Daily Health Policy Report

Monday, August 4, 2014

Last updated: Mon, Aug 4

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace

Veterans Health Care

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Hospital, Insurer Earnings Show Mixed Messages About Health Spending

Kaiser Health News staff writer Jay Hancock reports: “Analysts who fear health spending is accelerating got plenty of evidence in Wall Street's second-quarter results to support their thesis. But so did folks who hope spending is still under control. Now everybody's trying to sort out the mixed message. The answer matters because deficit debates and affordability concerns revolve around forecasts that health spending will speed up as the economy revives. If it doesn't, the future looks better for consumers, employers and taxpayers” (Hancock, 8/4). Read the story.

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A Doctor's Perspective On Obamacare Plans

WNPR’s Jeffrey Cohen, working in partnership with Kaiser Health News and NPR, reports: “On a recent afternoon at his office in Hartford, Connecticut, Dr. Doug Gerard examines a patient complaining of joint pain. Gerard, an internist, checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way. For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates. That's not something he's willing to put up with” (Cohen, 8/4). Read the story

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Political Cartoon: 'Suit Yourself?'

Kaiser Health News provides a fresh take on health policy developments with "Suit Yourself?" by Bob Englehart.

Meanwhile, here's today's haiku:

CHECKING THE HEADLINES

An August Monday...
Does that mean health news slows down?
Hmm... You be the judge.
-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

Justice Dept. Seeks Full Court Appeal Hearing In Health Law Case

Last month, a three-judge panel ruled against the administration in the case Halbig v. Burwell, which is viewed as a blow to the Affordable Care Act. Meanwhile, Stateline reports that, based on that ruling, only those states with clear state-based exchange credentials are on solid legal footing.  

Stateline: Court Rulings Add Urgency To State Exchange Decisions
As states ready their health insurance exchanges for a second open enrollment season in November, many have more to worry about than the computer glitches that plagued them last year. Last month’s federal appeals court ruling that said language in the Affordable Care Act allows only state-run exchanges to give consumers tax credits to help pay for policy premiums is spurring several states to solidify their state-based credentials. Only the District of Columbia and 14 states — California, Colorado, Connecticut, Hawaii, Kentucky, Maryland, Massachusetts, Minnesota, Nevada, New York, Oregon, Rhode Island, Vermont and Washington — have established state exchanges and are on firm legal ground, according the decision, Halbig v. Burwell (Vestal, 8/4).

Politico: White House Appeals Obamacare Subsidy Case
The Obama administration Friday asked a federal appeals court to grant another hearing in a case challenging Obamacare subsidies, and hours later, the court gave the subsidies opponents 15 days to respond to that request. The Justice Department filed the petition with the U.S. Court of Appeals for the D.C. Circuit in the case Halbig v. Burwell. In a blow to the Affordable Care Act, a three-judge panel ruled last month that the subsidies can’t flow through the federal exchange, HealthCare.gov, but only through state markets (Winfield Cunningham, 8/1).

The Associated Press: Justice Dept Seeks Appeal in Health Overhaul Case
The Justice Department asked a full federal appeals court Friday to take up a case that has endangered subsidies helping millions of low- and middle-income people to afford their health care premiums under ObamaCare. Last week, a divided three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit said financial aid can be provided only in states that have set up their own insurance markets, or exchanges (8/1).

Bloomberg:  Obama Administration Seeks Review Of Health Care Aid Ruling
“The text, structure and purpose” of the overhaul “make clear that tax credits are available to consumers ‘regardless of whether the exchange on which they purchased their health insurance coverage is a creature of the state or the federal bureaucracy,’” government lawyers wrote in a request for a re-hearing, citing the dissent in the case. The request, filed today, was widely expected after a 2-1 ruling on July 22 that struck down an Internal Revenue Service rule providing subsidies for needy customers on the insurance exchange run by the federal government. Later today, the appeals court ordered the plaintiffs to file within 15 days a response to the government’s motion. Yesterday, the plaintiffs asked the U.S. Supreme Court to hear the case, saying a ruling by the high court would end uncertainty about the IRS provision (Zajac, 8/1).

