Daily Health Policy Report

Tuesday, September 2, 2014

Last updated: Tue, Sep 2

KHN Original Reporting & Guest Opinion

Health Reform

Women's Health


Health Care Marketplace


Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

States To Help Pay Obamacare Tax On Insurers

Kaiser Health News staff writer Phil Galewitz reports: "When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. But with an $8 billion tax on insurers due Sept. 30 -- the first time the new tax is being collected -- the industry is getting help from an unlikely source: taxpayers" (Galewitz, 9/2). Read the story, which also ran in USA Today.

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Infertility Patients Finding Creative Financing Help

Kaiser Health News consumer columnist Michelle Andrews reports: "Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk for procedures that can run tens of thousands of dollars. Some even offer a money-back guarantee if patients don't conceive" (Andrews, 9/2). Read the story.

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Consumers Will Owe Uncle Sam If They Got Health Insurance Subsidies Mistakenly

Kaiser Health News staff writer Julie Appleby reports: "Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department. The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies" (Appleby, 8/28). Read the story.

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Capsules: Federal Judge Blocks Texas Restriction On Abortion Clinics; Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County

Now on Kaiser Health News' blog, KUHF's Carrie Feibel reports on a federal judge's ruling about Texas' abortion law: "In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers. The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities" (Feibel, 8/30).

Also on Capsules, Anna Gorman reports on the probe of nursing home investigations in Los Angeles: "Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week. The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required" (Gorman, 8/29). Check out what else is on the blog.

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Political Cartoon: 'What's Good For The Canada Goose?' By Joe Heller

Kaiser Health News provides a fresh take on health policy developments with 'What's Good For The Canada Goose?' By Joe Heller, Green Bay Press-Gazette


He can't be ignored
Even by the government
'Cause he's the tax man

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

Obamacare Questions: What Taxes? Will Job Insurance Last?

News outlets focused on varying aspects of the health law's costs to consumers.

Kaiser Health News: States To Help Pay Obamacare Tax On Insurers
When Congress passed the Affordable Care Act, it required health insurers, hospitals, device makers and pharmaceutical companies to share in the cost because they would get a windfall of new, paying customers. But with an $8 billion tax on insurers due Sept. 30 -- the first time the new tax is being collected -- the industry is getting help from an unlikely source: taxpayers (Galewitz, 9/2).

The Associated Press: Tax Forms Could Pose Challenge For Healthcare.gov
If you got health coverage through President Obama's law this year, you'll need a new form from your insurance exchange before you can file your tax return next spring. Some tax professionals are worried that federal and state insurance marketplaces won't be able to get those forms out in time, creating the risk of delayed tax refunds for millions of consumers (Alonso-Zaldivar, 8/30).

Kaiser Health News: Consumers Will Owe Uncle Sam If They Got Health Insurance Subsidies Mistakenly 
Consumers getting government subsidies for health insurance who are later found ineligible for those payments will owe the government, but not necessarily the full amount, according to the Treasury Department. The clarified rule could affect some of the 300,000 people facing a Sept. 5 deadline to submit additional documents to confirm their citizenship or immigration status, and also apply broadly to anyone ultimately deemed ineligible for subsidies (Appleby, 8/29).  

Fox News: Will Obamacare Mean The End Of Employer-Provided Insurance?
President Obama's famous promise that “you can keep your plan and your doctor, no matter what” was not the only misleading argument he made for his health care plan. There is yet another controversy, with even bigger consequences, brewing for Americans who already have health care. Analysts predict that as ObamaCare takes hold, it will mean the end of employer-provided insurance, with former Obama adviser Zeke Emanuel predicting that 80 percent of such plans will disappear within ten years. "It's going to actually be better for people," Emanuel argued (Angle, 8/29).

St. Louis Post Dispatch: Critics Take Aim At New Contraception Rule
The Obama administration’s latest attempt to end the contentious battle over contraception coverage is facing resistance, as expected, from some of the most vehement opponents of the federal health law requirement. New rules, announced last week by the U.S. Department of Health and Human Services, would allow religious nonprofits and some companies with religious owners to opt out of paying for birth control for female employees while ensuring that those employees still have access to contraception (Shapiro, 8/29).

