Daily Health Policy Report

Thursday, September 5, 2013

Last updated: Thu, Sep 5

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health On The Hill: 'It's A Fire Sale On The SGR'

Kaiser Health News' Mary Agnes Carey and CQ Roll Call's Emily Ethridge discuss current dynamics surrounding the Medicare physician payment. With the Congressional Budget Office projecting a reduced cost for a long-term "doc fix," Congress may seize the opportunity to end the annual adjustments to Medicare reimbursement rates (9/4). Watch the video or read the transcript.

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Navigators Say GOP Lawmakers' Information Requests Are 'Shocking'

Kaiser Health News staff writer Jenny Gold reports: "Organizations that received the latest round of health law navigator grants say last week’s letter from House Republicans could have a chilling effect on efforts to hire and train outreach workers to sign up Americans for health insurance by Oct. 1, the opening day for new online insurance marketplaces" (9/5). Read the story.

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'A Calling' To Care For The Poor At St. Louis' Grace Hill Community Centers

St. Louis Post-Dispatch's Jim Doyle, working in partnership with Kaiser Health News, reports: "Community health centers such as Grace Hill are a linchpin of President Barack Obama’s administration's efforts under the Affordable Care Act to eventually contain the nation’s health care costs by providing cost-effective, primary care to the poor. But key government funding for Grace Hill and other smaller nonprofit community health centers in St. Louis is in jeopardy, while the number of people in need of free and discounted care continues to rise" (Doyle, 9/5). Read the story.

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Capsules: Washington State Panel OKs 7 Insurers For Exchange

Now on Kaiser Health News' blog, the Seattle Times' Amy Snow Landa, working in partnership with KHN, reports: "In the end, it was a calm affair. The Washington Health Benefit Exchange Board met in a special session Wednesday afternoon to vote on the certification of health plans for the state’s new online health insurance marketplace in 2014" (Land, 9/5). Check out what else is on the blog.

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Political Cartoon: 'Shock And Awe?'

Kaiser Health News provides a fresh take on health policy developments with "Shock And Awe?" by Rick McKee.

Here's today's health policy haiku: 

WE'RE FROM THE CONGRESS; WE'RE HERE TO HELP YOU

Getting a letter
with a Washington postmark
is never welcome
-Anonymous 

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Health Reform

Bill Clinton Delivers Speech To Dispel Health Law Confusion

The former president -- dubbed the "explainer in chief" -- spoke from his presidential library in Arkansas to drum up support for the overhaul and scold Republicans for their repeal efforts.

The New York Times: Clinton Urges Americans To Sign Up For Health Care Exchanges
He chose his home state as the venue, and did not refrain from ticking off several problems he saw with the law. But former President Bill Clinton on Wednesday made a meticulous, if wonkish, case for Americans of all political leanings to embrace the Obama health care law (Goodnough and Chozick, 9/4).

The Washington Post: Bill Clinton Drums Up Support For Obama's Health-Care Law
President Obama deployed his highest-profile spokesman yet on Wednesday to tout his far-reaching health-care law: the 42nd president of the United States. And Bill Clinton even stuck to the script. As Obama and his aides try to win support for a military strike against Syria, the White House remains focused on raising the public profile of the Affordable Care Act, which is weeks away from the most critical stage of its implementation (Eilperin, 9/4).

Los Angeles Times: Bill Clinton Offers Case For Obamacare: 'We've Got To Do This'
At a crucial juncture a few weeks before the Oct. 1 opening of the law's health insurance marketplaces across the country, Clinton scolded Republicans who have voted to repeal the law more than 40 times, arguing that they have not offered "real alternatives." "The benefits of reform can't be fully realized, and the problems certainly can't be solved unless both the supporters and the opponents of the original legislation work together to implement it and address the issues that arise whenever you change a system this complex," he said during Wednesday's address at the Clinton Presidential Library (Reston, 9/4).

NPR: Bill Clinton Steps Up To Dispel The Confusion Over Obamacare
With the launch of the major piece of the Affordable Care Act less than a month away, the Obama administration is escalating the public relations push with one of their most effective weapons – former President Bill Clinton, now known to many as explainer in chief. Speaking from his presidential library in Little Rock, Ark., this morning, Clinton led what amounted to a graduate seminar on the Affordable Care Act, webcast live for those who cared to watch, on how the law is supposed to work and why it's needed (Rovner, 9/4).