NBC News: Obamacare Challengers Urge Quick U.S. Supreme Court Review
Challengers of a key provision of the Obama healthcare law Thursday asked the U.S. Supreme Court to take up the case and decide quickly whether people who buy their health insurance on state exchanges qualify for a federal subsidy. Two federal courts reached opposite conclusions on that issue last week. On Thursday, the challengers who lost asked the Supreme Court to step in (Williams, 8/1).

In other news related to health law challenges -

NBC News: This Is The Next Hobby Lobby
Laura Grieneisen and Liz Miller have a lot in common. Both are graduate students in biology at the University of Notre Dame ... Each wants to prevent pregnancy. Each was told by her doctor that her long stretches in the field would make her an excellent candidate for an intrauterine device, or the IUD. That’s where their paths diverged. ... But in what promises to be the next big birth control fight after Hobby Lobby, that accommodation hasn’t satisfied Notre Dame – or over 100 other nonprofit institutions suing the administration. They claim that signing the opt-out form also violates their religious liberty, because eventually, contraception is dispensed (Carmon, 7/31).

The Milwaukee Journal Sentinel: U.S. Senator Ron Johnson To Appeal Obamacare Lawsuit
U.S. Sen. Ron Johnson says he will appeal a federal judge's dismissal of his lawsuit challenging a rule related to the way members of Congress and their staff get health insurance under Obamacare. Johnson, a Republican, said in an opinion piece for the Milwaukee Journal Sentinel — which will run in print Sunday — that he feels compelled "to exhaust every legal recourse" as he challenges President Barack Obama's executive actions. U.S. District Judge William Griesbach in Green Bay had ruled in July that Johnson and his aide, Brooke Ericson, didn't have legal standing to bring their lawsuit because they hadn't been injured (Richards, 8/2).

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Online Marketplace Still Not Ready To Offer Brokers 'Direct Enrollment' Option

The option, when it is finalized, will allow customers to go to an insurance broker who will be able to provide all the services of the federal website, including calculating subsidies and applying those to the premium. In other news about the upcoming enrollment season for the exchange, Oregon officials announce new insurance rates.

The Washington Post's Wonkblog: There's A Way Around Healthcare.gov, But It's Still Not That Great
Some of the behind-the-scenes functions that consumers don't see, like the systems allowing federal subsidy payments to insurers, still need to be built. But there's another part of the enrollment system that isn't quite ready, and it doesn't sound as if it will be by the time the Affordable Care Act's second enrollment period rolls around. It's known as "direct enrollment," in which a consumer can go to a private online Web broker who provides a similar function that HealthCare.gov does — the brokers can sell a range of ACA health plans and offer insurance subsidies to those who qualify. The federal government reached agreements with several such entities last summer, with the idea that they would provide more opportunities for people to enroll in ACA plans (Millman, 7/31).

The Associated Press: Oregon Releases 2015 Health Insurance Plan Rates
Oregon will see a much tighter range of premium prices in 2015 for individual and small employer health insurance plans, according to new rates announced Friday by state regulators. The Oregon Insurance Division says Moda, the company that captured nearly two-thirds of the individual market share with some of the lowest prices in 2014, will see a 10.6 percent rate hike on average. ... Some of the smaller carriers will see rate decreases in 2015. Plans from Providence Health and Trillium Community Health will both drop by about 14 percent on average (Wozniacka, 8/1).

Oregonian: State Releases Oregon's 2015 Health Insurance Rates For Individuals, Small Businesses
Last year, federal changes to expand coverage of pre-existing conditions caused many rates to go up in the individual market even as insurers cut back on benefits. In Oregon, one of the most competitive insurance markets in the nation, 2014 rate hikes did not hit consumers as badly as expected. In part that's because Moda came in with low rates - so low that some accused the insurer of underpricing to more than double its market share. Moda officials denied it. For 2015, other insurers have made aggressive moves to cut rates, which were largely approved by state regulators. Providence Health Plan rates, for example, will drop 14 percent in the individual market (Budnick, 8/1).