Meanwhile -- 

The Wall Street Journal: GOP Eyes Agenda For Senate
One area likely to foster some internal GOP divisions is how to approach the Affordable Care Act. Some Republicans think seeking narrow changes would be most effective. In addition to repealing the medical-device tax, some Republicans aim to change the definition of a full-time worker under the health law to ease the law's requirements on businesses. Others say that voting on a wholesale scrapping of the law is crucial to establishing a GOP agenda (Peterson, 9/1).  

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Tenn., Utah Exploring Medicaid Expansion Options

Tenn. Gov. Bill Haslam says the state may soon send a proposal to Washington, while Utah Gov. Gary Herbert says he is hopeful about expansion for his state.

The Washington Post: 23 States Still Haven’t Expanded Medicaid. Which Could Be Next?
Thursday's announcement that Pennsylvania will expand its Medicaid program brings the country one state closer to the original expansion outlined under Obamacare. But because of the Supreme Court's 2012 decision making the expansion a voluntary program, there are still 23 states that haven't expanded public health insurance to all of their low-income residents. ... There are other states, though, that appear to be on the cusp of following in Pennsylvania's footsteps (Millman, 8/29).

The Tennessean/The Associated Press: Haslam May Submit Medicaid Expansion Plan In The Fall
In a move that could mean health coverage for thousands of Tennesseans, Gov. Bill Haslam said Thursday that the state may soon submit a proposal to Washington to expand Tennessee's Medicaid program but did not release any new details on how it might work (Wilemon, 8/28).

The Salt Lake Tribune: Utah’s Alternative To Medicaid Expansion Still Stalled
There's a persistent snag preventing federal health officials from agreeing, in concept, to Gov. Gary Herbert’s Healthy Utah plan: the work requirement. Herbert said Thursday during his monthly KUED news conference that he’s "cautiously optimistic" that he and the Obama administration’s Health and Human Services will resolve their differences over that final stumbling block when he’s in Washington next month (Moulton and Gehrke, 8/28).

In other state Medicaid news -

St. Louis Post-Dispatch: Call Center Wait Times Climb In Missouri As Medicaid Applicants Seek Answers
When Deborah Weaver, 28, had issues enrolling in the state’s Medicaid coverage for pregnant women, a switch from her Medicaid disability coverage, she was directed to use a toll-free number, 1-855-373-4636. When she called, Weaver endured long waits and received no guidance. ... The call center, run by a private company based in Mississippi, handles hundreds of thousands of calls from Missourians ... Recent records obtained from the Missouri Department of Social Services by the St. Louis Post-Dispatch show that nearly half of the individuals that phoned the call center ended up hanging up, or "abandoning" the call (Liss, 9/1).

The Tennessean: U.S. Attorney: Tenncare Has 'Ultimate Responsibility' For Medicaid Applications
The U.S. Attorney’s office is rejecting assertions by TennCare that the federal government is to blame for a bungled Medicaid application process in Tennessee that has spawned a lawsuit. ... The lawsuit has nothing to do with Medicaid expansion. The controversy centers around how the state is processing and determining eligibility for people who might qualify for coverage under Tennessee’s existing rules (Wilemon, 8/29).

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Exchange Roundup: MNSure Bogs Down; Md. Consumers Drop Coverage

Marketplace developments across the country, including in Minnesota, Maryland, Georgia and California.

Pioneer Press: MNsure Struggles To Keep Up With 'Life Event' Changes
When a new baby arrives, parents want the infant quickly added to their health insurance. But for 78 new moms in Dakota County this year, the process bogged down for months because of a change to Minnesota's new MNsure health insurance exchange (Snowbeck, 9/1).

The Baltimore Sun: Some Drop Maryland Exchange Programs During Last Month
Maryland's health exchange reported Friday a decline in the number of people who were covered by private plans through the online insurance portal created by the Affordable Care Act. But the total number of people obtaining coverage through the exchange still grew to 433,947 because of people signing up for Medicaid (Cohn, 8/29).

Georgia Health News: Another Insurance Deadline Only Days Away
More than 20,000 Georgians have until next Friday to provide missing information or they will lose their insurance exchange coverage Sept. 30. The regional administrator of the federal Centers for Medicare and Medicaid Services told GHN on Friday that most of the data discrepancies involve immigration or citizenship issues (Miller, 8/29).

Los Angeles Times: Shelley Rouillard Checks Up On Health Plans In California
As director of the California Department of Managed Health Care, Shelley Rouillard is the chief regulator for health plans that cover more than 21 million Californians. She's also a major player in the state's implementation of the federal health law. ... Her agency is currently investigating whether two of the state's largest health insurers, Anthem Blue Cross and Blue Shield of California, violated state law in connection with their provider networks on Obamacare policies. "This department wants to make sure health plans are following the law and patients are getting care when they need it," Rouillard said (Terhune, 8/31).