The Wall Street Journal: Bill Clinton Touts Health Law In Speech
Mr. Clinton touted the law's benefits and set out arguments for its provisions, but also highlighted glitches and called on Republicans to help fix "relatively simple matters" in its implementation. … In a wide-ranging speech, the former president hit on a number of themes, including the increase in health spending in the U.S., competition in insurance markets, the burden of covering health costs for the uninsured, and whether the law has led to employers hiring part-time workers instead of full-time employees (Radnofsky, 9/4).

Politico: Bill Clinton Calls For GOP To Improve – Not Repeal – Obamacare
Still he spoke about the law’s future in ways that Obama could not. He called out specific problems with complex legislation and held up his native Arkansas as a model of bipartisan Obamacare compromise. Clinton called for bipartisanship going forward, about a month after Obama scolded Republicans for making repeal their "holy grail" and as Republicans prepare to return to Congress next week ready to resume their push for defunding (Millman, 9/4).

USA Today: Bill Clinton Urges Unity For Obama's Health Care Law
It's not the first time Obama has turned to Clinton, with whom he once had a frosty relationship, to help him explain policies and garner public support. Clinton campaigned often for Obama in the 2012 election and delivered a forceful speech at the Democratic National Convention arguing why Obama was worthy of a second term. Obama joked afterward that he should appoint his predecessor the "Secretary of Explaining Stuff," and the moniker stuck (Camia, 9/4).

The Hill: Bill Clinton Says GOP Has Duty To Help Fix Obamacare 'Glitches'
Former President Bill Clinton on Wednesday said Republicans have a duty as elected officials to help fix the "glitches" in ObamaCare. Clinton lent his reputation as "explainer in chief" to the healthcare law's rollout, delivering a roughly hourlong speech in which he praised Obamacare and criticized congressional Republicans for their steadfast opposition (Baker, 9/4).

The Associated Press: Clinton Defends Federal Health Care Law In Speech
Bill Clinton urged opponents of the federal health care law Wednesday to stop trying to repeal it and instead work to improve it, as the White House enlisted the former president to make the case for its signature domestic accomplishment. Speaking at his presidential library in downtown Little Rock, Clinton offered a detailed defense and explanation of the law as a key part of its implementation nears (DeMillo, 9/4).

NBC News: Bill Clinton Reappears To Pitch Obamacare Implementation
As the White House remains consumed by the debate over military intervention in Syria, former President Bill Clinton made an unusual political appearance to urge bipartisan implementation of President Barack Obama’s signature domestic achievement: the 2010 health care reform law. Appearing in his home state of Arkansas, Clinton –once described by Obama as the "Secretary of Explaining Stuff" – worked to make a detailed case for the overhaul, acknowledging some problems with it, but arguing that opponents should work to fix those glitches rather than reject the law of the land (Dann, 9/04).

CBS News: Making A Push To Get People To Join "Obamacare"
The man President Obama calls his "secretary of explaining stuff" took on a special mission Wednesday -- to drum up public support for what the president calls "Obamacare." Former President Bill Clinton spoke at his library in Little Rock, Arkansas. "We need all hands on deck here," he said. "The health of our people, the security and stability of our families, and the strength of our economy are all riding on getting health care reform right. And doing it well. That means we have to do it together" (Tracy, 9/04).

Medpage Today: Clinton Speaks Out In Support Of Health Law
Speaking from his presidential library in Little Rock, Ark., Clinton called on Republicans and Democrats to work together to implement the 2010 health law and address glitches that come in such a massive law when they arise. … In a nearly 45-minute speech, he admitted the ACA isn't perfect but is better than the clearly unsustainable path the American health system was on, which he called "unaffordable and downright unhealthy for millions of Americans" (Pittman, 9/4).

McClatchy: 'Secretary Of Explaining Stuff' Explains Obamacare
President Barack Obama tapped the "Secretary of Explaining Stuff" to help him tout "Obamacare." As the deadline for implementation fast approaches for the health law, former president Bill Clinton tries to explain why it is good thing when so many Americans don't seem to like and Republicans seem intent to kill it (Kumar, 9/04).

Stateline: Bill Clinton: States Must Fix Poverty Glitch In Health Law
Former President Bill Clinton Wednesday championed the new Affordable Care Act, but urged Congress and the states to fix its worst problems. Speaking to an invitation-only audience at his presidential library in Little Rock, Ark., Clinton touted the law’s early successes and future benefits, while pointing out glitches he said need to be addressed (Vestal, 9/04).