State officials are also dealing with Medicaid issues-

Kansas Health Institute News Service: Hutchinson Hospital CEO Calls For Medicaid Expansion
The top executive at the Hutchinson Regional Healthcare System says he and other hospital officials are "baffled" by Gov. Sam Brownback’s unwillingness to expand the state’s Medicaid program. "I have heard all the arguments, both pro and con, on Medicaid expansion, and am at a total loss as to what the downside … might be" of allowing the federal government to pump millions of additional dollars into the Kansas health care system, Kevin Miller wrote in a recent opinion piece for the Hutchinson News. Kansas is one of 24 states that have chosen not to expand eligibility for their Medicaid programs in the wake of a U.S. Supreme Court decision in 2012 that made expansion an optional component of the Affordable Care Act, also known as Obamacare (Ranney, 8/1).

Rochester Democrat & Chronicle: Xerox's Medicaid Business Struggles
More than a dozen states and the District of Columbia contract with Xerox Corp. for help running their Medicaid programs. New York is expected to join them. But the company might not be able to count on glowing testimonials from some of its customers. The company has hit speed bumps with several states relating to its Medicaid work there. Texas canceled its Medicaid contract with Xerox in May, and is suing the company. Montana in June complained that Xerox is in breach of its contract, which the state said it was considering ending. Those problems were resolved last month. And Xerox and Alaska are in mediation over complaints Alaska has regarding the state's new Medicaid payment system, put in by Xerox. All of those are in addition to separate problems Xerox has encountered in a related business, running the Nevada health insurance exchange (Daneman, 8/4).

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The Health Law Fading From The Campaign Trail Spotlight

News outlets report that the sweeping overhaul appears to be less of a point of contention among candidates and less of a rallying point for voters.    

Los Angeles Times: Obamacare Loses Some Of Its Campaign Punch For Republicans
Six months ago, a House Republican campaign official listed the top three issues that would propel the party's candidates to victory in the midterm election: "Obamacare, Obamacare, Obamacare." It was a strategy that worked well in 2010, when GOP electoral gains were fueled primarily by a high-profile campaign to repeal the newly passed Affordable Care Act (Memoli and Mascaro, 8/3).

Modern Healthcare: Obamacare Not Seen As Flashpoint In Midterm Elections
Congress is all but done for the summer. That means attention will now pivot toward the fall elections. Four years ago during the August recess, legislators encountered voters in their home districts angry about the recent passage of the Patient Protection and Affordable Care Act. Republicans rode that backlash against the federal healthcare law to an electoral rout that resulted in a takeover of the House (Demko, 8/1).

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Newly Insured Get Schooling On How To Use Coverage

Health law advocates who had focused on enrolling people in insurance now are teaching them how to use their often-complicated policies. Meanwhile, a Hartford physician explains why he won't take Obamacare plans and thousands of inmates in a Cook County jail sign up for insurance.

The New York Times: Newly Insured, Many Now Face Learning Curve
Advocates of the Affordable Care Act, focused until now on persuading people to buy health insurance, have moved to a crucial new phase: making sure the eight million Americans who did so understand their often complicated policies and use them properly. The political stakes are high, as support for the health care law will hinge at least partly on whether people have good experiences with their new coverage. Advocates of the law also say teaching the newly insured how to be smart health care consumers could advance the law’s central goal of keeping costs down, such as by discouraging emergency room visits, while still improving care (Goodnough, 8/2).

Kaiser Health News: A Doctor's Perspective On Obamacare Plans
On a recent afternoon at his office in Hartford, Conn., Dr. Doug Gerard examines a patient complaining of joint pain. Gerard, an internist, checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way. For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates. That's not something he's willing to put up with (Cohen, 8/4).

