Daily Health Policy Report

Monday, August 5, 2013

Last updated: Mon, Aug 5

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions

Kaiser Health News staff writer Jordan Rau reports: "Medicare will levy $227 million in fines against hospitals in every state but one for the second round of the government’s campaign to reduce the number of patients readmitted within a month, according to federal records released Friday" (Rau, 8/2). Read the story.

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State Premium Watch: Pricing In The New Insurance Marketplaces

Kaiser Health News staff writer Phil Galewitz reports: "One of the biggest questions about Obamacare is whether its new consumer protections might lead to higher costs for some people buying coverage on their own -- or through small groups -- when they purchase it via the online insurance marketplaces that open for enrollment Oct. 1" (Galewitz, 8/4). Read the premium watch.

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Capsules: Physician Payments Sunshine Act Goes Into Effect Without Initial Concerns

Now on Kaiser Health News' blog, Kelsey Miller reports on the Sunshine Act: "The Physician Payments Sunshine Act, an Affordable Care Act provision requiring doctors and medical companies to disclose their financial relationships, went into effect Aug. 1. Physicians say they are now working to find a balance between necessary transparency and what some perceive to be burdensome filing" (Miller, 8/5). Check out what else is on the blog.

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Political Cartoon: 'School's Out For Summer?'

Kaiser Health News provides a fresh take on health policy developments with "School's Out For Summer?" by Matt Wuerker.


If 40 House votes
can't stop Obamacare law
maybe shutdown will?

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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Capitol Hill Watch

GOP Still Embroiled In Intra-Party Split Over Govt. Shutdown And Efforts To Defund The Health Law

Some Republican governors are urging members of Congress to step away from the government shutdown threat. And while some GOP leaders are signaling that efforts to gut health law funding will not be considered in this fall's budget battle, rank-and-file lawmakers have opinions of their own.

The New York Times: G.O.P. Governors Warn Party Members In Congress Not To Shut Government
Worried about the potential impact on the fragile economies in their states, Republican governors this weekend warned their counterparts in Congress not to shut down the federal government as part of an effort to block financing for President Obama’s health care law (Martin, 8/4).

The Wall Street Journal: GOP Leaders Signal Health-Care Card Not In Play In Budget Battle
Two top House Republicans suggested Sunday that they don't plan to use the threat of a partial government shutdown this fall to demand a repeal of President Barack Obama's health-care overhaul. Many rank-and-file Republicans have pledged to block any bill funding the government for the fiscal year that starts Oct. 1 if it includes funds to implement the health-care law. GOP leaders, however, have appeared wary of using the health-care legislation as a negotiating tool as Washington nears another fiscal crisis (Peterson, 8/4).

Medpage Today: GOP Split On Plan To Kill ACA Funding
Hard-line conservatives are rounding up support to hold up the spending bill that will fund the federal government after next month unless money to fund the ACA is taken away. Congress hasn't yet passed a spending bill -- known as a "continuing resolution" (CR) to keep the federal government open after Sept. 30 when the current fiscal year ends. The conservative Republicans involved in the defunding effort are vowing not to support any CR or stop-gap funding unless that legislation also cuts off money to the ACA's health insurance exchange subsidies and Medicaid expansion, and prohibits funds to implement or enforce the ACA (Pittman, 8/3).

Bloomberg: Republicans Split On Efforts To Defund Obama Health-Care Law
Shutting down the U.S. government to starve President Barack Obama’s health-care system overhaul is the wrong solution pushed only by a "few extreme people" in Congress, lawmakers from both major parties said. As Congress prepares to negotiate the federal budget for the fiscal year that starts Oct. 1, a faction of Republican senators -- led by Ted Cruz of Texas, Marco Rubio of Florida and Mike Lee of Utah -- has said it will force a government shutdown if funding continues for the $1.3 trillion Affordable Care Act (Jamrisko, 8/4).

The Hill: Norquist: GOP Should Push Delay Of Individual Mandate In Shutdown Fight
Americans for Tax Reform President Grover Norquist weighed in Friday with his recipe for GOP success in the fiscal battle this fall. A main part of the plan Norquist outlined to the The Hill involves taking a targeted approach when it comes to ending ObamaCare as part of the government shutdown fight (Wasson, 8/2).

