Daily Health Policy Report

Tuesday, August 5, 2014

Last updated: Tue, Aug 5

KHN Original Reporting & Guest Opinion

Health Reform

Health Care Marketplace


State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Patients Seeking Cheaper Care Are Soliciting Bids From Doctors Online

Reporting for Kaiser Health News, Sandra G. Boodman writes: “To Medibid founder Ralph Weber, a benefits consultant who said he left his native Canada for the United States in 2005 to escape "socialized health care," using the Internet to arrange non-emergency medical care is long overdue. Americans, he says, are increasingly going online to book travel and even find a mate. Medibid enables them to strip away the opacity that surrounds health-care pricing, Weber maintains, where charges vary wildly even in the same market and can be nearly impossible for consumers to obtain” (Boodman, 8/5). Read the story, which also appeared in The Washington Post.

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Insuring Your Health: Health Law Calls For Some Workers To Be Automatically Enrolled In Coverage

Kaiser Health News consumer columnist Michelle Andrews writes: “Newly hired employees who don’t sign up for health insurance on the job could have it done for them under a health law provision that may take effect as early as next year. But the controversial provision is raising questions: Does automatic enrollment help employees help themselves, or does it force them into coverage they don’t want and may not need? A group of employers, many of them retail and hospitality businesses, want the provisions repealed, but some experts say the practice has advantages and is consistent with the aims of the health law” (Andrews, 8/5). Read the column.

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Cleveland's Early Medicaid Expansion Paying Off

WCPN’s Sarah Jane Tribble, working in partnership with Kaiser Health News and NPR, reports: “So long before Ohio expanded Medicaid, the hospital redirected more than $30 million from Cuyahoga County taxpayers to create its very own Medicaid program for residents. Here’s how it worked: MetroHealth used extensive electronic medical records to carefully select uninsured patients and sent 28,000 of them Medicaid cards before they even applied. Then, the hospital gave highly personalized attention to some patients and kept track of them” (Tribble, 8/5). Read the story.

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Capsules: Study: ER Closures Raise Death Rates At Nearby Hospital; Smokers Paying Less For Some Health Plans Than Expected; Poverty Linked To Diabetic Amputations In California; Some California Hospitals, Insurers Disappointed in ‘Bundled Payments’

Now on Kaiser Health News’ blog, Roni Caryn Rabin reports on a study regarding ER closures and death rates: “Emergency patients who are admitted to the hospital are at greater risk of dying if another emergency room at a hospital nearby has closed its doors, a new study of California hospitals has found. The analysis is believed to be the first to examine the impact that emergency department closures have on the quality of patient care at other hospitals within the same service area” (Rabin, 8/4). 

Also on the blog, Shefali Luthra reports on the surcharges some tobacco users now pay as part of their health insurance premiums: “The health law allows insurance plans to charge tobacco users as much as 50 percent more for their premiums, but plans on average increased costs for these consumers by significantly less, according to a new study published in Health Affairs. Researchers found the median surcharge amount to be about 10 percent. Close to 90 percent of plans stayed well below the maximum surcharge, according to the study’s authors. But even still, because tobacco users were still charged more than others, they more frequently could not access affordable health insurance, a situation that the authors said could deter tobacco users from purchasing insurance at all” (Luthra, 8/4).

Daniela Hernandez reports on how bundled payments are viewed in California: "Giving health-care providers a lump sum payment for certain treatments – touted as a way to save money and improve coordination of care — yielded disappointing results for some major California hospitals and insurers, a study found. The RAND Corp. study, funded by a $2.9-million federal grant, looked at 'bundled payments' for care of insured orthopedic patients under 65 at a handful of large hospitals and insurers in California" (Hernandez, 8/5).

In addition, Anna Gorman reports on link between poverty and amputations: "People with diabetes in low-income neighborhoods in California are twice as likely to have a leg or foot amputated as those living in wealthier areas, according to a study released Monday. The study, published in the journal Health Affairs, underscores the stark differences in outcomes for diabetes patients throughout the state" (Gorman, 8/5). Check out what else is on the blog.

