Daily Health Policy Report

Thursday, August 29, 2013

Last updated: Thu, Aug 29

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Capitol Hill Watch

Health Care Marketplace

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Don Berwick's Newest Phase: Candidate, But Still Dr. Quality

WBUR's Martha Bebinger, working in partnership with Kaiser Health News and NPR, reports: "Dr. Donald Berwick might be running for governor of Massachusetts, but he's still got a foothold in his former life. Berwick, most recently known as the acting chief of the Centers for Medicare and Medicaid, had a long record as the leading authority on health care quality, including being founder and CEO of the Institute for Healthcare Improvement. And it was in that capacity that British Prime Minister David Cameron asked Berwick for his recommendations for improving safety and restoring confidence after higher-than-expected death rates at one hospital rocked the country" (Bebinger, 8/29). Read the interview.

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Capsules: AMA President Optimistic About A Fix For Medicare's Doctor Payment Formula

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "Debated and despised, the Medicare physician payment formula may finally be on the way out – at least that’s what AMA President Ardis Hoven believes" (Carey, 8/29). Check out what else is on the blog.

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Political Cartoon: 'Snidely Whiplashed?'

Kaiser Health News provides a fresh take on health policy developments with "Snidely Whiplashed?" by Mike Luckovich.

Here's today's health policy haiku:


It's not yet autumn,
but fed regulations are
dropping like fall leaves.

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 Spending And Fiscal Battles

As Deficit Talks Resume, Health Law Funding Fight Escalates

News outlets report little optimism that talks between a group of Republican senators and the White House will resolve the impasse. Meanwhile, House Republicans are expected to use the battle over raising the debt limit as leverage to block the health law -- either by stripping away its funds, or delaying implementation.

The New York Times: Deficit Talks Resuming, But Few Sound Hopeful
The two sides had said they would meet during the August recess, but the gathering will be the first in that time and is intended to take stock before Congress reconvenes in September. Neither side expressed optimism in interviews, with talks snagged on the same issues that killed past bipartisan efforts: Republicans' demands for deeper Medicare cuts and President Obama's insistence that they, in return, agree to higher taxes on the wealthy and some corporations (Calmes, 8/28).

The Washington Post: The House GOP Is Bracing For Debt-Limit Battle And Likely To Target Obamacare First
Boehner (R-Ohio) has proposed a short-term budget bill to keep the government open into the new fiscal year with relatively little fuss. But during a speech in Boise, Idaho, on Monday, he said House Republicans will draw a line in the sand over lifting the federal debt limit, demanding spending "cuts and reforms that are greater than the increase in the debt limit." … What kind of change? Senior Republican aides say it is becoming clear that Boehner will have to launch a concerted assault on the Affordable Care Act, President Obama’s signature health-insurance initiative. The Heritage Foundation, the Club for Growth and other conservative groups are demanding a full-on attempt to defund the law, and at least 80 House Republicans have signed on (Montgomery, 8/28).

The Hill: How The Obamacare Defunding Battle Exploded Into Political Showdown
The fight over defunding ObamaCare is a fight conservatives have spent months itching for. But few thought it could have intensified so fast, especially after President Obama’s reelection triumph and Democrats picking up seats in both chambers of Congress last November (Baker, 8/29).

Bloomberg: Republican Health-Care Attack Shifts From Defund To Delay
Republican congressional leaders, in a fresh strategy after repeatedly failing to dismantle President Barack Obama’s health-care law, are leaning toward an effort to postpone it rather than choke off funding. Freshmen Senators Ted Cruz of Texas and Mike Lee of Utah have commanded the spotlight during this month’s congressional recess, saying they want to shut down the government unless the law is defunded (Przybyla, 8/29).

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Health Reform

Bill Clinton Enlisted To Promote Health Law

The former president will speak about the overhaul Sept. 4 at his presidential library in Little Rock, Ark. Media outlets also explore the activities of two nongovernment groups reaching out to people who will be able to shop for insurance in new online marketplaces opening Oct. 1.

The Associated Press/Washington Post: White House Enlists Bill Clinton’s Help As Key Phase Of Health Care Nears
The White House is enlisting former President Bill Clinton's help in explaining President Barack Obama’s health care law as a key phase of the reform nears. Clinton will speak about the law on Sept. 4 at his presidential library in Little Rock, Ark. His remarks come less than one month before the public can start signing up for the health care exchanges, which will be crucial to the law's success or failure (8/28).