The Hill: Chambliss: Shutdown Over Obamacare Would Play Into Obama's Hands
Sen. Saxby Chambliss (R-Ga.) argued on Sunday that a government shutdown would hurt Republicans politically and harm the public. Several Republicans, including Sen. Ted Cruz (Texas), have argued that congressional Republicans should block any government funding bill that provides money for the implementation of the Affordable Care Act, President Obama's signature health care law (Sasso, 8/4).

Fox News: House Republican Leaders Outline Agenda For Immigration, ObamaCare, Budget Talks
House Republican leaders on Sunday outlined their caucus game plan for a critical next few months and beyond, suggesting a potential compromise on the sequester before an October deadline and a final vote on immigration reform. House Majority Leader Eric Cantor suggested that congressional Republicans are open to a compromise to end the deep, undiscerning cuts to the federal budget known as sequester but said the deal would require Democrats agreeing to entitlement cuts (8/4).

Kaiser Health News also tracked weekend news headlines, including reports about House Republicans' 40th effort to undo the health law and the Sunday talk show debate about linking a government shutdown to the threat of defunding the health law.

Meanwhile, the Wall Street Journal continues its coverage of an insider-trader probe --

The Wall Street Journal: Insider-Trading Probe Caught In A Washington Knot
Federal investigators interviewed a Senate staff member for four hours Thursday, part of a wide-ranging insider-trading probe into how a major change in U.S. health-care policy leaked to Wall Street traders before it was announced. But Thursday's interview with Rodney Whitlock, a health-care aide to Sen. Charles Grassley (R., Iowa), took place only after delays over the terms of the questioning, according to people familiar with the matter. In addition, Mr. Whitlock didn't answer several questions from investigators that touched on a parallel investigation by Mr. Grassley's staff, according to a written statement from Mr. Grassley's office (Grimaldi, Mullins and Barrett, 8/4).

And in other news from Capitol Hill --

McClatchy: N.C. Representative Favors Sequester Cuts, With Exception For Cancer Care
Rep. Renee Ellmers voted for across-the-board budget cuts and likes that they’re chipping down federal spending. But she’s fighting what she says is an unintended consequence: Senior citizens fighting cancer must pay more and often travel farther for their chemotherapy (Schoof, 8/4).

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Health Reform

Democratic Governors See Political Advantage In Efforts To Implement The Health Law

News coverage of issues related to state health exchange readiness and premium costs could boost Democrats in some states.

The Associated Press/Washington Post: Democratic Governors Fret About Health Care Law, But Say Readiness Favors Them in 2014
Democratic governors say they are nervous about getting the new federal health care law implemented but add they will be better positioned in next year's elections than many of their Republican counterparts who have resisted the far-reaching and politically polarizing measure. Several of the 12 Democratic governors shared that sense of nervousness-veiled-by-optimism at the National Governors Association meeting Saturday in Milwaukee (8/3).

Kaiser Health News: State Premium Watch: Pricing In The New Insurance Marketplaces
While individual consumers may not learn what premiums will be offered to them until the launch of the marketplaces, also called exchanges, a growing number of states have released their approved 2014 premiums and other details about individual and small group insurance plans that will available. Those rates do not take into account the federal tax credits that many people will be eligible for. In addition, the federal government must give final approval to the plans in September (Galewitz, 8/4).

Reuters: Analysis: In Obamacare Rate Debate, Price Gets Political
With the October 1 date for enrollment in the health insurance exchanges being created by Obamacare less than two months away, a war of numbers has been escalating. Health insurance will cost way less. Or it will cost way more. It depends who you ask (Humer, 8/5).

The Washington Post: Contractors Hoping To Win Work Marketing Health Care Options
With the technical part of building state and federal health insurance exchanges mostly complete, contractors are now hoping to find work communicating with potential customers. Companies from Adobe to Maximus are looking to work that will involve first-hand interaction with citizens, meaning they must prepare to combat misinformation and boil down complex decisions (Censer, 8/2).