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Political Cartoon: 'States of Confusion?'

Kaiser Health News provides a fresh take on health policy developments with "States of Confusion?" By Chip Bok.

Meanwhile, here's today's haiku:


Medicare Part D
Care for hepatitis C 
Costly alphabet

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

Hospitals See New Revenues, Stiffer Fines From Obamacare

A surge in insured patients using health services has increased hospital revenues, even as Medicare stiffens penalties for facilities with high readmission rates or patients who contract infections and injuries while admitted for other reasons.

The Wall Street Journal: Hospitals Cash In On The Newly Insured
A rush of newly insured patients using health services has boosted hospital operators' fortunes but has racked up costs that insurers didn't anticipate, corporate filings and interviews with executives show. People are getting more back surgeries, seeking maternity care and showing up at emergency rooms more frequently, executives say, boosting income for hospital operators (Weaver, 8/4).

The Hill: O-Care Rule Docks Poorly Performing Hospitals
Regulations issued Monday under the Affordable Care Act aim to crack down on hospitals with high readmission rates and records of patients acquiring new conditions after they’ve been admitted for something else. Implementation of ObamaCare’s Hospital Acquired Condition Reduction Program is among several provisions of a final rule updating the Medicare payment schedule for general acute care and long-term care hospitals in fiscal 2015. Under the rule, hospitals with the highest rates of hospital-acquired conditions would see their Medicare inpatient payments cut by one percent (Goad, 8/4).

Bloomberg: Medicare Reduces Payments For 2015 Hospital Re-admissions
Medicare, the U.S. program for the elderly and disabled, said payments for hospital admissions would fall $756 million next year as penalties stiffen for patients who return too early. Payments for inpatient services at about 3,400 acute-care hospitals will be cut about 0.6 percent in 2015, the Centers for Medicare and Medicaid Services said in a regulatory filing, including reductions in funding for hospitals who provide care for many low-income patients, those with too many patients who contract infections while admitted and higher penalties for readmissions within 30 days. The Obama administration has applauded reduced Medicare spending for hospital admissions, a trend encouraged by the Patient Protection and Affordable Care Act that has added 13 years to the life of Medicare’s key trust fund. The program’s actuaries have warned the payment cuts may not be sustainable as hospitals struggle to improve their efficiency (Wayne, 8/4). 

Earlier, related KHN coverage: More Than 750 Hospitals Face Medicare Crackdown On Patient Injuries (Rau, 6/22).

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Florida Health Plan Rates To Rise 13.2% On Average; Calif. Regulator Seeks Greater Authority

Florida officials release rates for 2015 health plans to be sold on the individual market. Another story examines the voter initiative being pushed by California's insurance commissioner to give his office greater power to regulate health insurance rates.

Miami Herald: Proposed Prices For Health Plans In 2015 Unveiled
Floridians who buy health insurance on the individual market for next year will face an average increase of 13.2 percent in their monthly premiums, according to rate proposals unveiled Monday by the state's Office of Insurance Regulation. The rate proposals affect all Affordable Care Act-compliant health plans on the individual market, whether they're sold through the federally-run exchange or not. Small and large group health plans typically offered by employers were not included in the data released by the state (Chang and Madigan, 8/4).

The Sacramento Bee/McClatchy: Obamacare At Center Of Debate Over California Health Insurance Initiative
As state insurance commissioner, Dave Jones has the power to regulate rates for car and homeowner insurance. He can halt an insurer's proposed increase if the company can't justify the higher cost. Health insurance is another matter. The former Democratic lawmaker has spent years working to give elected commissioners regulatory authority over health insurance rates. He's asking voters in November to give him that ability with Proposition 45, asserting it's the only way to slow down spiraling premium costs (Cadelago, 8/4).

In other news about state insurance markets and the online exchanges -

NPR: Minnesotans Question State's Ailing Insurance Marketplace
Minnesota spent $100 million on creating its new health care website, and while the state has added some 180,000 people to insurance coverage, some are asking whether it was worth it for the state to embark on its own — or even have an exchange at all (Stawicki, 8/4).