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Overhaul's Premium Costs Won't Be Cheap, But Consumers Will Have Options

A study by the Kaiser Family Foundation offered estimates of how much government tax credits would lower the price of the "silver" benchmark policy. A second study, this one by Avalere Health, examined sticker prices at a variety of levels.

The Associated Press/Washington Post: Independent Studies Break Down Health Law's Premiums: Wide Range Of Options And Costs
Coverage under President Barack Obama's health care law won't be cheap, but cost-conscious consumers hunting for lower premiums will have plenty of options, according to two independent private studies. A study released Thursday by the nonprofit Kaiser Family Foundation found that government tax credits would lower the sticker price on a benchmark "silver" policy to a little over $190 a month for single people making about $29,000, regardless of their age. … A separate study released Wednesday from Avalere Health, a private data analysis firm, took a wide-angle view, averaging the sticker prices of policies at different coverage levels (9/5).

The Hill: Kaiser Study Finds 'Lower Than Expected' Obamacare Premiums
A leading health policy research organization reported "lower than expected" premiums for Obamacare's new insurance exchanges in a major study released Thursday. The nonpartisan Kaiser Family Foundation compiled premium data from the new marketplaces in the 17 states where it is fully available and released a variety of figures showing how much consumers will pay if they choose to purchase coverage individually (Viebeck, 9/5).

The Associated Press/Washington Post: Sticker Price For Obamacare: $300/Month Premiums For Young To Middle-Aged Adults
The No. 1 question about President Barack Obama's health care law is whether consumers will be able to afford the coverage. Now the answer is coming in. The biggest study yet of premiums posted by states finds that the sticker price for a 21-year-old buying a mid-range policy will average about $270 a month. That's before government tax credits that act like a discount for most people, bringing down the cost based on their income (9/4).

Bloomberg: Obamacare Insurance Costs Affordable, Kaiser Survey Finds
A 25-year-old New Yorker earning $25,000 a year will pay as little as $62 a month for health insurance next year, and a peer living in Vermont may pay nothing, according to a 17-state survey of premiums under the U.S. health-care overhaul. The Kaiser Family Foundation report is the broadest look yet at what consumers will pay for health insurance when the Affordable Care Act takes full effect next year (Wayne, 9/5).

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GOP Lawmakers' Request For Info About Navigators May Slow Process

Meanwhile, in regard to a separate issue, West Virginia's attorney general is criticizing the Department of Health and Human Services for not responding to questions about navigator privacy concerns.

Kaiser Health News: Navigators Say GOP Lawmakers' Information Requests Are 'Shocking'
Organizations that received the latest round of health law navigator grants say last week’s letter from House Republicans could have a chilling effect on efforts to hire and train outreach workers to sign up Americans for health insurance by Oct. 1, the opening day for new online insurance marketplaces (Gold, 9/5).

The Associated Press: W. Va. Attorney General Criticizes Lack Of Health Care Answers
Attorney General Patrick Morrisey is criticizing federal health care officials for refusing to respond to questions over a plan to hire workers to help walk people through their health insurance options under the Affordable Care Act. Morrisey and a dozen other state attorneys general sent a letter to the U.S. Department of Health and Human Services last month pointing out privacy concerns with the plan to hire navigators to help roll out the health care reforms (9/4).

Other health exchange headlines include updates from Oregon, Iowa, New York, California and Connecticut --  

The Lund Report: Cover Oregon Takes Outreach Strategy Online
As Cover Oregon prepares to launch the state health insurance marketplace this fall, it's held nine community events -- all of which have been packed -- and plans to hold two more before it begins enrolling people in October. In addition to in-person events and a much-discussed advertising campaign, Cover Oregon is also trying to reach Oregonians online to educate them about the insurance options available in the coming months (McCurdy, 9/4).

Des Moines Register: Insurance Exchange Pricing Delayed
Iowa's insurance commissioner is delaying release of pricing information for policies to be sold on the state's new health insurance exchange, because he wants to wait for a firm commitment that a national carrier will participate. Commissioner Nick Gerhart had planned to release prices next week for policies to be offered on the new system, which is a key part of Obamacare (Leys, 9/4).