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Aetna Pulls Insurance Plans From Md.'s Health Law Exchange

In state health insurance marketplace news, Aetna won't sell its plans on Maryland's version of the exchange over concerns premiums wouldn't cover costs. Officials in Colorado, Missouri, California and Oregon also face decisions about their marketplaces and the challenges to enrolling their residents in them.

Baltimore Sun: Aetna Pulls Health Plans From State Insurance Exchange
Aetna Inc. said Friday it canceled plans to sell insurance on Maryland's new health insurance exchange, set to open Oct. 1 as part of the federal health care reform law, after regulators cut the rates it could charge consumers for its plans. Aetna was one of several carriers poised to sell on the state's exchange, along with Coventry Health Care, which Aetna acquired this spring. But Aetna told Maryland Insurance Commissioner Therese M. Goldsmith in a letter this week that cuts regulators made to the rates the companies had proposed "would not allow us to collect enough premiums to cover the cost of the plans." (Dance, 8/2).

The New York Times: Colorado Presses For Uninsured To Enroll 
Television commercials have already run suggesting that buying health coverage through the state's new insurance market, Connect for Health Colorado, will feel like winning the World Series. ... This is Colorado, five months before the central provisions of President Obama's health care law take effect: a hive of preparation, with a homegrown insurance market working closely with state agencies and lawmakers to help ensure the law's success (Goodnough, 8/2).

The New York Times: Missouri Citizens Face Obstacles To Coverage 
Looking for the new health insurance marketplace, set to open in this state in two months, is like searching for a unicorn. The marketplace, or exchange, being established by the federal government under President Obama’s health care law has no visible presence here, no local office, no official voice in the state and no board of local advisers. ... While states like Colorado, Connecticut and California race to offer subsidized insurance to their citizens, Missouri stands out among the states that have put up significant obstacles (Pear, 8/2).

Los Angeles Times: California's Latinos Critical For Success Of Obamacare
California has launched a major campaign to educate Latinos about Obamacare before enrollment begins Oct. 1. More than half of Latinos have little or no understanding of the Affordable Care Act, according to a recent survey by Latino Decisions, an opinion polling organization. The percentage is higher among those who speak mostly Spanish, the survey found (Gorman, 8/1).

The Oregonian: Oregon Officials Brace For Scammers Over Health Enrollment Push
Two days after filling out a state form to apply for health coverage, the Oregon woman received a call with good news: She'd been approved. The caller just needed her bank account information to cover the sign-up fee. The only problem? There was no sign-up fee, and the caller was a fake (Budnick, 8/3).

A study says if all states expanded Medicaid under the health law, 85 percent of residents would have some form of health coverage --

Stateline: Measuring The Effect Of Medicaid Expansion
If every state expanded Medicaid under the Affordable Care Act, at least 85 percent of the residents in each one would have some form of health insurance, according to a new report by the Kaiser Family Foundation and the Urban Institute. Current health coverage rates vary from more than 90 percent in Massachusetts, Hawaii and the District of Columbia, to less than 75 percent in Texas and Nevada (Ollove, 8/2).

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Public Unions Pushed To Accept Less Expensive Health Benefits

The New York Times explores how local governments are pressing unions to accept less expensive benefit packages to avoid the health law's so-called Cadillac tax which goes into effect in 2018. Other news outlets examine health law outreach efforts, as well as how August might be a 'steamy' month of town hall meetings.

The New York Times: Health Care Law Raises Pressure On Public Unions
Cities and towns across the country are pushing municipal unions to accept cheaper health benefits in anticipation of a component of the Affordable Care Act that will tax expensive plans starting in 2018. The so-called Cadillac tax was inserted into the Affordable Care Act at the advice of economists who argued that expensive health insurance with the employee bearing little cost made people insensitive to the cost of care. In public employment, though, where benefits are arrived at through bargaining with powerful unions, switching to cheaper plans will not be easy (Taylor, 8/4).