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Women's Health

Federal Judge's Ruling Blocks Shutdown Of Texas Abortion Clinics

Another ruling in Louisiana also puts a temporary hold on a restrictive law in that state -- one that would require abortion providers to have admitting privileges at nearby hospitals.

The New York Times: Judge Rejects Texas Stricture On Abortions
A federal judge in Austin, Tex., blocked a stringent new rule on Friday that would have forced more than half of the state's remaining abortion clinics to close, the latest in a string of court decisions that have at least temporarily kept abortion clinics across the South from being shuttered. The Texas rule, requiring all abortion clinics to meet the building, equipment and staffing standards of hospital-style surgery centers, had been set to take effect on Monday (Eckholm and Fernandez, 8/29).

Los Angeles Times: Federal Judge Strikes Down Key Part Of Restrictive Texas Abortion Law
Proponents of abortion rights, noting that Texas had 40 clinics before HB 2 was passed, cheered [Judge Lee] Yeakel's ruling. They said it was the third decision in a month that knocked down the requirement on admitting privileges after judges in Alabama and Mississippi reached similar conclusions (La Ganga and Hennessy-Fiske, 8/29).

Politico: Federal Judge Blocks Texas Abortion Clinic Law
U.S. District Judge Lee Yeakel said a provision requiring the clinics to meet the same building requirements as ambulatory surgical centers would impose "an unconstitutional undue burden on women throughout Texas and must be enjoined." The requirement, which was to take effect Monday, would have forced at least a dozen clinics to shut down. Fewer than seven facilities would then have remained, with much of the state left without any abortion provider (Villacorta, 8/29).

The Washington Post: Federal Court Blocks Tex. Rule That Could Have Closed Most Of State's Abortion Clinics
A federal judge Friday blocked a Texas restriction set to take effect Monday that could have led to the closure of most of the abortion clinics in the state. ... Lauren Bean, a spokeswoman for the Texas attorney general’s office, said the state would appeal. "The State disagrees with the court's ruling and will seek immediate relief," she said in a statement (Somashekhar, 8/29).

Kaiser Health News: Federal Judge Blocks Texas Restriction On Abortion Clinics
In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers. The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion -- all in major cities (Feibel, 8/30).

Dallas Morning News: Judge Tosses Out New Requirements For Abortion Clinics In Texas
A federal judge threw out new Texas abortion restrictions Friday that would have effectively closed more than a dozen clinics statewide in a victory for opponents of tough new anti-abortion laws sweeping across the U.S. U.S. District Judge Lee Yeakel sided with clinics that sued over one of the most disputed measures of a sweeping anti-abortion bill signed by Republican Gov. Rick Perry in 2013. The ruling stops new clinic requirements that would have left seven abortion facilities in Texas come Monday, when the law was set to take effect (Martin, 8/29).

Reuters: U.S. Judge Halts Major Part Of Texas Law Restricting Abortions
A U.S. judge struck down parts of a law restricting abortions in Texas, saying in a decision on Friday that a provision requiring clinics to have certain hospital-like settings for surgeries was unconstitutional. U.S. District Judge Lee Yeakel said the so-called "ambulatory surgical center requirement" was unjust because it placed an undue burden on women by reducing the number of clinics where they could seek abortions and the regulations had no compelling public health interests (Herskovitz and Garza, 8/29).

The Wall Street Journal: Judge Blocks Enforcement Of New Louisiana Abortion Law
A federal judge in Baton Rouge, La., issued a temporary restraining order Sunday night, blocking the enforcement of a Louisiana abortion law just hours before it was to take effect. The law, passed overwhelmingly this year by the state legislature, requires all abortion doctors in the state to have admitting privileges at a hospital within 30 miles of the clinic where they work. If doctors at clinics don't comply, the clinic can be closed. In his order, U.S. District Judge John deGravelles allowed the law to technically be enacted Monday but blocked for the time being any punishments or penalties for abortion clinics and their doctors (McWhirter, 8/31).