Reuters: Hipsters, Paul Bunyan Make Feel-Good Pitch In Obamacare Ads
New commercials to promote Obamacare's state health exchanges strive for an upbeat, and at times humorous, tone to sell healthcare reform to a skeptical and largely unaware audience. Guitar-strumming hipsters encourage Oregonians to "get the best care" and sign up for health insurance. Minnesota's Obamacare ads beckon with the help of Paul Bunyan and his Babe the Blue Ox. For New York State, an eye-catching skyline of Manhattan is seen as voice overs emphasize that "everyone deserves affordable health insurance” (Beasley, 9/4).

California Healthline: The Exchanges Won't Be 'Ready' In Time. And It (Probably) Won’t Matter
While other states waffled, Golden State officials quickly embraced key Obamacare provisions like expanding Medicaid and creating insurance pools for individuals with pre-existing conditions. At the same time, lawmakers crafted legislation intended to conform California's health insurance plans to new standards under the Affordable Care Act. … And a more essential issue might be getting lost, amid the growing number of questions over which state exchanges will be open for business on Oct. 1. "Lots of people are asking about readiness," said Caroline Pearson, who leads Avalere Health's efforts to track health reform implementation. "But no one is asking about whether it matters” (Diamond, 9/4).

CT Mirror Spanish-Language TV Series Will Promote Health Insurance To Latinos
Access Health CT, the state’s new health insurance marketplace, is launching a Spanish-language "edutainment" television series intended to reach uninsured Latinos. Latinos make up 14 percent of the state’s population, but a quarter of the people without health insurance in the state, making them a key target for those trying to enroll people in coverage as part of federal health reform (Becker, 09/04).

Meanwhile, under-the-hood difficulties continue to emerge regarding the online insurance marketplaces --

Reuters: Technical Snafus Confuse Charges For Obamacare Plans
Technical glitches still plague the display of new healthcare plans to be offered to millions of uninsured Americans starting in 26 days, including how medical charges and deductibles are listed, industry officials say. Health insurers planning to sell policies to people who are currently uninsured, under President Barack Obama's health care reform, say they expect the problems will be remedied by October 1, when consumers will be able to buy health insurance from state exchanges (Begley, 9/5).

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Ohio Group Takes Steps To Advance Medicaid Expansion As Ballot Initiative

The coalition, which is made up of health care providers, unions, businesses, religious organizations and others, views this effort as its back up plan if state legislators block Gov. John Kasich's push to expand the low income health insurance program.

Cleveland Plain Dealer: Group Takes First Steps Toward Putting Medicaid Expansion In Ohio On The Ballot For A Vote
A group pressing for expansion of Medicaid in Ohio to cover the working poor began the process today to force the General Assembly to consider it or face having it go to voters. Healthy Ohioans Work, a registered action committee, took the first step Wednesday when it filed paperwork with the Ohio attorney general for a law proposed by initiative petition. The proposal was accompanied by signatures from registered voters needed to get the process started (Higgs, 9/4).

Columbus Dispatch: Ballot Is 'Plan B' For Expanding Medicaid
If lawmakers don't approve Gov. John Kasich's plan to expand Medicaid, voters could decide whether to give tax-funded health coverage to an additional 275,000 poor Ohioans. A coalition of health-care providers, unions, businesses, religious organizations and other advocates for the uninsured launched a campaign yesterday that could put the plan on the November 2014 statewide ballot (Candisky, 9/5).

In addition, here's more news from Indiana -

CQ HealthBeat: Will One-Year Medicaid Waiver Extensions Drive Debates Over Expansion?
Negotiations over a potential expansion of Medicaid in Indiana can begin in earnest now that the Obama administration has granted Republican Gov. Mike Pence’s request to keep a Medicaid program that waived federal rules in place for one year (Adams, 9/4).

The Washington Post's Wonk Blog: Deep-Red Indiana Might Just Expand Medicaid
Michigan is the latest state to back the health law’s Medicaid expansion, bringing the total of states opting-in to 25. Could neighboring Indiana be next? The state isn’t currently on board and, on Tuesday, finalized a deal with the federal government that will just barely increase cover in the Hoosier State. But coming out of those negotiations, state officials and experts think there could be space for Indiana and the federal government to carve out a full Medicaid expansion–one that stands to look significantly different than other state plans (Kliff, 9/4).

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Investors, Lawyers Among Those Getting Early Boosts From The Health Law

Also in the news, Bloomberg reports that some employers may change their minds about offering employees insurance when tax advantages go up next year.  