CNN: Obamacare Battle Heads To States
Does this sound familiar? The summer before campaigning begins in earnest for midterm congressional elections, activists hit the road to wage war on President Barack Obama's health care ideas. If August 2013 is starting to shape up like August 2009 – that steamy month of angry town halls fueled by the then-burgeoning tea party movement – it's because the Affordable Care Act remains in the crosshairs for conservatives, whose commitment to repealing the law endures (Liptak, 8/2).

The Fiscal Times: Obamacare’s $95 Bet On Millenials Buying Insurance
Obamacare either looks like a deal or a rip-off, depending on which state you call home – and on which political party occupies the governor’s mansion. As state regulators release their 2014 monthly premium rates, it becomes clear how a combination of political motives and existing state regulations have distorted whether Obamacare can deliver the promised savings (Boak, 8/5).

Bloomberg: Obamacare Depends On Math Of Matt Saniie From Campaign Data Cave
The success of President Barack Obama’s health-care plan depends on signing up millions of uninsured Americans, and Matt Saniie knows how to find them. Fresh out of the Obama re-election campaign “Data Cave,” the 31-year-old math whiz has gone from tracking likely voters in battleground states to honing a statistical model that can predict with 99 percent accuracy whether someone has insurance (Dorning, 8/5).

Politico: Obamacare Message War Goes Local
A race to define Obamacare to the masses began today between the stacks at the Centreville Library. Over pizza in Decatur, Texas. And with a glass of wine in Naples, Fla. Dozens of communities around the country hosted pro-Obamacare events, convened by the president’s foot soldiers at Organizing for Action (Cheney, 8/4).

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State Watch

Federal Judge Blocks Wisconsin Abortion Law

A federal judge blocked a Wisconsin abortion law from taking effect until a decision is made about its constitutionality. The law would require that women have an ultrasound before having the procedure, and that doctors who perform abortions have admitting privileges at nearby hospitals.

The Washington Post: Federal Judge Blocks Wisconsin Abortion Law Through Fall Trial 
A federal judge extended a preliminary injunction Friday blocking a Wisconsin law that would require abortion doctors to have admitting privileges at a hospital within 30 miles of their clinics and a mandatory ultrasound before a woman receives an abortion. U.S. District Judge William Conley issued a temporary restraining order on July 8; this injunction extends through the trial about the law's constitutionality, which is scheduled to start Nov. 25 (Eilperin, 8/3).

Los Angeles Times: Federal Judge Keeps Blocking Part Of Wisconsin Abortion Law
The order, issued Friday by U.S. District Judge William Conley, stems from a lawsuit that Planned Parenthood and Affiliated Medical Services filed last month. The groups claim the law would shut two of the state’s four abortion clinics because providers at those facilities, in Appleton and Milwaukee, lack admitting privileges (Mueller, 8/3).

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State Highlights: NYC To Gather Bids For Its Health Insurance Costs

A selection of health policy stories from New York, Texas, Arizona and California.

The Associated Press: NYC To Put Health-Insurance Contract To Bid
Faced with annual health insurance costs of $6.3 billion, New York City is putting its health care contract out to bid, Mayor Michael Bloomberg said Friday. Bloomberg said the bid has not gone out yet but current health-insurance provider EmblemHealth has already chosen not to seek a rate increase for the next fiscal year (Mathews, 8/2).

The Associated Press/Washington Post: Nearly Dismantled By Turmoil, Criminal Probe, Texas' $3B Cancer-Fighting Eyes Comeback
Gone are the large conferences, big pharma funding, Nobel laureates and lavishly paid state officials who vowed scientific breakthroughs from Texas' unprecedented $3 billion crusade against cancer. What's left of the Cancer Prevention and Research Institute of Texas isn’t flashy, but that's precisely the goal for an agency regaining its footing after a year of turmoil and an ongoing a criminal investigation (8/4).

Houston Chronicle: Continuum-Of-Care Nurses See Demand In Houston Area
With the aging population and with baby boomers moving into their golden years, retirement communities are opening across the city and surrounding areas. Plus, many established senior living communities are expanding services and programs for continuum-of-care, known as transitional care. This is all good news for nurses with experience in geriatrics and the senior population (Maitland, 8/5).