Politico: Louisiana Abortion Law Temporarily Blocked
A federal judge has temporarily blocked a Louisiana law that would have required abortion providers to secure admitting privileges at a local hospital. The law, signed by Gov. Bobby Jindal in June, would have gone into effect today. The Center for Reproductive Rights, which brought the case on behalf of Louisiana health care providers, argued that they were not given enough time to obtain admitting privileges (Villacorta, 9/1).

The Associated Press: US Judge Blocks Enforcement Of New LA Abortion Law
A federal judge has temporarily blocked enforcement of Louisiana's restrictive new abortion law. But lawyers disagree about whether his order covers doctors at all five of the state's clinics or only two doctors and three clinics. District Judge John deGravelles says the law can still take effect Monday. But he says officials cannot penalize the doctors and clinics that sued for breaking it until after a hearing on a broader pretrial order (McConnaughey, 8/31).

The Associated Press: Louisiana Following Judge's Order On Abortion Law
The Louisiana health department will follow a federal judge's order and refrain from immediately penalizing doctors who are trying to comply with a new abortion law that requires them to obtain admitting privileges at a local hospital, a spokeswoman said Monday. U.S. District Judge John deGravelles issued a temporary restraining order late Sunday that blocked enforcement of the new law that took effect Monday (Deslatte, 9/1).

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Do Small Military Hospitals Meet The Grade?

The New York Times takes a critical look at small military hospitals where the limited number of patients may compromise doctors' ability to treat serious problems. Other stories look at a surge in surgery prices and at programs to standardize children's surgical care.

The New York Times: Smaller Military Hospitals Said To Put Patients At Risk
Mrs. Smith underwent hernia surgery at Winn Army Community Hospital in Fort Stewart, Ga., one of 40 hospitals across the country run by the armed forces. Her case illustrates what outside experts and dozens of current and former military hospital workers interviewed by The New York Times call a signal failing in a system that cares for 1.35 million active-duty service members and their families, among others. Put simply, they say, many of the hospitals are so small and the trickle of patients so thin that it compromises the ability of doctors and nurses to capably diagnose and treat serious illnesses. ... Two-thirds of the hospitals last year served 30 or fewer inpatients a day (LaFraniere and Lehren, 9/1). 

NBC News: Surgery Prices Surge With Innovation And Consolidation Under Obamacare
The price to remove a gall bladder or replace a hip has spiked more than 20 percent during the past five years, according to an analysis of data collected for NBC News. Surgery has bloomed into a $500 billion industry in the United States, where 80 to 100 million procedures are performed annually -- a per-capita rate that’s some 50 percent higher than in the European Union, said Dr. John Birkmeyer, a researcher and adjunct professor at the Dartmouth Institute and in the university's Community & Family Medicine program. The reason? Expensive yet safer technologies and hospital consolidations that create medical monopolies, according to doctors and researchers (Briggs, 8/31).

The Wall Street Journal: Programs Aim To Standardize Surgical Care For Children
For parents, the prospect of a child's surgery can be frightening, with little information on how to pick the best hospital or understand complex procedures. To help, surgeons have developed a new classification system for pediatric surgical centers according to the level of care they provide, similar to the one that classifies trauma centers. Meanwhile, hospitals are offering new programs to help demystify the risks and benefits of pediatric surgery (Landro, 9/1).

Dallas Morning News: Baylor, Methodist Hospital Systems Aligning With Elite
Two of the largest health care systems in North Texas are aligning with two of the best-known national providers, part of ongoing efforts to improve quality and control the cost of care. Baylor Scott & White Health said it is about to complete an agreement that will make three of its Dallas-area hospitals part of the Cleveland Clinic’s national cardiology network. And Methodist Health System plans to partner with the Mayo Clinic, The Dallas Morning News has learned. Citing nondisclosure agreements, Methodist did not offer details. But it appears that Methodist will join Mayo’s expanding network of affiliates across the country. Affiliates can consult with Mayo specialists, share Mayo know-how and get advice on improving operations (Jacobson, 8/29).

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Health Care Marketplace

Doctors, Retail Clinics Adopt New Business Models

The financial ground is changing for doctors in private practice and for patients seeking care.

Los Angeles Times: Doctors Are Shifting Their Business Models 
Being a doctor in private practice today is more complicated than it used to be, with growing financial pressures, more government regulation, greater oversight by insurers, rapid developments in medicine and pressure to keep up with technology. ... Experts outline a few common ways doctors are shifting the way they do business and how they're likely to affect your care and your wallet (Zamosky, 8/31).