The Associated Press: Vermont: State Severs Link To Website Designer
The state is ending its relationship with CGI, the company that designed the troubled website used to sign people up for health insurance. ... The state has hired the company Optum to continue work on the website. CGI will continue to host the website (8/4).

The Oregonian: Five Things To Know About The Latest Federal Health Law Fracas And Its Oregon Fallout
Late last month, a video of Obamacare architect Jonathan Gruber discussing the Patient and Protection Affordable Care Act sparked vigorous and renewed debate over a legal case that could affect millions of Americans' pocketbooks. The video and ensuing flap in the blogosphere -- dubbed "Grubergate" -- added a new layer of controversy and political intrigue to an otherwise dry legal debate, and shortly became more fodder for the courts. Here's what you need to know about the case, the video, and what is at stake for the more than 60,000 Oregonians who pay reduced premiums for private insurance under federal reforms (Budnick, 8/4).

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GOP Operatives In Search Of Anti-Health Law Messages That Will Stick

Politico reports that, as the midterm elections are quickly approaching, Republican pollsters are testing out messages with likely voters in order to determine which ones resonated best with key target groups. Meanwhile, The New York Times examines the role of social issues as the campaign season heats up.   

Politico: Obamacare Opponents Seek Message To Drive Midterms
Three months before the mid-term elections, political operatives and activists are groping for an anti-Obamacare message that sticks — or 57 of them. Republican pollsters tested nearly five dozen criticisms of the health care law with likely voters and listed the most effective messages to combat the law, as well as the ones that resonated best with target groups like seniors, tea partiers or independents (Cheney and Wheaton, 8/4).

The New York Times' Political Memo: Democrats Seize On Social Issues As Attitudes Shift
On some divisive issues like abortion, attitudes have not shifted much; sonograms and advances in medical treatment have increased the discomfiture of some Americans with the procedure. Part of Republicans' defensive crouch on social issues, pollster Whit Ayres noted, reflects the fact that "Democrats have done a better job" with campaign communications. Republicans tried to regain advantage by casting the Hobby Lobby decision as being about religious freedom rather than the availability of contraception. But Democrats' aggressive response underscored their higher confidence (Harwood, 8/4).

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Where New Coverage Is Involved, There's Satisfaction, But Questions About Whether New Enrollees Will Go To The Doctor

News outlets report on the behaviors and the satisfaction levels of people who have new insurance as a result of the health law.

The California Health Report: Many Young Men Now Have Insurance, But Will They See a Doctor?
Twenty-one-year-old Albert is a self-described transient who picks up odd jobs whenever possible. On this day in mid-July, he's waiting to be picked up for day labor in Santa Ana. Albert has a black spot on his foot that he knows could signal diabetes, an illness that runs in his family and forced his uncle to lose a leg. He has read about the condition and switched to a plant-based diet as a result. But he doesn't intend to see a doctor. Albert, who declined to give his last name because of the health details he shared, doesn't lack medical insurance — he recently signed up for California's low-income program, Medi-Cal, while applying for public assistance. He just doesn't seek preventive health care (DePaul, 8/4).

Philadelphia Inquirer:  Most Are Satisfied, But Change Is Coming
Seven months after coverage began for people who bought health insurance under the Affordable Care Act, more are now insured and most of the nearly 10 million people who have signed up say they are satisfied with their plans. Yet now a new set of challenges looms. Will the plans be affordable, and will users know how to use tiered networks and other innovations without incurring huge bills? ... (Calandra, 8/3). 

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Health Care Marketplace

Tenn.-Based Hospital Company To Pay $98 Million To Settle Improper Billing Claims

Community Health Systems and the federal Justice Department announced the settlement Monday. In other hospital news, Tenet says its financial outlook is improving.