The Wall Street Journal’s Washington Wire: White House Enlists Bill Clinton To Sell Obamacare
President Barack Obama has tapped former President Bill Clinton to raise awareness about the nation’s health care law as the White House grapples with how to explain the new complex regulations to the public. Mr. Clinton will speak from his presidential library in Little Rock, Ark., about the health-care law on Sept. 4—just one month before insurance marketplaces created under the Affordable Care Act take effect, the Clinton Foundation said in a press release (Favole, 8/28).

Bloomberg: Bill Clinton Enlisted By Obama To Promote U.S. Health Law
Bill Clinton agreed to lend his weight to President Barack Obama’s effort at educating people about the U.S. health-care overhaul, a helping hand needed to combat confusion as key parts of the law begin Oct. 1. Clinton, a two-term U.S. president who left office in 2001, will promote the Affordable Care Act in a Sept. 4 speech from his museum in Little Rock, Arkansas, according to a statement today from his philanthropic foundation (Wayne, 8/28).

The Washington Post: How Organizing For Action Spent The August Recess, By The Numbers
For many, August is a time for rest and relaxation. For members of Organizing for Action, it is a time for more than 2,000 rallies. That’s according to a new memo by the group's executive director Jon Carson, which members will receive Wednesday morning. According to the missive, titled, "The Undeniable Success of 'Action August,'" the group pressed its case for issues including health care, immigration reform, climate change and gun control in a myriad of communities across the country (Eilperin, 8/29).

The Hill: Enroll America Using School Events To Push Obamacare Exchanges
A group charged with bolstering enrollment in ObamaCare's new insurance exchanges is taking advantage of the back-to-school season to advance its effort. Enroll America is encouraging exchange enrollment at fall events around the country like back-to-school fairs and backpack giveaways, the group said Wednesday (Viebeck, 8/28).

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Health Law Rules Aim To Protect Insurance Marketplace Funds, Consumers

The regulations are designed to safeguard how federal funds will be used in online insurance marketplaces and to provide protections to consumers. News outlets also detail a number of health law implementation issues, including a study about how rate shock warnings might be "overblown."

CNN: HHS Finalizes More Obamacare Policies
As part of its continued effort to solidify Affordable Care Act regulations before insurance exchanges open on October 1, the Department of Health and Human Services finalized a new rule on Wednesday clarifying how a number of issues will be handled in the new marketplaces. "The overarching goal is to safeguard federal funds and to protect consumers by ensuring that issuers, marketplaces, and other entities comply with federal standards meant to ensure consumers have access to quality, affordable health insurance," the department said in a press release (Aigner-Treworgy, 8/28).

The Wall Street Journal: Prepaid Debit Cards Allowed As Health-Insurance Payment
The Obama administration said Wednesday it would require insurers to let uninsured Americans pay for health coverage this fall with prepaid debit cards rather than limit them to bank-account transfers, though it won't require insurers to accept automatic monthly payments from credit or debit cards. Allowing prepaid cards is aimed at ensuring millions of lower-income Americans can sign up for coverage even if they don't have checking accounts (Radnofsky, 8/28).

The Associated Press: 4 Tips For Savvy Health Care Shopping
Your employer and President Obama are imploring you to become a better health care consumer. They want everyone to take a more active role in their care because it's vital to help slow the seemingly perpetual rise of health care expenses (Murphy, 8/28).

The Courier-Journal/USA Today: Study: Obamacare Rate Concerns 'Overblown'
With Affordable Care Act set to begin in earnest next year, fears are mounting that insurance premiums will skyrocket when American workers re-enroll for health benefits through their jobs. But experts and a newly released study say those fears appear largely unfounded (Ungar, 8/29).

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Poor People In At Least 21 States To Face Medicaid Coverage Gap

McClatchy reports that in most states opting against the health law's Medicaid expansion, millions will be stranded without insurance:  They will make too much to qualify for Medicaid, but too little to get subsidies to help buy coverage on the new insurance marketplaces. Other news organizations report on the Michigan Senate's decision to move ahead with expansion, but not until April, and on the continuing debate in Ohio.

McClatchy Medicaid 'Coverage Gap' Looming For The Poor In 21 States
The law was supposed to provide health insurance for most Americans next year by expanding Medicaid in all states to people earning up to 138 percent of the federal poverty level. That’s about $15,900 for an individual in 2013, or nearly $32,500 for a family of four. But when the Supreme Court ruled that states could opt out of the expansion, Republican-led states took advantage. Rather than expand their Medicaid programs, most kept their programs as is – open mainly to the poorest of the poor (Pugh, 8/28).