NBC News: Are You Ready For Walmart Care Clinics?
Wal-Mart has played it safe when it comes to retail clinics, partnering with regional hospitals to offer services like flu shots. But now, the retailer is taking a more aggressive tack, with in-store branded clinics offering primary care at a price competitors may find hard to match (Coombs, 8/29).

Kaiser Health News: Infertility Patients Finding Creative Financing Help 
Even as insurance plans are modestly improving their coverage of such treatments, clinics and others are coming up with creative ways to cover the costs to help would-be parents reduce their risk for procedures that can run tens of thousands of dollars. Some even offer a money-back guarantee if patients don't conceive (Andrews, 9/2).

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More Big Firms Shifting To High-Deductible Health Plans

The New York Times examines the movement among large employers towards high-deductible plans that shift more health care costs to workers. Meanwhile, The Wall Street Journal looks at how the ACA may affect job-based plans next year.

The New York Times: High-Deductible Health Plans Weigh Down More Employees
Just as employers replaced pensions with retirement savings plans, more large companies appear to be in the midst of a similar cost-sharing shift with health plans. Besides making workers responsible for more of their care, employers hope these plans will motivate employees to comparison-shop for medical services — an admirable goal but one that some say is hard to achieve. ... With high-deductible health plans, consumers pay for all their medical services — at the insurer's negotiated rate — until they meet their deductible. After that, consumers typically pay coinsurance, which is a percentage of each service — say 10 to 35 percent — until they reach the out-of-pocket maximum (Siegel Bernard, 9/1).

The Wall Street Journal: Get Ready For Health-Insurance Enrollment 
If you get health insurance through your workplace, you'll probably have a chance this fall to make important decisions about your coverage and costs. Because many corporate health plans hold their annual open-enrollment periods in October and November, many employees can expect to get a packet of benefits, or instructions for making elections online, as well as updates on changes to their plans required by the Affordable Care Act (Johnson, 8/30). 

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Bypassing Politics, Insurers Pay For End-Of-Life Talks

These doctor-patient conversations had been labeled "death panels" by opponents of the Affordable Care Act. Meanwhile, in a bid to reduce backlogs, Medicare offers a deal to hospitals to pay 68 percent of short-term stay medical claims that were rejected by outside auditors.

The New York Times: End-Of-Life Talks May Finally Overcome Politics
Five years after it exploded into a political conflagration over "death panels," the issue of paying doctors to talk to patients about end-of-life care is making a comeback, and such sessions may be covered for the 50 million Americans on Medicare as early as next year. Bypassing the political process, private insurers have begun reimbursing doctors for these "advance care planning" conversations as interest in them rises along with the number of aging Americans (Belluck, 8/29).

The New York Times: Medicare Will Settle Short-Term Care Bills
Sharply criticized by Congress and others, Medicare quietly announced on Friday that it would settle hundreds of thousands of hospital appeals over bills for short-term care, by offering deals that could add up to several hundred million dollars (Abelson, 8/29).

Modern Healthcare: CMS Offers Holiday Sale On Audit Appeals
In a pre-Labor Day weekend bid to lower its backlog of contentious payment disputes, the CMS late Friday offered to pay hospitals 68 percent of all medical claims appealed by the service providers after having been rejected by outside auditors (8/30).

And some treatments continue to get scrutiny -

Kansas Health Institute: Physician Payment Data Put Costly Eye Treatments Under The Microscope
To [retina specialist Dr. Ajay] Singh, drugs like Lucentis represent the biggest breakthrough in ophthalmology since the advent of safe cataract surgery three or four decades ago. … But the therapeutic benefits of the drugs have, to a certain extent, been clouded by a long-running debate about the cost effectiveness of Lucentis in comparison with a closely related drug called Avastin. Genentech, a biotechnology company based in San Francisco, manufactures both. At stake are potential savings to Medicare  (Sherry, 9/1).

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Public Health & Education

Nomination Signals New Approach To Drug Abuse Policy

The nomination of Michael Botticelli to head the Office of National Drug Control Policy symbolizes the shift toward dealing with drug use as a public health rather than as a criminal justice issue, writes The Washington Post. Reuters looks at how opioid abuse fears keep cancer patients from getting pain relief.

The Washington Post: The White House Is Spending Billions To Combat Drugs But Drug Use Keeps Rising
The White House officially nominated Michael Botticelli on Thursday to lead the Office of National Drug Control Policy, the office charged with overseeing and administering federal drug policy. The White House has been moving toward dealing with drug use as a public health issue, rather than a criminal justice one. The nomination of Botticelli, himself a recovering alcoholic, might be the most significant concrete sign of that shift to date (Ingraham, 8/29).