Bloomberg: Affordable Care Act Sees More Employers Embracing Credits: Taxes
Boutique accounting, medical and legal firms that resisted offering insurance to their employees under the new health-care law may change their minds when the tax advantages go up next year. Companies with 10 full-time employees or less, making an average wage of $25,000 or less, may get a 50 percent tax credit for the amount of their contribution to cover premiums in 2014, Bloomberg BNA reported. Nonprofit employers can get 35 percent, the Internal Revenue Service said in its proposed rules (Beyoud, 9/5).

Fox News Early Big Winners Of Obamacare: Investors, Lawyers, Consultants, Tech Experts
While polling data suggests many Americans remain anxious and skeptical about ObamaCare, the early big winners of the president’s signature law include investors, lawyers, consultants and purveyors of new technology. Since March 23, 2010, when it was signed into law, the health care sector of stocks in the S&P 500 has increased in value by 50 percent. Gilead Sciences, a California-based drug maker with 5,000 workers, has seen its stock price explode by 157 percent in the last three and a half years (Ross, 9/05).

Meanwhile, for some immigrants, the health law's impact is not so clear cut:  

The Seattle Times: How Will Immigrants Fare Under Obamacare? It's Complicated
Likos Afkas is a native of the Federated States of Micronesia, part of a cluster of islands in the Pacific where nuclear testing by the U.S. government during the Cold War left behind high rates of cancer…Ultimately, how he and other immigrants fare under this massive health-care overhaul will depend on many factors: their income, immigration status, how long they’ve lived in this country and — in the case of people like Afkas — their country of origin (Turnbull, 9/4).

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Capitol Hill Watch

GOP's United Front On Obamacare Softens

The GOP's once rock-solid stance on Obamacare has softened as some Republicans look to move on from waging all-out war on the three-year-old law. Tea Party activists, however, are urging conservative lawmakers to try to stop it. In the meantime, lawmakers from both sides look more united than ever in trying to reform how Medicare pays doctors.

NBC News 'Obamacare' Turns From GOP Uniter To Internal Divider 
Opposition to Obamacare has united the GOP for the past four years, but now it's threatening to become a central fault line in the party's simmering civil war. While still unified on philosophical grounds against President Barack Obama’s signature health care reform law, Republicans are no longer using "Obamacare" to pummel Democrats so much as each other. The divide exists between Republicans engaged in a crusade to repeal the law at all costs and those resigned to accept a government program three years into its implementation (O’Brien, 09/04).

Richmond Times Dispatch Tea Party Activists Urge Cantor To Halt Affordable Care Act
Roughly 100 tea party activists turned out Wednesday on the edge of an Innsbrook parking lot outside House Majority Leader Eric Cantor's district office to urge him to use his congressional clout to stop implementation of President Barack Obama’s Affordable Care Act (Nolan, 09/05). 

Kaiser Health News: Health On The Hill: 'It's A Fire Sale On The SGR'
Kaiser Health News' Mary Agnes Carey and CQ Roll Call's Emily Ethridge discuss current dynamics surrounding the Medicare physician payment. With the Congressional Budget Office projecting a reduced cost for a long-term "doc fix," Congress may seize the opportunity to end the annual adjustments to Medicare reimbursement rates (9/4).

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Catholic Bishops Urge That Marketplace Insurance Benefits For Congress Not Include Abortion

Members of Congress and their staffs will switch from the federal health system to the health law's new exchanges next year and the bishops are demanding that the current prohibitions on abortion funding continue.

Politico: Bishops: No Hill Funds For Abortion
The U.S. Conference of Catholic Bishops has asked the Obama administration to take precautions to make sure federal funds don't go to abortion coverage for lawmakers and congressional staffers (Haberkorn, 9/4).

CQ HealthBeat: Advocates Debate Whether Hill Staff Can Get Abortion Coverage In Exchanges
The battle between supporters and opponents of abortion re-emerged on Wednesday when the U.S. Conference of Catholic Bishops warned the Obama administration that it must make sure the benefits lawmakers and congressional staff will get through the new marketplaces do not include abortion coverage (Adams, 9/4).

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Coverage & Access

Obama Administration To Provide Veterans' Same-Sex Spouses Benefits

Attorney General Eric Holder told Congress in a letter that the recent Supreme Court decision clears the way for this change in policy.