The Associated Press: Community Health Paying $98M To Settle US Claims
Community Health Systems Inc. has agreed to pay $98 million to settle federal claims of improper billing by the hospital company. The Justice Department and Community Health announced the settlement Monday. The government alleges that the company admitted patients to the hospital when it wasn't medically necessary and then billed Medicare, Medicaid and the military's Tricare program for those inpatient services. Community Health should have billed for less costly outpatient or observation cases, the government said. Franklin, Tennessee-based Community Health said there is no finding of improper conduct under the settlement and denied any wrongdoing (8/4).

The Wall Street Journal: Tenet Healthcare's Loss Narrows As Admissions Increase
Tenet Healthcare Corp. said its second-quarter loss narrowed amid improved admissions that received a boost from the U.S. health-care policy overhaul. For the year, the hospital operator raised its projection for adjusted earnings before interest, taxes, depreciation and amortization to a range of $1.85 billion to $1.95 billion, from its previous estimate of $1.8 billion to $1.9 billion. Tenet in October completed its acquisition of Vanguard Health Systems Inc., a move that aimed to broaden its geographic reach (Stynes, 8/4).

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California Insurance Giants Create Patient Database

Two major insurers -- Anthem Blue Cross and Blue Shield of California -- are creating a joint health-information exchange, making the medical records of about nine million plan members available to participating doctors and hospitals. 

Los Angeles Times: Insurance Giants Creating Massive Database Of Patient Records
Two of California's largest health insurers are partnering to create a massive database of patient medical records. With just a few strokes of a keyboard, doctors and nurses will be able to access the medical histories of about one in four California residents. Supporters say the effort by Anthem Blue Cross and Blue Shield of California could mean faster, cheaper and better healthcare. But the system faces significant technological challenges and privacy concerns (Logan and Pfeifer, 8/4).

The Wall Street Journal: Two Insurers To Pool Medical Records In California
Two major California insurers are teaming up to create what will be one of the nation's largest health-information exchanges, making the medical records of about nine million plan members available to participating doctors and hospitals. It is an ambitious effort, as dozens of similar information exchanges have closed or consolidated because of financial and administrative problems (Beck and Wilde Mathews, 8/5).

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Costly Specialty Drugs Drive Up Medicare Tab

ProPublica and The New York Times look at the explosive spending growth from an obscure medication for treating multiple sclerosis and a rare kidney disease -- and how several top prescribers have links to drugmaker, Questcor Pharmaceuticals. The Wall Street Journal examines the impact of new drugs to treat hepatitis C. 

ProPublica/The New York Times’ The Upshot: The Obscure Drug With A Growing Medicare Tab
An obscure injectable medication made from pigs’ pituitary glands has surged up the list of drugs that cost Medicare the most money, taking a growing bite out of the program’s resources. Medicare’s tab for the medication, H.P. Acthar Gel, jumped twentyfold from 2008 to 2012, reaching $141.5 million, according to Medicare prescribing data requested by ProPublica. The bill for 2013 is likely to be even higher, exceeding $220 million. Acthar’s explosive growth illustrates how Medicare’s prescription drug program — perhaps more than private health insurers and even other public health programs — is struggling to contain the taxpayer burden of expensive therapies aimed at rare conditions (Ornstein, 8/4).

ProPublica/The New York Times’ The Upshot: Top Medicare Prescribers For Acthar Have Links To Its Maker
Many of Medicare’s top prescribers of the expensive specialty drug H.P. Acthar Gel have financial ties to the drug’s maker. Only 18 practitioners wrote 15 or more prescriptions for the drug in 2012. At least nine — and all of the top four — were promotional speakers, researchers or consultants for Questcor Pharmaceuticals, a ProPublica analysis shows (Ornstein, 8/4).

The Wall Street Journal’s Pharmalot: What Will The New Hepatitis C Medicines Do To Medicare Part D?
In the latest salvo fired over the cost of hepatitis C treatments, a new report projects that the cost of these drugs – including the Sovaldi medication sold by Gilead Sciences – will increase 2015 federal spending by Medicare Part D between $2.9 billion to $5.8 billion (Silverman, 8/4).