Reuters: Fears Of Addiction Keep Cancer Patients From Getting Pain Relief
Fears of opioid abuse and addiction might be keeping patients with advanced cancer from getting enough pain medicine, researchers say. “At the end of life, we should feel comfortable providing whatever necessary to control pain,” said Joel Hyatt, assistant regional director at Kaiser Permanente (Belisomo, 8/29).

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State Watch

State Highlights: Mass. Health Care Costs Grow By Only 2.3 Percent; New Rules In Calif. For Some Inmates

WBUR:  A First-Year Victory In The Mass. Fight To Control Health Costs
Two years ago, Massachusetts set what was considered an ambitious goal: The state would not let that persistent monster, rising health care costs, increase faster than the economy as a whole. Today, the results of the first full year are out and there’s reason to celebrate. The magic number, the one that will go down in the history books is 2.3 percent. It’s well below a state-imposed benchmark for health care cost growth (Bebinger, 9/2).

Boston Globe: Spending On Health Care Rises In Mass.
Spending at Massachusetts’ biggest health insurer and health care provider helped drive overall health care spending well above inflation last year, as the state’s efforts to control rising costs met mixed success, according to a report to be released Tuesday. Spending at Blue Cross Blue Shield of Massachusetts jumped 3.65 percent, and as much as 4 percent for some Partners HealthCare patients last year, compared with an inflation rate of 1.4 percent in the Boston metropolitan area (McKluskey, 9/2).

Los Angeles Times: New Cells Will Lessen Solitary Confinement For Mentally Ill Inmates
State prison officials plan to open special solitary confinement units for the mentally ill as part of an effort to comply with court orders to improve their care. The cellblocks -- while still isolating prisoners from the rest of the population and largely from one another -- will increase the time those inmates are allowed outside their cells and the amount of treatment they receive (St. John, 8/29).

The New York Times: Federal Judge Approves California Plan To Reduce Isolation Of Mentally Ill Inmates
The revised policies, filed in Federal District Court on Friday by the California Department of Corrections and Rehabilitation, were drafted in response to an order issued by Judge Lawrence K. Karlton last April. When put in place, they should greatly reduce the number of mentally ill prisoners held in so-called Security Housing Units, where prisoners remain in their cells for 23 or more hours a day, and in several other types of isolation units throughout the state (Goode, 8/29).

Los Angeles Times: Ventura County Medi-Cal Health Plan Probed
California officials are investigating financial dealings between Ventura County's Medi-Cal health plan and a key outside contractor, Xerox Corp., The Times has learned. The California attorney general's office has issued a subpoena to Gold Coast Health Plan for records related to its work with a Xerox unit, Affiliated Computer Services. Xerox is a major government contractor for Medicaid and other health programs nationwide (Terhune, 8/29).

Los Angeles Times: Despite Fractures Among Labor, Paid Sick Days Bill Clears Legislature 
A bill that would significantly expand working Californians' access to paid time off for sick leave cleared the Legislature early Saturday morning. The measure by Assemblywoman Lorena Gonzalez (D-San Diego) would require employers to give their workers at least three paid sick days per year. Supporters say it would provide paid leave to approximately 6.5 million workers in the state (Mason, 8/30).

Reuters: California Governor Lauds Passage Of Historic 'Sick Leave' Bill
If Brown signs the measure into law, California will join Connecticut as the only states mandating paid sick leave, according to the National Conference of State Legislatures (O'Brien, 8/30). 

Kaiser Health News: Another Audit Finds Fault With Nursing Home Inspections In Los Angeles County
Los Angeles County public health officials inappropriately closed nursing home investigations and failed to follow state guidelines on prioritizing complaints, according to an audit released this week. The Los Angeles County auditor-controller also found that even after nursing home inspectors found serious problems, their supervisors downgraded the severity of findings without any explanation or without discussing the changes with the inspectors as required (Gorman, 8/29).

USA Today: U Of Oregon Grads Plot The Future Of Rural Health Care 
While many college graduates spent their summer looking for entry-level work, two recent graduates of the University of Oregon -- Oliver Alexander, 22, and Orion Falvey, 24 -- were getting ready to open their own business. The duo are co-founders of Orchid Health, which opened its first clinic in the rural town of Oakridge, Ore. this August. ... Orchid Health offers memberships to patients for a monthly free. For non-members the company accepts patients with Medicare and Medicaid and offers cash walk-in prices (Maiman, 8/30).

