Director Darin Gordon told lawmakers Tuesday that nearly a year after the new state’s new Medicaid eligibility system was supposed to be completed, the contractors building the system have not finished even the first of four testing phases (Harrison Belz, 8/27).

Health News Colorado: Race To Win $87 Million Could Fuel Blended Physical, Behavioral Health
Integration is a hot buzzword to describe efforts to blend physical and behavioral health care. But the sad truth from experts who have been doing integration for decades is that most efforts won't work, either because managers don't know how to fully integrate their health systems or because they can't pay for it. Colorado health policy leaders are trying to strengthen and expand integration pilot programs with a jolt of federal cash. Much like "Race for the Top" funds in education, states are competing for a new pot of $700 million in federal cash to fuel innovations in health. Colorado officials are applying for $87 million and could get an answer by the end of October (Kerwin McCrimmon, 8/27).

Minneapolis Star-Tribune: Minnesota Doctors Now Must Report Dense Breast Tissue On Mammograms
The standard "all-clear" letter sent after mammograms to tell women they are cancer-free is going to contain new and potentially troubling information for thousands of Minnesota women -- the disclosure that they have dense tissue in their breasts that could cloud their cancer screenings. Minnesota mandated as of Aug. 1 that doctors notify women if their mammograms discover dense breast tissue, which can mask the presence of a tumor on an X-ray (Olson, 8/27).

Atlanta Journal-Constitution: Increased Medicaid Pay For Doctors Set To End This Year
Dr. Sean Lynch is forced to turn away as many as seven low-income patients every day, and that number could soon grow. For the past two years, Lynch and other Georgia doctors have received more money for treating Medicaid. ... But the reimbursement hike — fully paid for by the federal government for two years — is set to end on Dec. 31 unless the state opts to extend the increase with its own money (Murchison, 8/28).

Stateline: Fighting Financial Scams Aimed At Seniors
Sally Hurme figured that if anyone knew about financial scams targeted at older Americans, it would be her family and friends. After all, Hurme, an attorney and AARP project advisor, had spent two decades educating seniors across the country about fraud and how to avoid it. That's why she was so shocked when her own husband, Art, 71, became the victim of a fraud in January. The retired Army Corps of Engineers marine biologist wound up losing $3,000 in an "imposter scam" after receiving a call at his Alexandria, Va., home from a sobbing woman claiming to be his daughter (Bergal, 8/27).

Kaiser Health News: Capsules: Urgent Care Centers Opening For People With Mental lllness
Mental health urgent care centers, also known as crisis stabilization units, are opening throughout California in response to the shortage of psychiatric beds and the increase in patients with mental illnesses showing up at hospital emergency rooms with nowhere else to go, experts and advocates said. In Los Angeles County, four such centers have opened and several more are planned. L.A. County's mental health director Marvin Southard said the centers are a more effective way to care for many patients with mental illness and are less disruptive to hospitals. And county Supervisor Mark Ridley-Thomas, who led the effort to open the center, said they are "more humane" and a smarter approach (Gorman, 8/28).

The Associated Press: Deal On Health Care Aids Port Contract Talks
Negotiators hoping to forge a new contract for dockworkers and keep hundreds of billions of dollars in cargo moving smoothly through West Coast seaports made significant progress with a tentative deal on health care benefits, a knotty issue that tied up talks for months. West Coast dockworkers already have unusually generous health benefits -- so generous, argue their employers who pay for the coverage, that the insurance plan has become riddled with fraud (8/27).

The Associated Press: Firm Allegedly Gipped Workers Out Of Jobs, $100K
Prosecutors hammered a Brooklyn contractor Wednesday with allegations he cheated workers out of $100,000 and reneged on promises of permanent jobs and health care. Contractor Anthony Miller and his firm Bael Out Enterprises were arraigned in Brooklyn Supreme Court on charges they schemed to defraud more than 70 workers and failed to obtain workers' compensation insurance (8/27).