Detroit Free Press: Delay In Medicaid Expansion To Be Costly
Getting the expansion of Medicaid passed in the state Senate Tuesday night was a huge victory for Gov. Rick Snyder, state health officials and, ultimately, nearly 500,000 low-income Michiganders. But the failure of the Senate to vote to give the bill immediate effect, thus delaying the implementation of the law until April 1, could cost the state and individuals hoping to qualify for Medicaid coverage dearly (Gray, 8/29).

Stateline: Michigan Senate Narrowly Passes Medicaid Expansion
The Michigan Senate narrowly voted in favor of expanding Medicaid eligibility Tuesday night, extending Medicaid benefits to an additional 345,000 residents (according to the Kaiser Family Foundation and The Urban Institute) now without health insurance. The measure is expected to be approved by the House in early September and signed by Republican Gov. Rick Snyder, who lobbied forcefully for expansion. Under the legislation, beneficiaries would be required to pay a portion of their premiums (Ollove, 8/28).

Columbus Dispatch: Citing Depression, Maurice Clarett Joins Call To Boost Medicaid
Mental health advocates gathered at the Statehouse today to push for Medicaid expansion in Ohio. Among the supporters? Former Ohio State phenom running back Maurice Clarett. Clarett, part of the 2002 National Championship team, had numerous off-the-field troubles, including robbery and weapons convictions that put him in prison. He has since been treated for depression (Felser, 8/29).

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Some GOP Leaders Still Resist The Health Law, Others View It As Political Reality

News outlets offer varying takes on how governors and state leaders are interacting with the health law.

The Washington Post: States Find New Ways To Resist Health Law
Several Republican-led states at the forefront of the campaign to undermine President Obama’s health-care law have come up with new ways to try to thwart it, refusing to enforce consumer protections, for example, and restricting federally funded workers hired to help people enroll in coverage. And in at least one state, Missouri, local officials have been barred from doing anything to help put the law into place (Somashekhar, 8/28).

The Associated Press/Washington Post: GOP Governors On 2014 Ballot In Swing States Are Accepting Political Reality Of Health Law
Despite unrelenting pressure by congressional Republicans to repeal President Barack Obama's health care overhaul, GOP governors in swing-voting states are grudgingly bowing to the reality that "Obamacare" is the law of the land and almost certainly here to stay. The governors' reluctant acceptance is based on what they call financial prudence and what appears to be political necessity (8/28).

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Colorado Continues Preparing For Exchange Challenges

Meanwhile, researchers say that if Connecticut's streamlined enrollment process works well, it could mean a significant jump in the number of people who gain insurance for the first time.

Bloomberg: Colorado's Data Tangle Shows Strain For Obamacare Targets
With 33 days and counting until online health insurance exchanges must open for business, states are racing to fine-tune computer systems, educate consumers and manage expectations. Marketplaces in California and Oregon said this month that technical hurdles may force consumers to apply with a broker or counselor instead of online when the exchanges start Oct. 1 (Oldham and Linskey, 8/29).

Health Policy Solutions (a Colo. news service): Exchange Preps For Snafus – Like Squirrels
In Colorado, an exchange of a different sort — Connect for Health Colorado — is bracing for different disasters: blizzards, floods and severed data lines. But the most likely potential problems center on connections with Colorado’s Medicaid computers, insurance industry websites and the federal data hub, which must provide information on tax subsidies to help cut the cost of new health plans (Kerwin McCrimmon, 8/28).

Health Policy Solutions (a Colo. news service): Confused About Obamacare? There's An App For That
While politicians continue to argue over the fate of Obamacare, consumers are deeply confused about what reform may mean to them and how they can find help. A new tool aimed at delivering answers debuted in Colorado this week: the Blue Guide from the Colorado Consumer Health Initiative. It’s mobile. It offers statewide information. And if you tell the website or app where you are, it will use geolocation to instantly show you nearby clinics, mental health centers or assistance sites where you can sign up for health insurance once Colorado’s new health exchange, Connect for Health Colorado, launches on Oct. 1 (Kerwin McCrimmon, 8/28).

The Seattle Times: Questions Arise Over Coverage For Abortion In Group Health Plans
After Group Health Cooperative confirmed Tuesday that it has dropped abortion coverage in the individual health-insurance plans to be sold inside the state’s new exchange marketplace — but will provide access to elective abortion in its medical centers without extra cost — a number of questions arose (Ostrom, 8/28).

CT Mirror Easier Enrollment Process Could Mean Thousands More With Coverage Under Obamacare, Researchers Say
Having a seamless, one-stop shopping process for state residents to enroll in health care coverage could ensure that an additional 26,000 people get insurance, and 36,000 avoid losing their coverage, according to research released this week. It comes amid questions about how easy it will be for the uninsured to enroll in coverage as part of federal health reform, and about how the process will be affected by outdated technology and delays in handling applications at the state Department of Social Services (Becker, 8/28).