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New Study Quantifies Impact Of ER Closures On Neighborhoods

The study, which appeared in Health Affairs, focused on California and is thought to be the first of its kind to examine the impact of emergency department closures on the quality of patient care.

Los Angeles Times: Study: Emergency Room Closures Can Be Deadly For Area’s Residents
It stands to reason that when a hospital emergency room closes, people in the surrounding neighborhood suffer. But how much? A new study quantifies the impact in California, finding that patients affected by ER closures were 5% more likely to die after being admitted to a hospital than were patients who didn’t lose an ER in their neighborhood (Kaplan, 8/4).

Kaiser Health News: Capsules: Study: ER Closures Raise Death Rates At Nearby Hospital
Emergency patients who are admitted to the hospital are at greater risk of dying if another emergency room at a hospital nearby has closed its doors, a new study of California hospitals has found. The analysis is believed to be the first to examine the impact that emergency department closures have on the quality of patient care at other hospitals within the same service area (Rabin, 8/4). 

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State Watch

Federal Judge Strikes Down Alabama Abortion Clinic Law

U.S. District Judge Myron Thompson ruled Monday that state lawmakers exceeded their authority when they passed a law last year requiring doctors at abortion clinics to have hospital admitting privileges. He ruled that the state law, which would have led to the closure of three of the state's five abortion clinics, was unconstitutional. 

The Associated Press: U.S. District Judge Rules Ala. Abortion Clinic Law Unconstitutional
A federal judge says an Alabama law restricting abortion doctors is unconstitutional. U.S. District Judge Myron Thompson ruled Monday that state lawmakers exceeded their authority when they passed a law last year requiring doctors at abortion clinics to have hospital admitting privileges. Thompson issued an order temporarily blocking enforcement of the law (8/4).

Reuters: U.S. Judge Slows Abortion Restrictions Tide By Striking Down Alabama Law
A U.S. judge on Monday ruled unconstitutional an Alabama law that threatened to close three of the state's five abortion clinics, while a trial opened in Texas with an abortion rights group trying to overturn restrictions imposed in that state. A number of abortion clinics have closed in recent months due to laws passed in 11 U.S. states requiring doctors who perform abortions to have admitting privileges at a nearby hospital. Supporters say the measure protects women's health while opponents say it is an unnecessary regulation designed to force clinics to shut down (Gates, 8/4). 

Los Angeles Times: Federal Judge Rules Alabama Abortion Law Unconstitutional
A law that would have closed three of five abortion clinics in Alabama is unconstitutional, a federal judge ruled Monday, concluding in an extensive 172-page opinion that a “climate of extreme hostility” toward abortion already makes it difficult for doctors to perform and for women to access the procedure in the state (Semuels, 8/4).

Politico: Judge: Alabama Abortion Clinic Law Unconstitutional
A federal judge has blocked an Alabama law requiring abortion providers to obtain admitting privileges at a nearby hospital, making it the second such law to be ruled unconstitutional within a week. U.S. District Judge Myron Thompson issued an order Monday that temporarily blocks enforcement of the Alabama statute, which he said would place an undue burden on women seeking an abortion by forcing the closure of three of the state’s five clinics. A federal appeals court issued a similar ruling last week on a Mississippi law, which would have shuttered that state’s only clinic (Winfield Cunningham, 8/4).

The Hill: Federal Judge Blocks Law Restricting Alabama Abortion Docs
A federal judge blocked an Alabama law restricting abortion doctors in a victory for Planned Parenthood and other abortion-rights groups. U.S. District Judge Myron Thompson ruled Monday that a law requiring abortion doctors to have hospital admitting privileges is unconstitutional. Last week, a federal appeals court ruled against a similar law in neighboring Mississippi. Advocates feared that the laws would shutter the handful of abortion clinics that remain open in those states and impose a burden on women. Supporters of the rules say they protect women in distress during difficult abortion procedures (Viebeck, 8/4).