Kaiser Health News: Health Law Spurs Focus On Faster Drug Development
Imagine if scientists could recreate you -- or at least part of you -- on a chip. That might help doctors identify drugs that would help you heal faster, bypassing the sometimes painful trial-and-error process and hefty health care costs that accompany arriving at the right treatment. Right now, at the University of California, Berkeley, researchers in bioengineer Kevin Healy's lab are working to make that happen. Funded under a provision of the health law, they're trying to grow human organ tissue, like heart and liver, on tiny chips (Hernandez, 8/28). 

Pioneer Press: Minnesota Health Care Union Vote Bucks National Labor Trend
The creation of a new bargaining unit to represent the state's 27,000 home health care workers could boost the dwindling ranks of union membership in once labor-strong Minnesota. While the percentage of Minnesota workers affiliated with unions is still above the national average, it has been steadily declining since its peak at 22 percent in 1992, according to a report by the U.S. Bureau of Labor Statistics (Woltman, 8/26).

Detroit Free Press: New Nonprofit Aims To Boost Michigan Women's Access To Health Care
A new nonprofit dedicated to informing Michiganders about the types of laws passed or being considered by the state Legislature that it sees as detrimental to women's access to health care will officially get off the ground today. Sen. Gretchen Whitmer, D-East Lansing, is the spokeswoman for the new group -- Right to Health -- that will travel the state to talk to women about obstacles to obtaining quality health care (Gray, 8/28).

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Weekend Reading

Longer Looks: A New Kind Of Abortion War; Foster Kids And Psychotropic Drugs

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

Pacific Standard: A Tale Of Two Abortion Wars
While pro-life activists fight to rescue IVF embryos from the freezer, pregnant women in their third trimester with catastrophic fetal anomalies have nowhere to turn. ... Perhaps there is no other issue that touches on so many core dimensions of American society—legal, medical, scientific, theological, political, philosophical, biological, ethical, and ecological. What some on one side of the debate call reproductive justice, others call taking a life. What some call a person, others call a cluster of cells. This seemingly intractable split is part of the larger culture wars that have fractured the nation for decades, pitting traditionalist and progressive values against each other (Ananda Rose, 8/25).

Vox: An Interview With Healthcare.gov’s Chief Executive
Connecticut's health exchange had one of the most successful open enrollment seasons of any Obamacare marketplace this year ... It's no surprise then that the White House has now tapped AccessHealthCT executive director Kevin Counihan to run Healthcare.gov as chief executive. ... Counihan and I last spoke in June, to debrief about the first open enrollment season ... SK: How do you think the 2015 open enrollment will go? ... KC: It's going to be very complex. Not only are people going to be enrolling and going to be renewing, but there are going to have to be new determinations of what tax credits people qualify for. The education is going to be critical (Sarah Kliff, 8/26).

The Economist: Paternalism 2.0
American exceptionalism takes many forms. In the corporate world, one example is particularly odd: companies choose health insurance for their workers. Almost all firms with over 200 employees offer health coverage. Company-sponsored insurance is common for working-age Americans. In no other big and rich country is it the norm. But this form of paternalism is diminishing fast, accelerated by Barack Obama's health reform. ... Some employers are going further, asking workers to shop not only for health care, but for insurance. Workers can use their firm’s money to choose among plans from new private health exchanges. ... Eventually companies might relinquish their grip on health insurance completely (8/23).

San Jose Mercury News: Drugging Our Kids
They are wrenched from abusive homes, uprooted again and again, often with their life’s belongings stuffed into a trash bag. Abandoned and alone, they are among California’s most powerless children. But instead of providing a stable home and caring family, the state's foster care system gives them a pill. With alarming frequency, foster and health care providers are turning to a risky but convenient remedy to control the behavior of thousands of troubled kids: numbing them with psychiatric drugs that are untested on and often not approved for children. An investigation by this newspaper found that nearly 1 out of every 4 adolescents in California's foster care system is receiving these drugs — 3 times the rate for all adolescents nationwide (Karen De Sa).