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Small Businesses Passing Health Cost Increases On To Workers; Employers Blame Health Law For Shrinking Benefits

Businesses are still trying to sort out many of the issues that come with the implementation of the Affordable Care Act.

The Washington Post: As Rates Soar, Small Business Owners Pass Along More Health Care Costs To Employees
Health insurance costs for small business owners have been rising for more than a decade, and some are concerned the health care law will drive their premiums higher at an even faster clip. Many appear to be coping by passing some of the costs along to their employees (Harrison, 8/28).

CNN Employers Play Obamacare Blame Game
No more health benefits for spouses. Higher deductibles for employees. More cost-sharing. Employers are citing increased costs imposed by the Affordable Care Act -- as Obamacare is formally known -- as part of the reason they are pulling back on benefits. ... UPS and UVa said they are dropping coverage for employees' spouses that have access to benefits elsewhere. Delta said in a letter to administration officials that it will have to pass along some of the rising costs to its employees. While there's no doubt Obamacare comes with increased costs for employers, health reform can only be blamed for a piece of the price hike, experts say (Luhby, 8/29).

CBS News Health Care Is A Priority For Employers In 2014
Not only are companies concerned about health care plans, but they are concerned about actual employee health as well: 60 percent of HR executives cite "lowering overall healthcare costs" and "improving overall employee health" as top priorities for 2014. This shows a continuation of the trend for companies [to] develop and implement "wellness" programs. Thirty four percent of companies are looking to increase participation in already existing healthcare plans (Lucas, 8/28).

San Jose Mercury News/Digital First Media: How 13 Major Companies Have Responded To Obamacare
What effects will Obamacare have on business? With the health insurance exchanges set to launch on Oct. 1, the fight over whether the law is good or bad for business continues. There's still not solid information on either side, but some big-name businesses have weighed in, either through words or actions (Beckwith, 8/28).

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Poll: Americans Divided On Health Law But Oppose Defunding It

A majority of Americans don't want to defund Obamacare, even as they remain divided on liking the law. The poll by the Kaiser Family Foundation also found that 51 percent of Americans don't understand how the law will affect them. (KHN is an editorially independent program of the Foundation.)

Los Angeles Times: Americans Oppose Withholding Funds For Health Law, Poll Shows
While Americans remain deeply divided over President Obama’s health care law, a clear majority opposes withholding funding to implement the 2010 law, a new national survey indicates. Fifty-seven percent of Americans say they disapprove of cutting off funding for the Affordable Care Act, while just 36 percent say they would approve such a move, according to the most recent poll from the nonprofit Kaiser Family Foundation (Levey, 8/28).

CBS News Majority Oppose GOP Plan To Defund Obamacare, Poll Finds
A clear majority of Americans are opposed to the Republican-led effort to defund Obamacare, a new poll shows. Fifty-seven percent of Americans say they disapprove of the proposal to cut off funding as a way to stop the implementation of the Affordable Care Act, according to a new survey from the nonpartisan Kaiser Family Foundation (Condon, 8/28).

The Wall Street Journal’s Washington Wire: Consumers Remain Baffled By Health Law, Poll Shows
Two big numbers to think about today: There are 33 days until open-enrollment season for insurance coverage under the new health law begins, and 51 percent of Americans say they don’t understand how it will affect them or their family, according to the latest tracking poll from the nonpartisan Kaiser Family Foundation. That proportion is higher among the uninsured, the mid-August poll found. Some 62 percent of the uninsured say they don't have enough information about the health law, which aims to extend coverage to millions of them through new insurance marketplaces and subsidies towards the cost of premiums (Radnofsky, 8/28).

CBS News Health Insurance Choices For Young Adults
A new survey showed that the number young adults who go without health insurance has dropped from 18.1 million in 2011 to 15.7 million in 2013. According to the report, Covering Young Adults Under the Affordable Care Act, its estimated that 7.8 million of the 15 million young adults who were enrolled as a covered dependent under a parent's health plan last year would not have been eligible for this coverage without the dependent coverage provision now required under the new health reform law (Martin, 8/28).

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Capitol Hill Watch

After Voting To Cut Payments To Dialysis Clinics, Many Lawmakers Seek A Reversal

On Capitol Hill, some lawmakers are rethinking the Medicare policy for kidney patients because clinics argue they may have to close or cut services. Elsewhere, the president of the American Medical Association is optimistic Congress will change Medicare's payment formula, and a Republican senator wants all congressional staff to get coverage in Obamacare's exchanges.