Bloomberg: Alabama Restrictions On Abortion Doctors Unconstitutional
Alabama’s requirement that abortion clinic doctors have admitting privileges at local hospitals unconstitutionally burdens womens’ rights to the medical procedure, a federal judge ruled. While the decision is a defeat for abortion opponents who, in recent years, have pressed legislators across the country to enact laws limiting availability and regulating those who perform the procedure, U.S. District Judge Myron Thompson in Montgomery, Alabama, confined his ruling today to the parties in the case before him and declined to immediately issue a sweeping injunction. The U.S. Supreme Court, in the 1973 ruling in Roe v. Wade and subsequent decisions, has declared women have a constitutional right to an abortion before a fetus is capable of surviving outside the womb and that lawmakers can’t unduly burden access to the procedure (Harris, 8/4). 

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Texas Abortion Providers Ask Federal Court To Block Portion Of Stringent State Law

Owners of abortion clinics in the state are seeking relief from enforcement of a state law that is set to take effect Sept. 1. It sets out the same strict building and equipment regulations that are applied to ambulatory surgical centers. Monday marked the first day of court room action.

The New York Times: Abortion Providers In Texas Press Judge To Block Portions Of New Law
Owners of Texas abortion clinics asked a federal judge on Monday to block enforcement of stringent new building and equipment standards, set to take effect on Sept. 1, that they say could force more than half the state’s remaining abortion clinics to shut down, leaving fewer than 10 across a sprawling state (Fernandez and Eckholm, 8/4).

Texas Tribune: Opening Statements Made In Trial Over Abortion Regulation
On the first day of a trial over a new abortion regulation scheduled to take effect next month, attorneys for Texas abortion providers called witnesses who testified that the new requirement would leave low-income women in rural areas without reasonable access to abortion services. The witnesses testified Monday after both sides made their opening arguments in a federal district court in Austin on the regulation, which would require abortion facilities to meet the same regulations as ambulatory surgical centers, or ASCs (Ura and Edelman, 8/4).

Dallas Morning News: Texas Abortion Clinics Fight Rules in Federal Court
Abortion providers argued Monday that 14 of the state’s remaining 20 abortion clinics would close by the end of August if new requirements are allowed to take effect. In a case before U.S. District Judge Lee Yeakel, the providers said the requirement that all clinics meet high surgical standards is medically unnecessary, costly and unconstitutionally inconvenient for Texas women. The arguments are the second challenge of a sweeping law passed last year that bans abortion after 20 weeks, requires doctors who perform abortions to have admitting privileges at nearby hospitals, and requires facilities to meet space and safety rules of ambulatory surgical centers (Martin, 8/4).

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Medicaid Repayment Possibilities Put New York State Credit Rating At Risk

In related news, New York City will pay $1 million to settle Medicaid probe.

The Wall Street Journal: Moody's: Medicaid Issue Puts New York State Rating At Risk
One of the nation's biggest credit-rating firms warned New York officials and investors Monday that the state's much-improved rating is at risk as the federal government tries to claw back nearly $1.3 billion in Medicaid payments. In its report published Monday, Moody's Investors Service said the potential Medicaid repayment is a "credit negative" for the state. The "repayment would result in an unwelcome drain on the state's cash balances," the report said, and future repayments would "pinch the state's liquidity" (Kravitz, 8/4).

The Associated Press: NYC To Pay $1M To Settle Medicaid Probe
Federal authorities say New York City has agreed to pay $1.05 million to settle allegations that the city's Human Resources Administration failed to stop Medicaid payments for health care coverage for beneficiaries who became ineligible (8/5).

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State Highlights: New York Hospital Mergers Surging

A selection of health policy stories from New York, California, Ohio, Wisconsin and Massachusetts. 

The Wall Street Journal: Hospital Mergers In The New York Area Bring Cost Fears
Hospital takeovers are surging in the New York region, raising concerns that health costs could climb and care could change. In New York state, at least a dozen hospitals, many of them financially ailing, have become part of larger networks since 2011, according to the state Department of Health. More than a dozen have new owners or new affiliations in New Jersey during the same period as well (Dawsey, 8/4).