The Boston Globe: Brave And Afraid, And Heading Down The Longest Road (Three-Part Series)
Mike was 33 years old. He'd been in and out of institutions for half his life, since he first got sick when he was 17. His diagnosis had changed over the years — it was schizophrenia, then bipolar disorder, then schizoaffective disorder — and his medications were in constant flux. Things stayed good for a while, then went bad again. Now Mike's medications seemed to be working, and he was saying that he wanted to stay on them — a view he didn't always take. But there had been so many days like this, so many hopeful new beginnings (Jenna Russell, 8/23-8/25).

The Atlantic: Healthcare In The Time of Grey's Anatomy
A 2005 survey by the Centers for Disease Control and Prevention found that the majority of primetime TV viewers reported learning something new about a disease or other health issue over six months of viewing. About one-third of viewers took some kind of action after learning about a health issue on TV. Many medical shows have physicians consult for accuracy, and an article in the American Medical Association Journal of Ethics notes that starting with ER in the 90s, TV shows began using more detailed medical jargon to describe conditions and procedures. But there are still inconsistencies. Treatments for patients with seizures are sometimes downright dangerous, with doctors trying to hold patients down, or put things in their mouths (they could choke) (Julie Beck, 8/26).


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Editorials and Opinions

Viewpoints: Medicare No Longer 'Busting' The Budget; A 'Nightmare' Trying To Get Coverage In D.C.

The New York Times' The Upshot: Medicare: Not Such A Budget-Buster Anymore
You're looking at the biggest story involving the federal budget and a crucial one for the future of the American economy. Every year for the last six years in a row, the Congressional Budget Office has reduced its estimate for how much the federal government will need to spend on Medicare in coming years. The latest reduction came in a report from the budget office on Wednesday morning. The changes are big. The difference between the current estimate for Medicare’s 2019 budget and the estimate for the 2019 budget four years ago is about $95 billion (Margo Sanger-Katz and Kevin Quely, 8/27). 

The Washington Post's Plum Line: Yes, Obamacare Is Cutting The Deficit
Today the Congressional Budget Office released its latest economic and fiscal projections, and guess what: The news is pretty good. In fact, all the "deficit hawks" out there who are deeply concerned about too much borrowing and the terrible choices our grandchildren will confront might want to write a letter of thanks to one Barack Hussein Obama. To start things off, the CBO says the deficit this year will be $506 billion, or 2.9 percent of GDP. In 2013 it was $680 billion, so that’s a pretty steep drop. And in terms of GDP, not only is that slightly lower than the average deficit of the last 40 years (3.1 percent), it's also a 70 percent decline from Obama's first year in office, where because of the Great Recession, which brought both the need for more spending and a plunge in tax revenues, the deficit peaked at 9.8 percent of GDP (Paul Waldman, 8/27). 

The Washington Post's Plum Line: On Obamacare, Democrats Should Attack, Not Defend
Yesterday, state treasurer Doug Ducey won the GOP nomination for governor to replace Jan Brewer in Arizona. Brewer was one of eight GOP governors who accepted the expansion of Medicaid, something Ducey had opposed. Ducey's comments on the subject are vague ... when asked whether he'd repeal the expansion, he bobs and weaves. And it isn't hard to understand why. Looking at this race in combination with other close races, you see that the politics of health care have shifted profoundly in recent months. As Democrats are stroking their chins wondering whether they can turn the Affordable Care Act into a winning issue this fall, and if so how to do it, the answer is simple: Don't defend, attack (Paul Waldman, 8/27).

The Washington Post: Even A Harvard-Educated Lawyer Has 'Nightmare' With D.C. Health Insurance Site
Diana Daniels's experience with the District's health insurance Web site is the sort that gives government bureaucracy — and Obamacare — a bad reputation. The Northwest Washington mom filed her online application for medical coverage for her two teenage daughters on June 4. The process supposedly requires three weeks at most. No coverage materialized for nearly three months, despite Daniels's numerous calls to D.C. Health Link trying to sort things out (Robert McCartney, 8/27). 