The New York Times: In Congress, A Bid To Undo Dialysis Cuts
Eight months ago, Congress ordered the Obama administration to eliminate a stark example of federal government waste: more than $500 million a year in excessive drug payments being sent to dialysis clinics nationwide. But in a demonstration of just how hard it is to curb spending in Washington, more than 100 of the same members of Congress who voted in January to impose the cut are now trying to push the Obama administration to reverse it or water it down (Lipton, 8/28).

Kaiser Health News: Capsules: AMA President Optimistic About A Fix For Medicare's Doctor Payment Formula
Debated and despised, the Medicare physician payment formula may finally be on the way out – at least that's what AMA President Ardis Hoven believes (Carey, 8/29). 

Roll Call: Heller Wants All Congressional Staff In Obamacare Exchanges
Sen. Dean Heller is asking the Office of Management and Budget to require all congressional staff to get health care through the new exchanges. The Nevada Republican's letter comes one day after two other Senate Republicans announced legislation to require senior executive branch officials and all congressional staff to get their health care through the Obamacare exchanges. Those senators were Michael B. Enzi of Wyoming and David Vitter of Louisiana (Lesniewski, 8/28).

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Health Care Marketplace

Some Insurers Refusing To Pay For Proton-Beam Cancer Therapy

Blue Shield of California joins two other insurers who contend that other cancer treatments are just as good, and far less expensive.

The Wall Street Journal: Prostate-Cancer Therapy Comes Under Attack
At least three major insurers have recently decided to stop covering proton beam therapy for early stage prostate cancer or are reviewing their policy, saying that while it is an effective treatment, it is much less cost-effective when compared to the price of comparable treatments. The moves come amid ongoing concern about U.S. health care costs and a land-rush atmosphere among leading medical centers to acquire proton beam technology (Winslow and Martin, 8/28).

Los Angeles Times: Blue Shield Of California To Curb Coverage Of Pricey Cancer Therapy
As hospitals race to offer the latest in high-tech care, a major California health insurer is pushing back and refusing to pay for some of the more expensive and controversial cancer treatments. Blue Shield of California is taking on this high-cost radiation treatment just as Scripps Health in San Diego prepares to open a gleaming, $230-million proton beam therapy center this fall, only the second one in California and the 12th nationwide (Terhune, 8/28).

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State Watch

States Search For, Reap Benefits From Programs To Lower Health Care Costs

Bloomberg explores the heavy financial toll of caring for a loved one with a disability. In the meantime, as states like Minnesota, Oklahoma and Florida see slower health care cost growth through implementing novel programs, others -- like Nevada and Wisconsin -- search for the magic tonic to lower their own costs.

Bloomberg: Ways To Fend Off The Wealth-Sapping Costs Of A Disability
Lynn Francis was worried when her 81-year-old mother Joann started forgetting things a few years ago…Looking after the aging, especially those with mental and physical incapacities, is almost always emotionally and physically exhausting for families. It can also become a financial nightmare as families struggle to cover the costs of medical care, assisted living facilities and nursing homes -- a burden far greater than most people realize (Braham, 8/28).

The Associated Press: Minn. Health Care Costs, Cost Growth Below Average
Minnesota likes to think of itself as an innovator in health care with some of the lowest costs yet one of the healthiest populations in the country. And the state's official health care economist says its efforts to put a lid on rising costs seem to be paying off. Those moves include bipartisan legislation in 2008 under GOP Gov. Tim Pawlenty, additional initiatives under Democratic Gov. Mark Dayton that dovetail with the Obama administration's health care overhaul, and new delivery strategies that have come from the state's health care providers and insurers, said Stefan Gildemeister, director of the Health Economics Program at the Minnesota Department of Health (Karnowski, 8/28).

The Associated Press: Wellness Programs Help Lower Oklahoma Health Costs
Health advocates say anti-smoking, wellness programs and community public health initiatives across the state are helping to improve Oklahoma residents' health and control the rapidly rising costs of health care. Programs developed by the Department of Health and other state agencies focus on the leading causes of death among Oklahomans: heart disease, cancer and stroke (Talley, 8/28).

The Associated Press: Insurers Curbing Costs As Health Care Costs Rise
As health care costs rise in Florida, insurers and hospitals vested in the success of the Affordable Care Act, are coming up with new ways to cut costs from buying services in bulk and piloting programs to lowering hospital readmission rates and limiting the number of doctors within a plan's network. Florida's health care costs is rising an average of 6.9 percent a year, higher than the national average of 6.5 percent (Kennedy, 8/28).