Chicago Tribune: Dart: Up To 9.000 Inmates Signed Up For Obamacare To Help With Mental Health Treatment
Cook County Sheriff Tom Dart, attempting to cope with what he says is a growing mental health crisis among inmates at the county jail, said up to 9,000 people who have been incarcerated have signed up for health insurance under the Affordable Care Act in an attempt to get the care they need. “Systemically, over the course of decades, we’ve sort of carved back all the mental health services to the point where there is this question, we’ve carved it back to next to nothing,” Dart said on “The Sunday Spin” on WGN AM-720. The sheriff said that the process of closing mental health institutions under the goal of putting the mentally ill into community-based treatment has led to 3,000 of the jail’s 10,000 inmates requiring treatment. As a result, he said, costs have increased and jail staff has undergone greater training (Peterson, 8/4).

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Health Care Marketplace

Health Insurer To Stop Covering Uterine Procedure

Highmark Inc., which sells plans in Pennsylvania, Delaware and West Virginia, will stop covering power morcellation, a technique often used in hysterectomies, after the Food and Drug Administration advised doctors against it because it may spread cancer. 

The Wall Street Journal: Health Insurer To Stop Covering Uterine Procedure
In the procedure, a bladed device is used to cut up common uterine masses called fibroids, often in hysterectomies, so the tissue can be removed through tiny incisions in minimally invasive surgery. Highmark is the first insurer known to be halting coverage of power morcellation, and the move is the latest in a series of mounting pressures on use of the tool. ... The FDA estimates the instruments were being used in 50,000 hysterectomies a year (Levitz, 8/2).

Reuters: U.S. Insurer To Stop Coverage Of Gynecological Procedure
A health insurer with 5.2 million members in three Eastern U.S. states said on Saturday it would stop providing coverage for a procedure called laparoscopic power morcellation that is used in gynecological surgery and may inadvertently spread cancer. Highmark Inc, which has customers in Pennsylvania, Delaware and West Virginia, will stop covering the procedure on Sept. 1, company spokesman Aaron Billger said in an email. It is the first insurer to halt coverage of power morcellation after the U.S. Food and Drug Administration advised doctors in April against it (Walsh, 8/3).

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Some Medical Schools Trim Time To Degree

A survey of 120 medical schools, conducted by the New York University School of Medicine, found that 30 percent were considering or already planning three-year programs. Meanwhile, medical school enrollments are expanding faster than entry-level residency positions.

The New York Times: The Drawn-Out Medical Degree
Should medical education be shorter? The answer is yes, at least according to administrators at many of America’s leading medical schools. The idea may conjure up images of clueless residents Googling symptoms on their smartphones at the patient’s bedside, but advocates insist that time spent in school can be trimmed without shortchanging education or compromising quality of care. And they say there are compelling reasons to speed up the process: to reduce the crushing debt many face by eliminating a year’s tuition and allowing doctors to start careers, and earn money, earlier (Grady, 8/1).

Related KHN Coverage: Some Medical Schools Shaving Off A Year Of Training (Boodman, 1/14).

The New York Times: Going Professional: The Ins And Outs
The nation needs doctors, and students and schools are heeding the call. Last year the number of applicants to medical schools surpassed 48,000, for 20,055 slots, according to the Association of American Medical Colleges. Both numbers were a record.  ... The good news: The number of spots is growing. ... Meanwhile, colleges of osteopathic medicine more than doubled their capacity from 2002 to 2013. ... [But] enrollments are expanding faster than entry-level residency positions are increasing (Hoover, 8/1).

The New York Times: The Physician Assistant Will See You
Flora Traub is a 37-year-old mother of three with a master’s in public policy from Harvard’s John F. Kennedy School of Government. But after years as a policy analyst, she found herself reflecting on her undergraduate premedical studies and the happy year she spent in AmeriCorps Community HealthCorps after college. She decided she wanted a new career, in medicine, but not as a doctor. “I wouldn’t dream of medical school,” said Ms. Traub, who entered Boston University’s physician assistant training program this year (Moran, 8/1). 