The Associated Press: Indiana Hospitals Fight State's Salary Disclosure Law
Indiana county hospitals are seeking an exemption from a requirement that they make the salaries of doctors and staff public, saying doing so puts them at a disadvantage with their private counterparts. State law requires that salaries of public employees be made public. They can be accessed through the Indiana Gateway for Government Units (9/1). 

The Seattle Times: As Newly Insured Seek Care, Rural Doctor Shortage Worsens
As more people get health-insurance coverage through the Affordable Care Act, the doctor shortage in rural areas is worsening. In Port Angeles, for example, a local clinic is turning away 250 callers a week (Stiffler, 9/1).

The Seattle Times: New WSU Health Clinic Won't Be Restricted By Catholic Directives
Bylaws for a new health clinic that will open on the campus of Washington State University Spokane will be changed to ensure that care provided at the clinic isn’t restricted by Catholic health-care directives. The announcement Friday comes two days after the American Civil Liberties Union expressed concern about the clinic’s bylaws and asked Washington State University regents to address the matter at their Sept. 11 meeting (Hatch, 8/29).

The Denver Post: Saline IV Shortage: Searching For A Solution
Colorado hospitals are working overtime to find stock and are changing their daily practices to protect patients in the wake of an urgent national shortage of normal saline. Normal saline, the single most-used medicine, is little more than salty water that closely matches blood serum's natural salt levels, according to Dr. Eric Lavonas, the chairman of the Pharmacy and Therapeutics Committee at Denver Health (Mocine-McQueen, 8/31).

Earlier, related KHN story: Shortage Of Saline Solution Has Hospitals On Edge (Dembosky, 6/25)

The Denver Post: Colorado Medical-Marijuana Caregiver Rules Could Pinch Young Patients
Dozens of families who moved to Colorado to treat their severely disabled children with a special kind of marijuana could lose access to the treatment under new rules proposed by the state health department. The proposed rules would stop medical marijuana caregivers from serving more than 10 patients at a time (Ingold, 9/2). 

Charlotte Observer: Putting Teeth In Health Reform: Dental Clinics Aren't Enough 
When hundreds of desperate dental patients converge on the Charlotte Convention Center next week, it will be a testament to civic generosity and systemic failure. Over the past decade, North Carolina’s Missions of Mercy program has become one of the nation’s largest providers of free mobile dental clinics (Doss Helms, 9/1). 

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Editorials and Opinions

Viewpoints: Medicaid Expansion Spreading; 'GOP's Woman Problem'

The New York Times: Endless Assault On Health Care Reform
The latest jerry-built effort to destroy health care reform could be defeated in the full federal appeals court in the District of Columbia. In July, a three-judge panel of that court — taking a ridiculously crabbed view of a section in the law — ruled 2-to-1 that tax-credit subsidies are allowed only for those buying insurance on a health exchange "established by the state." Therefore, it said, no subsidies for people in 36 states where the federal government set up the exchange because the states refused to do so. There is no evidence that Congress intended to make this distinction, which defies the law's central purpose (8/30).

The Washington Post: Playing Politics With Health Care
We would congratulate Pennsylvania Gov. Tom Corbett (R), if it were seemly to commend public officials for doing the obvious. On Thursday, Mr. Corbett finalized a bargain with federal officials to expand Medicaid, the state-federal program that provides health-care coverage to low-income Americans, in Pennsylvania. Five hundred thousand needy Pennsylvanians stand to get care at almost no price to the state. Reform may even be revenue positive. It should not have taken this long (8/31).

The Washington Post: When Robert Bork Called Congress Suing The President A 'Monstrosity'
Before leaving for its August recess, the Republican-led House of Representatives voted to sue President Obama over his failure to fully implement a provision of the Affordable Care Act. Some Democrats have characterized this legal action as unprecedented, frivolous and even outrageous. But it brings back a lot of memories for me, some of which may be uncomfortable for my fellow Democrats and some of which ought to give pause to conservative Republicans rushing to support the lawsuit. In the 1980s, the tables were turned (Michael D. Barnes, 8/29).