Arizona Republic: Entrepreneurs See Opportunity In Senior-Care Industry
As the Baby Boom generation ages, the senior-care industry in metro Phoenix is growing at a rapid pace, and Valley entrepreneurs are capitalizing on the trend through franchise businesses. About 18 months ago, Jim Crew started operating an in-home elderly care business in Scottsdale. Last November Alice Starzinski began running a service that helps families find the best assisted-living facilities for elderly relatives who can no longer care for themselves (Brown, 8/3).

California Healthline: Getting Dental Care To Pregnant Women
Among the new national guidelines for providers released this week by the American College of Obstetricians and Gynecologists is a new emphasis on making sure pregnant women get dental care. That's something policymakers in California have been working on for years, and is a welcome addition to national guidelines, according to officials at the Children's Dental Health Project, a nonprofit children's health advocacy organization (Gorn, 8/2).

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Editorials and Opinions

Viewpoints: Republicans' 'Temper Tantrum' On Health Care; 'Mixed Message' On Cancer

The New York Times: Republicans Against Reality
Last week House Republicans voted for the 40th time to repeal Obamacare. Like the previous 39 votes, this action will have no effect whatsoever. But it was a stand-in for what Republicans really want to do: repeal reality, and the laws of arithmetic in particular. The sad truth is that the modern G.O.P. is lost in fantasy, unable to participate in actual governing (Paul Krugman, 8/4).

The New York Times: Mixed Blessings
Pity the poor patient who tries to make sense of federal advisory committee reports that appear headed in opposite directions. For at least three decades, Americans have been told that it's best to detect cancers early, when they are theoretically most curable. So it was not all that surprising when an authoritative advisory group recommended that very heavy smokers get an annual CT scan to check for early signs of lung cancer. It was much more surprising, however, when a separate group of experts suggested that for several cancers — including potential lung cancers — early scans are detecting too many abnormalities that aren't dangerous and should not be treated (8/4).

Los Angeles Times: Is The GOP Self-Destructing?
How divided are Republicans in Congress? So divided, one conservative joked, that it shouldn't be called a civil war: "It's not organized enough for that." The Republicans are divided over how much to cut federal spending and how fast. [Sen. John] McCain and his "Gang of Eight" GOP senators are negotiating with Obama on a bargain that could include new spending on jobs in the short run in exchange for cuts in Medicare and other programs in the long run. To tea party Republicans like [Sen. Ted] Cruz, that's anathema. The GOP is also divided on how to fight the implementation of Obama's healthcare law, which begins signing up clients Oct. 1 (Doyle McManus, 8/4).

Los Angeles Times: Give America's Caregivers A Break
In the next two decades about 78 million baby boomers in the U.S. will turn 65. As they age, a portion of them will be cared for by their families, and others will no doubt enter facilities for the elderly. But many will rely on a growing cadre of domestic in-home workers. According to the U.S. Department of Labor, the demand for the kind of personal-care aides who can help cook, clean and bathe the elderly and disabled is expected to grow by 70% from 2010 to 2020. Today, these caregivers often labor in conditions that would not be tolerated in any other industry (8/2).

The Washington Post: Pension Crunch For States Means Schools Vs. Nursing Homes
The bankruptcy of Detroit is an extreme example, but it is not an isolated case. State and local governments face a prolonged squeeze between costly commitments to retirees and demands for better services. Think schools, police, libraries, parks, roads and prisons. As the Great Recession fades, pressures for immediate service cuts may recede, Detroit notwithstanding. Don’t be fooled. The reality is that the scramble for scarce resources is intensifying. Schools compete with nursing homes (Robert J. Samuelson, 8/4).

The Wall Street Journal: Congress's ObamaCare Exemption
To adapt H.L. Mencken, nobody ever went broke underestimating the cynicism and self-dealing of the American political class. Witness their ad-libbed decision, at the 11th hour and on the basis of no legal authority, to create a special exemption for themselves from the ObamaCare health coverage that everybody else is mandated to buy (8/5).