The Washington Post: Early Tax Planning May Be Needed Because Of The Affordable Care Act
Having gone through tax season not that long ago, you may not want to face any issues related to your tax situation until next year. But some of you may need to do some tax planning now nonetheless. It has to do with the Affordable Care Act (Michelle Singletary, 8/26).

The Wall Street Journal: An $8.3 Billion Rebuke To The FDA
Amid this summer's M&A fever, Roche's agreement Monday to buy the San Francisco biotech InterMune deserves special notice. The tie-up is an $8.3 billion guided missile into the fortified bunker that is the Food and Drug Administration. InterMune has never turned a profit in 16 years of existence and other than its clinical expertise the company holds a single asset: an idea for treating a lethal lung disorder called idiopathic pulmonary fibrosis with no known cause, cure or approved therapy—at least in the U.S. An InterMune drug called pirfenidone that slows the progression of irreversible lung scarring is on the market in Europe, Japan, Canada and even China (8/27). 

The New England Journal Of Medicine: A VA Exit Strategy
The VHA's [Veterans Health Administration] current crisis provides an opportunity to dramatically rethink the role that the agency plays in improving access to high-quality, high-value care for its service population. To simply go on doing more of the same is to fail to recognize the challenge that the VHA's cost and population structure pose in the longer run. Just as they plan for new roles for the federal government as part of an exit strategy from a war that is winding down, politicians with longer-term views might envision a new way for the VHA to work with other federal departments and the private sector to reduce its overall and per capita costs, shed costly and unproductive assets, save taxpayers money, reduce veterans' health care expenditures, and improve veterans' outcomes (Dr. William B. Weeks and David Auerbach, 8/28).

The New England Journal Of Medicine: Updating Cost-Effectiveness — The Curious Resilience Of The $50,000-per-QALY Threshold
For more than two decades, the ratio of $50,000 per quality-adjusted life-year (QALY) gained by using a given health care intervention has played an important if enigmatic role in health policy circles as a benchmark for the value of care. Researchers have summoned this cost-effectiveness ratio in order to champion or denounce particular investments in medical technologies and health programs. ... Invoking thresholds, however, means acknowledging limits  ... It also suggests that more of our spending should focus on underutilized interventions with ratios below the threshold; substituting more cost-effective interventions for less cost-effective ones could improve health outcomes and save money (Peter J. Neumann, Joshua T. Cohen and Milton C. Weinstein, 8/28).

JAMA: Legalizing Medical Marijuana May Reduce Opioid Deaths
Opioid-overdose deaths increased in states across the country between 1999 and 2010, but states that legalized medical marijuana saw less-steep increases than those without, according to a study published in JAMA Internal Medicine this week. Growing use of prescription opioids over the past 2 decades to treat chronic pain has helped drive increasing rates of opioid overdoses. ... Marcus A. Bachhuber, MD, a Robert Wood Johnson Foundation Clinical Scholar at the Philadelphia Veterans Affairs Medical Center, and his colleagues analyzed opioid overdose rates in states with or without legalized medical marijuana (Bridget Kuehn, 8/26). 

JAMA: What Near-Death Experience Can Tell Us About Medical Care
In 2005, a survey was conducted examining how aggressively physicians treat patients near the end of life. Some 1500 primary care physicians and cardiologists were presented a scenario describing an 85-year-old man with severe congestive heart failure. ... Recently, the responses to this survey were analyzed by me, Ariel Stern, PhD; Jonathan Skinner, PhD; David Wennberg, MD, MPH. Although the data are nearly a decade old, there is no reason to think that answers today would be any different. Our analysis of these responses reveals the troubled state of American health care—as well as the possibilities ... No one is trying to do the wrong thing, but the consequences of unstandardized and often excessive care is wasted money and unnecessary pain. Establishing the right systems, realigning payments, and pushing for the right care can accomplish far more than many think is possible (David Cutler, 8/27).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.