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Veterans Health Care

Experts Question Accuracy Of Fast-Growing Veterans' PTSD Claims

The number of VA disability awards based on post traumatic stress disorder symptoms has grown fivefold over the past 13 years, and some mental health officials suggest that financial rewards may be causing some vets to exaggerate their conditions. Also, a New GAO report suggests changes in a Department of Defense health plan.

Los Angeles Times: As Disability Awards Grow, So Do Concerns With Veracity Of PTSD Claims
As disability awards for PTSD have grown nearly fivefold over the last 13 years, so have concerns that many veterans might be exaggerating or lying to win benefits. [Psychologist Robert] Moering, a former Marine, estimates that roughly half of the veterans he evaluates for the disorder exaggerate or fabricate symptoms. Depending on severity, veterans with PTSD can receive up to $3,000 a month tax-free, making the disorder the biggest contributor to the growth of a disability system in which payments have more than doubled to $49 billion since 2002 (Zarambo, 8/3).

The Fiscal Times: DOD's $1B Redundant Health Program: GAO Says Scrap It
The government spends about $1 billion every year on a health care program for military families that auditors say is redundant and should be scrapped. A new report from the Government Accountability Office says the U.S. Family Health Plan, which provides health care to at least 130,000 military family members and retirees, offers the same TRICARE Prime benefits that are offered by the regional TRICARE managed care support contractors. Created in 1982, The program—USFHP—is an association of six health care systems that provides TRICARE Prime benefits to military families (Ehley, 8/4).

NPR: Obama Moves To Overhaul VA With Compromise Measure
Two months after VA Secretary Eric Shinseki resigned, President Obama looks set to sign legislation to overhaul the Department of Veterans Affairs, to the tune of nearly $17 billion (8/3).

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State Watch

Medicaid Roundup: Fla. Gets 3-Year Renewal For Managed Care Program

About 3 million Floridians are enrolled in the privatized program. Meanwhile, Illinois Medicaid puts limits on who is eligible for Sovaldi, an expensive hepatitis C drug, and Kansas recoups more than $28 million in Medicaid fraud.

The Associated Press: Feds Grant Fla. 3-Year Medicaid Managed-Care Renewal
The federal government has granted a three-year renewal of Florida's Medicaid managed-care program. About 3 million Floridians — more than half are children — are enrolled in the program, which has been rolling out statewide over the past few months. Under Medicaid privatization, the state gives insurance companies a set amount of money each month for patient care, giving the insurer broad authority to decide which doctors they can see and what treatments can be prescribed (8/3).

The Wall Street Journal: How Illinois Allocates $84,000 Drug For Hepatitis C
The $84,000-a-patient cost of the Sovaldi hepatitis C treatment has intensified a national debate among lawmakers, insurers and economists about the value of expensive medicines to society at large. The dilemma sparked by Sovaldi, which is made by Gilead Sciences, is also presenting hard choices to state Medicaid programs. In Illinois, for instance, officials recently instituted a new set of 25 stringent criteria for using Sovaldi that includes treating only those patients with the most advanced stage of liver disease and limiting treatment for those with a history of drug use and alcohol abuse (Silverman, 8/3).

Kansas Health Institute  News Service: State Medicaid Fraud Unit Recovers More Than $28M
The state recovered more than $28 million in taxpayer funds through its Medicaid fraud enforcement during the recently ended state fiscal year, Kansas Attorney General Derek Schmidt said Friday. During fiscal 2014, which ended June 30, the Medicaid Fraud and Abuse Division of the Kansas attorney general's office recovered more than $28.7 million. The recoveries were reported in the division’s annual report to the U.S. Department of Health and Human Services. This was the second-highest year of recoveries, following last fiscal year’s record $33.7 million (8/1).

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State Highlights: Federal Trial Testing Texas Abortion Law Begins Today

A selection of health policy stories from California, Texas, New Jersey, Pennsylvania, D.C. and Minnesota.  