The Associated Press: Nevada Health Cost Stats Fueled By Boom Years
Nevada's growth rate in health care expenditures over the last few decades is tied to the boom years that brought tens of thousands of workers to the Silver State when the economy was on overdrive, health experts said. Statistics provided by the Kaiser Family Foundation showed that from 1991-2009 Nevada had the highest-in-the-nation average annual growth rate of health care expenditures, averaging 9.2 percent (8/28).

The Associated Press: Wis. Takes Collaborative Approach To Health Costs
A massive statewide database of health care claims years in the making is set to go public in 2014, allowing Wisconsin residents to do comparison shopping before they choose a doctor or schedule surgery. The Wisconsin Health Information Organization has accumulated 250 million claims for care provided to 3.7 million Wisconsin residents over the past several years (Bauer, 8/28).

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State Highlights: Calif. Dems Propose Alternative Prison Care Plan

A selection of health policy stories from California, New York, Georgia, Massachusetts and Kansas.

Los Angeles Times: State Senate Democrats Propose Alternative To Brown's Prison Plan
Democratic leaders of the state Senate on Wednesday proposed an extra $200 million annually for rehabilitation, drug and mental health treatment as an alternative to Gov. Jerry Brown's plan for reducing prison crowding (McGreevy, 8/28).

The Associated Press/Wall Street Journal: N.Y. Taking Steps To Curb Rising Medical Costs
With medical expenses among the nation's highest, New York has begun cutting Medicaid costs by replacing pay-as-you go services with managed care for prescription drugs. And plans are in the works to extend that approach to acute care, long-term care, addiction services and mental health services. Nearly half the $53.5 billion health care budget for 5.3 million low-income New Yorkers goes for fewer than 700,000 chronically ill, elderly patients (8/28).

Georgia Health News: Enrollments For Medicaid, PeachCare Hits New High
Georgia enrollment in Medicaid and PeachCare has jumped to almost 1.9 million, a new record, state officials said Wednesday. Put in perspective, that’s nearly one of every five Georgians. It's more than the population of several U.S. states (Miller, 8/28).

The Associated Press/Wall Street Journal: Federal Authorities Settle MRI Case For $3.57M
Federal prosecutors say they've settled allegations of false reimbursement claims for radiology scans against a company's ex-owners and radiologist for $3.57 million. They say New York-based Imagimed LLC, its former owners, William B. Wolf III and Dr. Timothy J. Greenan, and former chief radiologist Dr. Steven Winter agreed to the civil settlement (8/29).

Kaiser Health News: Don Berwick's Newest Phase: Candidate, But Still Dr. Quality
Dr. Donald Berwick might be running for governor of Massachusetts, but he's still got a foothold in his former life. Berwick, most recently known as the acting chief of the Centers for Medicare and Medicaid, had a long record as the leading authority on health care quality, including being founder and CEO of the Institute for Healthcare Improvement. And it was more in that capacity that the British Prime Minister David Cameron asked Berwick for his recommendations for improving safety and restoring confidence after higher-than-expected death rates at one hospital rocked the country (Bebinger, 8/29).

Kansas Health Institute: Regional Mental Health Hubs Poised To Begin Services
A new, "regional" initiative aimed at keeping mentally ill people out of jails or hospitals is expected to begin operating as soon as next month. Angela Hagen, director of behavioral health at the Kansas Department for Aging and Disability Services, said that draft plans for the five regional "hubs" where treatment services will be offered or coordinated should be finalized and approved by KDADS within the next several days and that the hub operations likely would begin in early September (Shields, 8/28).

California Healthline: Stakeholders Assess Delayed Duals Project
The Department of Health Care Services last week delayed the launch of its duals demonstration project. Cal MediConnect, previously scheduled to start Jan. 1, is now slated to launch no sooner than April 2014. Cal MediConnect aims to integrate Medicare and Medi-Cal services and funding for about one million Californians who are eligible for both programs. The duals demonstration project begins that process in eight California counties (Gorn, 8/28).

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Weekend Reading

Longer Looks: Should Women Pay More Than Men For Insurance?

Every week reporter Ankita Rao selects interesting reading from around the Web.

Slate: Why Aren’t There More Cancer Vaccines?
Six years from now, when my daughter turns 11, she will get a three-part human papillomavirus vaccine that will reduce her chances of getting cervical cancer by around 70 percent. Currently a little over half of American girls get the HPV vaccine, a public health intervention that will prevent tens of thousands of cancers. It’s one of modern medicine’s few success stories in finding a means of preventing cancer. ... in an as yet unpublished study, economists Eric Budish and Heidi Williams teamed up with patent lawyer Ben Roin to argue that the scarcity of preventive measures and relative abundance of late stage cancer treatments can also be blamed on the distorting effects that the U.S. patent system has on medical research (Ray Fisman, 8/26).