USA Today: Health Care 'Temper Tantrum' Could Punish GOP: Our View
ObamaCare's most diehard opponents are escalating their tactics in a dangerous way. These opponents say that unless the law is defunded, they will block a measure to keep the government operating after Sept. 30 — a threat as delusional as it is doomed to failure. ... Once Americans who could never get affordable health insurance begin to get it, and the 85% of Americans who are mostly unaffected by the law realize it's not the freedom-robbing boogeyman they've been told it is, ObamaCare might actually become popular. Although the law is far from perfect, it's much better than the status quo (8/4).

USA Today: Sen. Mike Lee: Defund ObamaCare
The House can add language to the next spending bill, known in Washington as a "continuing resolution," that says Congress will fund all the functions of government — the military, veterans benefits, Social Security, entitlement programs, etc. — except ObamaCare. After the House passes that bill, Sen. Harry Reid, D-Nev., and Senate Democrats will have a choice: Fund the government or shut it down to protect ObamaCare. The only responsible choice now is to protect the country from ObamaCare's looming disaster, start over and finally begin work on real health care reform that works for everyone (Sen. Mike Lee, R-Utah, 8/4).

The Washington Post: The GOP Flips The Script On Obama
Republicans need to make up their minds: Is President Obama a socialist or a corporate stooge? ... Republican lawmakers seem to think that Americans have short memories and lack Internet connections, for their latest line of attack — that Obama's health-care and tax policies favor the corporate elite — directly contradicts their previous allegation that Obama was waging "class warfare" with "socialist" policies attacking these very same corporate elites (Dana Milbank, 8/2).

Washington Post: Getting Children The Nutrition They Need
A bologna sandwich. Celery sticks. Canned oranges and chocolate milk. It's hardly a feast, but don't tell that to the children for whom this meal makes all the difference. The experience of a food bank running a summer lunch program for needy children in rural Tennessee shows that more ways must be found to feed the millions of children who go hungry when schools let out (8/4).

The New York Times: For Obamacare to Work, Everyone Must Be In
Two beliefs continue to shape debate on Obamacare. First, pre-existing medical conditions shouldn't prevent people from obtaining affordable health insurance. And second, people who don't want health insurance shouldn't be forced by the government to purchase it. These may seem to be reasonable positions. But they are incompatible (Robert H. Frank, 8/3).

Atlanta Journal Constitution: A Campaign Of Organized, Conscious Mendacity
Forty. As their last official act before leaving on a five-week recess, House Republicans voted Friday for the 40th time to repeal or undo ObamaCare. Their vehicle this time was the Keep The IRS Off Our Health Care Bill, sponsored by U.S. Rep. Tom Price of Marietta. According to House Majority Leader Eric Cantor, the law is needed because otherwise, the IRS “will have access to the American people’s protected health care information” and, he implied, might use that against the administration's political enemies. ... It is also a bald-faced, blatant lie, a lie that exposes the moral bankruptcy of the case that Cantor and others are attempting to make (Jay Bookman, 8/3).

Denver Post: Obamacare Exchanges Present A Privacy Risk
Americans were told that we would find out the fine points of Obamacare after it passed. Well, add another horror lurking in the details. When individuals sign up for federal insurance exchanges, they enter their personal information into a new Federal Data Hub. This program then collects medical records, Social Security numbers, tax information, and bank account data, by coordinating with the relevant federal departments, to determine the individual's eligibility for an insurance subsidy (Ken Buck, 8/2). 

Des Moines Register: Concerns About Wellmark? Get Involved
Wellmark Blue Cross and Blue Shield is Iowa's largest health insurer. It controls about 86 percent of the individual health policies and sells insurance to individuals not covered under group policies, to employers insuring their workers and to seniors buying Medicare supplemental coverage. Wellmark is a for-profit company, but you can't buy shares of its stock. That's because Wellmark is a mutual insurance company, meaning it is owned by its policyholders. You would be forgiven, however, if you thought Wellmark was privately owned, because the company does a poor job of looping its policyholders in on management of their company (8/3).

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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.