The Wall Street Journal: Morning After In America
On Wednesday the Congressional Budget Office updated its fiscal and economic outlook for the next decade, and to adapt Ronald Reagan for a new era, the report could be called the Morning After in America. ... Entitlements will cruise on autopilot by 4% this year, despite an historically low increase of 2% in Medicare that could be temporary. The major budget driver now is Medicaid, which will surge by 15% on ObamaCare's expansion of that program. The figure would be still higher had not 23 states opted out to protect the integrity of their own budgets. Some 85 cents of every increased dollar of spending over the next 10 years will flow to entitlements, mainly health care (8/29).

Politico: The GOP's Woman Problem
The GOP's autopsy, trainings and memos made one thing very clear: The party does not understand that its problem with female voters has nothing to do with presentation, rhetoric or outreach. The problem is, and has always been, Republican policies. Policies that prevent us from moving closer to equal pay for women, policies that would make it more difficult for women to exercise their right to vote, policies that would allow insurance companies to discriminate against women and policies that would allow politicians and employers to get involved in medical decisions that belong between a woman and her doctor (Rep. Debbie Wasserman Schultz, D-Fla., 8/31).

The New York Times' Upshot blog: What Happens When Health Plans Compete
As a candidate in 2008, President Obama promised that health reform would reduce family premiums by up to $2,500, equivalent today to about a 15 percent reduction from the 2013 level. Though Mr. Obama might have been including the effects of premium subsidies in his calculation, a key premise of the Affordable Care Act is that competition among health insurers will drive premiums downward. So it’s worth asking: How much savings can additional competition produce? (Austin Frakt, 9/1).

The New York Times: The Medicare Miracle
For years, pundits and politicians have insisted that guaranteed health care is an impossible dream, even though every other advanced country has it. Covering the uninsured was supposed to be unaffordable; Medicare as we know it was supposed to be unsustainable. But it turns out that incremental steps to improve incentives and reduce costs can achieve a lot, and covering the uninsured isn’t hard at all. When it comes to ensuring that Americans have access to health care, the message of the data is simple: Yes, we can (Paul Krugman, 8/31).

The New York Times: Ways To Reduce The Kidney Shortage
While some argue that the way to reduce the growing shortage is to pay living donors for kidneys, either in cash or government benefits, there are many ways to increase the supply without paying for human organs, which is prohibited by the 1984 National Organ Transplant Act and generally opposed by the World Health Organization (9/1).

The Wall Street Journal: Why Doctors Are Sick of Their Profession
All too often these days, I find myself fidgeting by the doorway to my exam room, trying to conclude an office visit with one of my patients. When I look at my career at midlife, I realize that in many ways I have become the kind of doctor I never thought I'd be: impatient, occasionally indifferent, at times dismissive or paternalistic. Many of my colleagues are similarly struggling with the loss of their professional ideals (Dr. Sandeep Jauhar, 8/29).

Los Angeles Times: Fines Alone Won't Fix 'Patient Dumping' Of Homeless
Los Angeles City Atty. Mike Feuer announced on Wednesday that his office had reached an agreement with Glendale Adventist Medical Center over allegations that the respected hospital had improperly discharged a homeless patient to the streets of skid row. ... Feuer is to be commended for his efforts to thwart a vile practice .... But if it's challenging for outreach agencies to find the right services and housing for the homeless, it's just as daunting, if not more so, for hospitals required to do it as a condition for discharging homeless patients (8/31).

The Wall Street Journal: Heading Off A Bigger Ebola Catastrophe
[T]he Obama administration has stressed that the disease is highly unlikely to spread inside America. Given international travel, we will certainly see cases diagnosed here, and perhaps even experience some isolated clusters of disease. For now, though, the administration's assurances are generally correct: Health-care workers in the U.S. and other advanced Western nations maintain infection controls that can curtail the spread of non-airborne diseases like Ebola. Yet our ability to prevent an epidemic here doesn't reduce our obligations abroad (Dr. Scott Gottlieb and Tevi Troy, 9/1).

The Washington Post: The Lessons Of The Ebola Outbreak Suggest A Larger, Faster Response Is Needed
West African nations, with fragile health-care systems and weak governments, had no experience in fighting the disease. Panic, suspicion and fear have overrun public health concerns. The lesson is that health authorities and governments need to pay attention to the attitudes of everyone, not just the infected. To calm the affected regions in the months ahead will require delivery of massive humanitarian aid to the living above and beyond the medical supplies required to treat the sick (9/1).

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Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

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