Salon: Nutrition Labels Are Misleading Us
Diane Cary still chuckles when she remembers the scene she witnessed in a supermarket cereal aisle. A mother and her child were haggling over which cereal to get. The mother insisted on Grape Nuts because she felt it was healthy, but the kid desperately wanted Count Chocula. Exasperated, the mom put both boxes side-by-side and proposed they review the nutrition labels and buy the more nutritious of the two. When Cary passed the family again in another aisle, they had two boxes of Count Chocula in their cart. As it turns out, in a 100-calorie portion, sugary Count Chocula actually packs more of many vitamins than Grape Nuts (although it does have less protein and fiber) (Jill Richardson, 8/28).

The Philadelphia Inquirer: HIV Researchers Turn To Social Media For Recruits
"Hey, stud. Busy?" "Not really," Eiren Shuman, 27, coquettishly typed back in response to what he suspected was an automated message. …This service, called Grindr, is an app that gay and bisexual men use to hook up over the Internet. And it is the same app that Penn researchers used to recruit Shuman into HVTN 505, a national clinical trial for an HIV vaccine. Men who have sex with men account for 63 percent of new HIV infections and are the focus of a new techie approach to HIV prevention (Leila Haghighat, 8/28).

American Medical News: Policing Medical Practice Employees After Work
The University of Pennsylvania Health System and its affiliates recently joined Cleveland Clinic and other hospitals in banning the employment of smokers. Proponents say such policies lower health care costs and improve employee and community health. Others believe these restrictions may be the beginning of a slippery ethical slope in which employees can be fired or banned for personal decisions and activities unrelated to their specific jobs. The question is: Will and can private physician practices soon follow suit, banning or disciplining employees not only for smoking but also for other outside activities deemed detrimental to the image of the group? ... These issues, say human resources, health policy and legal experts, are complex and evolving (Sheryl Cash, 8/26).

Time: Women Should Pay More For Health Care
The Obama Administration is about to spend $684 million on a public relations and enrollment campaign to persuade young, uninsured Americans to buy government-approved Obamacare plans.  In order to be successful, it needs to persuade young men in particular to enroll, but Obamacare requires insurers to charge men the same for their premiums as women in 2014. This attempt at fairness is anything but. If fairness were really the guiding principle, it would be quite simple: women would pay more for health insurance because women consume more health care (Hadley Heath, 8/23).

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Editorials and Opinions

Viewpoints: Rove Says Job Losses Growing Under Health Law; GOP Strategists Say Health Overhaul Is Aiding Their Path To White House; Mich. Senators Who Opposed Medicaid Expansion Gave Themselves Lifetime Medical Benefits

The Wall Street Journal: ObamaCare For Everything
Thousands of American higher-education administrators will spend part of Labor Day weekend trying to plumb the meaning of the ideas President Obama dropped on them last week to "reform" the American college and university system. Given the political genome of college administrators nowadays, they'll try to make the Obama plan work. But for the handful who want to preserve and protect their hallowed institutions, here's a recommendation: Drop by the nearest medical school for a chat with the doctors about how it's going with the Affordable Care Act, aka ObamaCare (Daniel Henninger, 8/28). 

The Wall Street Journal: Here Comes The Unaffordable Careless Act
Harvard (and later Columbia) sociologist Robert K. Merton wrote in 1936 about the "unanticipated consequences of purposive social action." Pity that Barack Obama, an alumnus of both universities, either never read or took to heart Merton's warnings. It would have saved Americans a lot of misery. The president certainly did not promote the Affordable Care Act by promising it would mean more part-time and fewer full-time jobs. Yet that is one of its unanticipated consequences (Karl Rove, 8/28). 

The New York Times' Opinionator: Can Republicans Paint The White House Red?
[Republican strategist Stuart Stevens] argues that a successful 2016 Republican presidential scenario can be credibly pieced together. ... [P]ublic discontent with Obamacare grows. Young voters, a key to recent Democratic victories, bristle over the requirement to buy insurance or pay a fine. Corporate plans cut spousal coverage. Businesses replace full-time workers with part-timers, ineligible for benefits. Health insurance premiums continue to rise faster than inflation. The discontent with the Affordable Care Act on the part of the three major unions – the Teamsters, United Food and Commercial Workers and Unite-Here – spreads throughout the labor movement. Glitches in rolling out the massive new healthcare program increase public opposition (the regulations governing the hiring of healthcare "navigators" to help consumers enroll total an estimated 13,900 words in the Federal Register). Increasing numbers of people cannot keep either their current doctor or their healthcare plan (Thomas B. Edsall, 8/28).