Los Angeles Times: Court Says Paid Caregivers Can’t Sue If Injured By Alzheimer Patients
Home health workers hired to care for unruly Alzheimer's patients may not sue them or their families for injuries inflicted by the patients, the California Supreme Court decided Monday. In a 5-2 decision, the state's highest court said employers have no liability as long as the caregiver was warned of the risks and the injury was caused by symptoms of the disease. Workers voluntarily assume the risk of violent injury in caring for patients with the brain disease, the court said (Dolan, 8/4).

Kaiser Health News: Cleveland's Early Medicaid Expansion Paying Off
So long before Ohio expanded Medicaid, the hospital redirected more than $30 million from Cuyahoga County taxpayers to create its very own Medicaid program for residents. Here’s how it worked: MetroHealth used extensive electronic medical records to carefully select uninsured patients and sent 28,000 of them Medicaid cards before they even applied. Then, the hospital gave highly personalized attention to some patients and kept track of them (Tribble, 8/5).

The Milwaukee Journal Sentinel: Milwaukee VA Medical Center Director Optimistic About System's Future
Robert Beller was appointed director of the Zablocki Veterans Affairs Medical Center in 2007 and oversees a health system that provided care to 61,462 veterans last year. The medical center is among 30 VA medical centers nationwide charged with treating the most complex patients. It also is an academic medical center for the Medical College of Wisconsin, and about three-fourths of its physicians in Milwaukee have faculty appointments at the medical school. The Zablocki VA Medical Center, which includes four outpatient clinics in eastern Wisconsin and employs 4,056 people, was not cited in the recent scandal involving the VA and performs better overall than most VA medical centers on public quality measures. But Beller acknowledges that the Milwaukee medical center faces many of the same challenges as the VA system, such as recruiting physicians (Boulton, 8/4).

WBUR: Governor Reviewing Mass. Bill That Would Expand Autism Supports
Many parents of children on the autism spectrum are celebrating passage of a bill that is among dozens already on Gov. Deval Patrick’s desk. The bill would create a tax-free savings account for autism and disability care; would require Medicaid coverage for autism behavioral treatment; and would give thousands of residents with autism access to state disability services. Currently only those whose IQ is under 70 qualify (Bebinger, 8/4).

The Associated Press: Insurers Face Tougher Mental Health Coverage Fines
A bill approved Monday by the Legislature would increase penalties for health insurance companies that provide substandard benefits for mental health care. SB1046 advanced to the governor's desk on a 70-0 vote in the Assembly. It aims to strengthen long-standing rules designed to increase patient access to psychiatric treatment by preventing insurers from skimping on benefits. Under state and federal laws, insurers must cover treatments for serious mental illness similar to how they would cover other injuries and diseases. That means plans cannot include separate limits on mental health benefits or include higher co-pays and out-of-pocket costs for counseling and medication (8/4).

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Editorials and Opinions

Viewpoints: Treating Ebola Patients In The U.S.; Medicare Costs; Discouraging Medicaid Enrollment

Los Angeles Times: How To Deal With The Ebola Outbreak
It was a commendable decision — and more unnerving than risky — for Emory University to accept into its hospital two Americans who contracted the deadly Ebola virus while doing humanitarian work in Africa. The arrival of the first patient on Saturday is considered to be the first instance of the virus entering the U.S.— albeit in the care of infectious disease specialists working in an isolation unit built in collaboration with the Centers for Disease Control and Prevention. Officials of the CDC say there is little safety threat and no cause for panic among Americans (8/4). 

Reuters: The Best Way To Treat Ebola Patients Who Return To America
Dr. Kent Brantly, an American physician stricken with Ebola, was evacuated this weekend from Liberia to Emory University Hospital in Atlanta, where he will receive treatment for the deadly virus. His colleague Nancy Writebol, also infected with the Ebola virus, is expected to follow in the coming days. But many Americans have expressed outrage over transport of these Ebola patients into the United States. This reaction is unjustified — and callous. In the United States, much more can be done for a critically ill Ebola patient than if he or she were on the ground in West Africa (Celine Gounder, 8/4).