The New York Times: California Asks: Should Doctors Face Drug Tests?
At a time when random drug testing is part of the job for pilots, train operators, police officers and firefighters — to name a few — one high-profile line of work has managed to remain exempt: doctors. That may be about to change. California would become the first state to require doctors to submit to random drug and alcohol tests under a measure to appear on the ballot this November. The proposal, which drew approval in early focus groups, was inserted as a sweetener in a broad initiative pushed by trial lawyers (Nagourney, 8/1).

The Wall Street Journal: Texas Trial To Test Higher Standard For State's Abortion Clinics
In a federal trial set to begin here on Monday, abortion-rights supporters are seeking to strike down a new provision of a state law that will require abortion clinics to qualify as "ambulatory surgical centers" starting next month, saying it will force even more of the state's facilities to close. Since Texas Gov. Rick Perry signed a hotly contested law in July 2013 requiring abortion doctors to have admitting privileges at nearby hospitals, the number of licensed Texas clinics providing abortions has declined by half over the past year, to 18 from 36. Many abortion doctors have been unable to obtain admitting privileges from neighboring hospitals, leaving swaths of the sprawling state without any clinics at all (Koppel, 8/3). 

Houston Chronicle: Whole Women’s Health Closes Austin Clinic Due To New Abortion Law
Whole Woman’s Health will close its flagship clinic in Austin, its operators said Thursday, due to strict abortion restrictions state lawmakers passed last year. The announcement comes just days before Whole Woman’s Health and the Center for Reproductive Rights again take the state to court over the rules, which among other new restrictions requires abortion clinics to upgrade their facilities to meet the standards of an outpatient surgery clinic. A trial starting Monday in Austin federal court will focus, in part, on this portion of the law, which is set to take effect on Sept. 1.According to a study released last week, abortion rates in the Lone Star State have dropped 13 percent since the law was passed (McGaughy, 7/31).

The New York Times: In New Jersey, Workers’ Advocates Aim To Put Paid Sick Time On Ballot
Frustrated in their efforts to make paid sick leave mandatory for businesses throughout New Jersey, workers’ advocates are now pressing their campaign city by city, emboldened by laws recently passed in Newark and Jersey City, as well as in New York City (McGeehan, 8/3). 

The Wall Street Journal: Christie Pushes For Smaller Pension Benefits
Gov. Chris Christie on Friday stepped up his push to scale back the state pension and health benefit system, creating a commission to study the perks of public workers. The five-member New Jersey Pension and Health Benefit Study Commission will be charged with figuring out how to reap savings that will make the underfunded benefits system sustainable, Mr. Christie said (8/1).

The Associated Press: Hospital Killing Shows Safety Gap In Mental Health
When a man opened fire at a hospital outside Philadelphia, fatally shooting his caseworker and wounding his psychiatrist, the doctor saved his own life and probably the lives of others by pulling out a gun and shooting the patient. If Dr. Lee Silverman's decision to arm himself at the office was unusual, the violence that erupted at Mercy Fitzgerald Hospital served as yet another illustration of the hazards mental health professionals face on the job — and, experts say, the need for hospitals to do more to protect them (Rubinkam, 8/3).

The Washington Post: D.C.’s United Medical Center Is On Financial Upswing, But Its Future Is Mired In Politics
Shortly after David R. Small took over as chief executive of D.C.’s United Medical Center last year, a woman at a community meeting gave him some unwelcome news about the facility he’d been hired to run. “It was,” Small recalls being told, “the hospital where you go to die.” The 354-bed hospital on Southern Avenue SE has long suffered from a dismal reputation as a hospital of last resort, an image buttressed by long-standing and well-publicized financial woes and its location, in one of the region’s most concentrated pockets of poverty (DeBonis, 8/3).

Los Angeles Times: California Adopts New Policies On Treatment Of Mentally Ill Inmates
California prison officials adopted sweeping new policies intended to protect mentally ill prisoners from abusive force and punishment, including use of pepper spray and deep isolation in solitary confinement cells (St. John, 8/2).