Detroit Free Press: These Senators Voted Against Medicaid, But For Lifetime Health Care For Themselves
Some Republicans bristled that [Gov. Rick] Snyder’s Medicaid expansion passed despite the opposition of a majority of the GOP lawmakers in both houses. ... As for protecting future generations from the burden of entitlement spending, consider that every one of the 18 Republican senators who opposed extending health care eligibility to Michigan's working poor — every one! — voted in November 2011 for legislation to make sure that every incumbent Republican senator except Colbeck (and every Democratic incumbent except state Sen. Vince Gregory, D-Southfield), would enjoy lifetime medical benefits (Brian Dickerson, 8/28).

The Washington Post: Health-Care Costs Are A Civil Rights Issue
In 1963, when Martin Luther King, Jr. gave his "I Have A Dream" speech, America spent 5.5 percent of gross domestic product on health care. Today we spend 18 percent, while most other wealthy nations spend 10 to 12 percent through systems that deliver equal or better health outcomes. In a $16 trillion economy, our excess health-care spending — that is, money we devote to health care that plainly isn't needed for quality care — thus comes to a staggering $1 trillion a year (Matt Miller, 8/28).

The New York Times' Taking Note: Abortion Rights Arithmetic
In case you weren't already alarmed by the barrage of state laws and regulations aimed at curtailing women's constitutionally protected right to an abortion, we now have a concrete understanding of their actual impact. Earlier this week, Laura Bassett reported on a Huffington Post national survey of state health departments, abortion clinics and local abortion-focused advocacy groups (Dorothy J. Samuels, 8/28). 

The Wall Street Journal: Wounded Vets Deserve Better
On Aug. 22, Secretary of Veterans Affairs Eric Shinseki said that the department has reduced a backlog of disability claims by 20% to some 773,000 cases, including about 480,000 that have been pending for more than 125 days. Yet no number of new claims processors will be skilled enough, no computer fast enough or shortcut quick enough to deal with the ever-rising tide of claims unless the VA refocuses on the kind of care the system was designed to deliver. The enumeration of benefits has evolved far beyond the nation's obligation to those who became ill or injured while in service. It is time to return to original principles (Anthony Principi, 8/28). 

JAMA: Fixing Disjointed Chronic Care
The US health care system does many things very well. But one thing it doesn't do well is coordinate care over time and between sectors. Whenever a patient transitions from hospital to home or from hospital to nursing home or hospice, he or she is likely to end up confused and to encounter care glitches and perverse financial incentives. While the US health care system does a better job coordinating between sectors during illness episodes, better coordination between sectors over time is needed for Americans with lengthy illnesses (Stuart Butler, 8/28).

The New England Journal of Medicine: Coordination Versus Competition In Health Care Reform
Many current proposals to increase the value of care delivered in the U.S. health care system focus on improved coordination — and with good reason. Badly coordinated care, duplicated efforts, bungled handoffs, and failures to follow up result in too much care for some patients, too little care for others, and the wrong care for many. A host of current reform efforts aim to reduce these inefficiencies in both public and private markets. ... These laudable efforts, however, may unintentionally be at odds with another strategy for improving value: promoting competition in health care markets (Katherine Baicker and Helen Levy, 8/29).

The New England Journal of Medicine: Prescription-Drug Coupons — No Such Thing As A Free Lunch
It has famously been said that "there is no such thing as a free lunch." Drug coupons are no exception to this rule. Everyone likes to save money, and coupons for essential therapies may be helpful for certain patients, particularly those with life-threatening conditions for which there are not reasonable generic substitutes. However, the majority of drug coupons are for therapies for which lower-cost and potentially equally effective alternatives exist. Physicians need to talk to their commercially insured patients about the implications of drug-coupon use and make sure that their inclination to reduce short-term out-of-pocket spending doesn't come at the cost of higher long-term expenses for themselves and society (Drs. Joseph S. Ross and Aaron S. Kesselheim, 8/28).

Fiscal Times 4 Signs Health Care Costs Are Still Out Of Control
Telling most working families that health care costs keep rising every year is like saying there are clouds in the sky. It’s simply an accepted fact. Yet when we delve into the details of why and how health care costs are climbing – often well beyond the ability of families to keep pace – the picture becomes even more troubling. It provides yet another reason to pursue meaningful reforms (John F. Wasik, 8/28).

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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.