The Washington Post: The Slowing Growth Of Medicare Provides An Opportunity For Reform
For years, lawmakers, policy experts and journalists have fretted about the explosive growth of health-care spending. Would the United States ever find a way to "bend the curve" on economic charts that projected seemingly endless growth in health care's share of the gross domestic product and, consequently, uncontrolled expansion of federal spending on health-care entitlement programs? Lately, though, the situation has quietly been improving — as the most recent government data released last week again confirmed (8/4). 

The Wall Street Journal’s Washington Wire: Little Reason To Celebrate About Medicare
Lost amid discussion of the Medicare trustees report and the additional four years until the program becomes insolvent is the fact that for the sixth consecutive year, Medicare's hospital insurance trust fund paid out more in benefits than it generated in revenue (Chris Jacobs, 8/4). 

The New York Times' Well: Throwing Money At The Past
The current physician training system, heavily subsidized by the federal government, has not produced doctors prepared to serve in a changing health care system and cannot account for billions of dollars in public funding each year, an exhaustive new report has concluded (Dr. Pauline W. Chen, 8/4). 

The Wall Street Journal’s Washington Wire: A Closer Look At The Courts' Impact On Health Policy
Court decisions can have huge policy implications. Because judges are not policy experts, statistical modelers or economists, and because these are inexact sciences anyway, the policy implications of judicial rulings may not be fully appreciated when they are made. A good example is the 2012 U.S. Supreme Court ruling that made Medicaid expansion optional for states. It’s hard to imagine that the justices had any idea that their decision would leave 4.8 million low-income people in a coverage gap without insurance in states that chose not to expand (Drew Altman, 8/4). 

The Wall Street Journal: No Need For A Halbig Rehearing
The D.C. Circuit Court of Appeals ruled last month in Halbig v. Burwell that the Obama administration's regulations for federal health-insurance exchanges violate the Affordable Care Act's plain language. But the administration hopes that its loss will prove short-lived: On Friday the Justice Department formally petitioned the court to rehear the case en banc—that is, for all 11 active judges to vacate the original three-judge panel's decision. ... But if the D.C. Circuit rehears the case en banc, it would be a sharp break from history. The D.C. Circuit rehears virtually none of its cases (Adam J. White, 8/4). 

Bloomberg: You Qualify For Medicaid: Don't Sign Up
The debate over Obamacare's Medicaid expansion divides states into two broad categories -- those that expand their program and those that don't. New research suggests we should talk more about a third group: States that agree to expand Medicaid, then impose premiums whose only purpose seems to be keeping people out of the program. A paper released today in the journal Health Affairs, written by researchers from the federal government's Agency for Healthcare Research and Quality, seeks to quantify the effect of premium increases on children's enrollment in Medicaid or its sister plan, the Children's Health Insurance Program. They found that even small premiums lead to big drops in sign-ups (Christopher Flavelle, 8/4).

Charleston (S.C.) Post and Courier: Expedite Medicaid Applications
Medicaid expansion remains a topic of heated debate. So do numerous other aspects of the Patient Protection and Affordable Care Act. But there should be no debate about the need to give Americans who apply for Medicaid fair -- and prompt -- notification of whether they are eligible for the program. Unfortunately, though, as reported on Tuesday's front page by Lauren Sausser, that need is not being met in our state (7/30).

Sheboygan (Wis.) Press/Eau Claire Leader-Telegram: Walker Should Accept Medicaid Expansion
Democrats have pounced on [Gov. Scott] Walker, a Republican, for refusing to accept an additional $119 million in available federal money for 2013-15 to cover the entire cost of expanding Medicaid coverage for adults with incomes up to 133 percent of the federal poverty level. ... Walker said he is concerned that the debt-ridden federal government will renege on its promised funding, leaving states in the lurch. Fretting over something that may happen in the future while leaving people needlessly without insurance in the present doesn't make much sense. ... You don't have to be a cynic to believe that politics played a major role in all of this (8/4).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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