Minnesota Public Radio: Hennepin Co. First Responders Now Carry Drug To Reverse Opiate Overdose
Twenty-four Hennepin County Sheriff's deputies hit the streets Friday with a new tool they hope will save lives. Hennepin is the first county in the state to take advantage of a law that went into effect Aug. 1 that allows law enforcement personnel and first responders to carry and administer a drug that can reverse opiate overdoses. The brand name version of the drug is called Narcan. It also goes by the generic name naloxone. The antidote can overpower the opiates in an overdose victim's body and restart their respiratory system (Collins, 8/2).

Minnesota Public Radio: State To Resume Indefinite Storage Of Newborn Health Data
Minnesota's newborn screening program is again storing newborn screening data indefinitely. A law passed during the legislative session removes a restriction that required the Minnesota Department of Health to destroy dried blood spot cards after 71 days and test results after two years. To prepare for the change, the Minnesota Department of Health has sent more than 1,600 letters to prenatal providers informing them of the law (Benson, 8/1). 

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Editorials and Opinions

Viewpoints: Ignagni On Prices Of New Drugs; Sen. Johnson On The Difficulty Of Suing A President

The Wall Street Journal: Paying For The Thousand-Dollar Pill 
Lately, there has been considerable debate about the soaring prices of specialty drugs, which are aimed at difficult-to-treat diseases. The good news is that more of these breakthrough drugs are now coming onto the market, giving people new hope and a chance to live longer, healthier lives. But along with the drugs have come prices so high—some more than six figures for a course of treatment—that they threaten the sustainability of the health-care system. This isn't a debate about medical advancement, but rather a larger systemic question of whether the prices being charged for some new drugs are rational and allow people access to the innovation we all want. Do the prices reflect the cost of investment, or are we entering a new phase where monopolies approved under patent law are producing prices entirely untethered to the cost of developing drugs? (Karen Ignagni, 8/3). 

The New York Times' The Upshot: $1,000 Hepatitis Pill Shows Why Fixing Health Costs Is So Hard
A new drug for the liver disease hepatitis C is scaring people. Not because the drug is dangerous — it's generally heralded as a genuine medical breakthrough — but because it costs $1,000 a pill and about $84,000 for a typical person's total treatment. A Washington advocacy effort has sprung up overnight, largely devoted to objecting to the cost of this one medication, Sovaldi. ... But maybe we are looking at the costs of Sovaldi in the wrong way. One reason it is causing such angst among insurers and state Medicaid officials is that treatment costs are coming all at once (Sanger-Katz, 8/2).

The New York Times: Adventures In Prior Authorization
"Dear Doctor,” the letter from the insurance company began. "We are writing to inform you that a prior authorization is required for the medication you prescribed." That’s usually where I stop reading. Thousands of these letters arrive daily in doctors’ offices across the country. They are attempts by insurance companies to prod doctors away from more expensive treatments and toward less expensive alternatives. To use the pricier option, you need to provide a compelling clinical reason (Danielle Ofri, 8/3).

The Milwaukee Journal Sentinel: Why I Took President Barack Obama To Court
During the week of July 4, as we celebrated our country's independence from the rule of kings and renewed our commitment to the rule of law, President Barack Obama explained his own unique conception of the separation of powers: If Congress wants to prevent unlawful administrative action, it should either pass a bill he likes ... or, "sue me." Well, I tried to sue him and discovered why the president was confident he could offer such an arrogant challenge to a supposedly co-equal branch of government (Sen. Ron Johnson, R-Wis., 8/2).

The Washington Post's Post Partisan: The Insiders: The Boehner Lawsuit And Our Bored Icon President
Rather than responding to the House's lawsuit by showing leadership, it appears this is just one more instance in which President Obama can't seem to rise to the occasion. If handled correctly, the former constitutional law professor could use this as a teachable moment. But that would require the president to talk about his view of the separation of powers and how he sees the stakes involved. Instead, the bored icon currently stuck in the presidency chooses to be flippant. He says snarky things to partisan crowds and gets attaboys from the sycophants around him (Ed Rogers, 7/31). 

The Washington Post: Five Myths About Impeachment
Some 40 years after Richard Nixon resigned to avoid his likely impeachment by the House of Representatives, Washington is again talking impeachment. ... House Republicans on Wednesday voted to sue Obama for exceeding his constitutional authority when implementing the Affordable Care Act. ... House Speaker John Boehner has done everything short of hiring blimps to say that there will be no impeachment. Obama is as likely to be impeached as he is to be installed as the next pontiff. And I say that as someone who has testified in Congress that this president has violated federal laws (Joanthan Turley, 8/1).

Los Angeles Times: What Happens When A State Tries To Make Obamacare Work -- Or Not Work
There were signs almost from the start that the great unknown about the Affordable Care Act was how effectively individual states would implement the law. ... Some of [Kentucky's] poorest counties, including the infamous Harlan County, went from recording the highest levels of uninsured residents to the lowest. ... So that's how the ACA works when state officials fulfill their responsibilities. On the other side of the coin is Mississippi, which apparently wishes to turn itself into a laboratory for making its residents miserable (Michael Hiltzik, 8/1).

The Tennessean: Wake Up, Tennessee: Your Health Care Is In Jeopardy
No matter where you live in Tennessee, your health care is in jeopardy. The jeopardy begins with TennCare. Designed to ensure access to health care for the poorest and most vulnerable among us — children, pregnant mothers, patients with cervical and breast cancer — it has faltered seriously. ...  Thousands of TennCare-eligible Tennesseans have been denied access to care. Some, including newborns, have waited more than six months and gone without treatment. On June 27, in a serious rebuke to state officials, the federal Centers for Medicaid & Medicare Services cited TennCare for failure to comply with six out of seven benchmarks. No other state falls so short of the law. ... It is time to raise our voices for the health of us all (Nancy F. O'Hara and Sharon H. Cox, 8/2).

The Washington Post: On Obamacare, Opinion Is Locked In For A Long, Long Time
The latest Kaiser Health Tracking Poll is out, and among other things it shows an uptick in the number of Americans who say they disapprove of the Affordable Care Act, from 45 percent in June to 53 percent in July. This is a curious finding, given all the good news we've had in recent months about the law's performance. At the same time, we've had a blizzard of anti-Obamacare ads around the country, nonstop Republican rhetoric against the law, and the lawsuit against the president over a part of it — all of which has probably helped stoke general disapproval of the ACA (Paul Waldman, 8/1). 

The New York Times: Censorship In Your Doctor's Office
According to a recent decision by the United States Court of Appeals for the 11th Circuit, everything a doctor says to a patient is "treatment," not speech, and the government has broad authority to prohibit doctors from asking questions on particular topics without any First Amendment scrutiny at all. The case, Wollschlaeger v. Governor of Florida, concerned the constitutionality of the Florida Firearm Owners Privacy Act. ... While some of our fellow Second Amendment advocates may be tempted to celebrate this ruling, it is, at most, a symbolic victory for gun rights. And it comes at the cost of a serious and dangerous defeat for the First Amendment (Aul Sherman and Robert McNamara, 8/1).

The Wall Street Journal: Scandal Pays Off For The VA
There's nothing like an imminent August recess to focus Congressional minds, usually in expensive directions. This summer's example is the $17 billion that purports to fix the Department of Veteran's Affairs, Congress's parting gift last week to that failed bureaucracy (8/3). 

USA Today: Social Security, Medicare Coffers Fine
The annual Social Security and Medicare trustees report was just released, and it will presumably inspire the predictable scaremongering about those programs by many in the media and in politics. We'll be told that those programs are running out of money, that they're going to go bankrupt, and that they'll be insolvent. But the programs won't really run out of money (Duncan Black, 8/1). 

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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.