Politico: Same-Sex Spouses Allowed To Receive Veterans' Benefits
President Barack Obama has directed his administration to take steps allowing the same-sex spouses of military veterans to have access to federal benefits, Attorney General Eric Holder said Wednesday in a letter to Congress. The move is the administration's latest effort to extend benefits to married same-sex couples in light of the Supreme Court's June ruling striking down a key piece of the Defense of Marriage Act, and extends the court's reasoning to Title 38 of the U.S. Code, which governs the granting of benefits by the Veterans Administration and the Defense Department (Epstein, 9/4).

The New York Times: V.A. To Provide Spousal Benefits To Gays, Administration Says
The move will allow the same-sex spouses of service members to receive health care benefits, and widows and widowers from same-sex marriages to receive survivor benefits, among other matters (Savage, 9/4).

The Associated Press: Feds OK Same-Sex Veterans Benefits
The Obama administration said Wednesday it will stop enforcing a law that blocks benefits to partners of military veterans in same-sex marriages.  In a letter to congressional leaders, Attorney General Eric Holder said that a provision in federal law on benefits to veterans and their families defines "spouse" to mean a person of the opposite sex (Yost, 9/5).

In addition, the Associated Press examines a program that helps the families of veterans who have been badly wounded -

The Associated Press: Many Veterans' Caregivers Cut Out From Federal Benefit
John Thomas Doody was in a coma and on a ventilator, but his mom refused to follow a doctor's advice and put the Iraq war veteran in a nursing home. Chris Ott quit her job, moved the family to Tampa, Fla., so her son, known as J.T., could be near the Veterans Affairs hospital. She spends most of her waking hours trying to meet his many needs. … To ease the financial burden, Ott relies on a relatively new federal program that pays her a stipend of about $2,000 per month, trains her on how to care for J.T. and provides at least 30 days of respite care each year. ... The extra help has eased one family's financial hardship. Yet there's a question of fairness. For every family receiving the caregiver benefit, many more make do without (Freking, 9/5).

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State Watch

State Highlights: Calif. Bill To Expand Abortion Providers Passes

A selection of health policy news from Texas, California, North Carolina, Missouri, Oregon and Colorado.

Dallas Morning News: Some Texas Abortion Clinics Prepare To Shut Down After New State Law
At least four abortion clinics in rural Texas and possibly three more are preparing to close, hobbled by a state law that requires the clinics to meet tougher medical standards. Administrators say a major reason for shuttering the clinics is that their doctors are having trouble getting admitting privileges (9/04).

Bloomberg: Insurers Pay Hospitals Twice Rate Of Rivals In Some Areas
Kansas City, Missouri, and Indianapolis residents with private health plans face some of the widest disparities in U.S. hospital costs, often being charged twice as much as nearby facilities, a study found. The highest-priced hospitals in 13 cities studied are typically paid 60 percent more for inpatient services and almost double for outpatient care than the lowest-priced hospitals in the same communities, according to a study released today by the Center for Studying Health System Change. Hospitals with more market power have greater muscle in negotiations with insurers and can extract higher prices, the group found (Armour, 9/5).

California Healthline: Abortion Bill OK’d, Headed To Governor
The Assembly gave final approval last week to a bill designed to allow certain mid-level providers to perform aspiration abortions in the first trimester when supervised by a physician. Approval of the bill was linked by one Republican legislator to rejection of a different measure to expand mid-level practitioners' role in a more general clinical setting. An Assembly floor vote concurred amendments and approved AB 154 by Assembly member Toni Atkins (D-San Diego) on Friday. The bill already passed Assembly and Senate votes, and now heads to the governor's desk (Gorn, 9/4).

The Associated Press/Raleigh News & Observer: Berger Says NC Medicaid Delays To Get Addressed
The North Carolina Senate's top leader said Wednesday he's committed to resolving difficulties with new state computer programs that process Medicaid claims and determine whether people qualify for government services. Senate leader Phil Berger, R-Rockingham, told the chamber's ranking Democrat on the Senate floor that fellow Republicans would work with the minority party to address delays related to the Medicaid system and another program, NC FAST (Robertson, 9/4).

St. Louis Post-Dispatch/Kaiser Health News: 'A Calling' To Care For The Poor At St. Louis' Grace Hill Community Centers
Community health centers such as Grace Hill are a linchpin of President Barack Obama's administration's efforts under the Affordable Care Act to eventually contain the nation's health care costs by providing cost-effective, primary care to the poor. But key government funding for Grace Hill and other smaller nonprofit community health centers in St. Louis is in jeopardy, while the number of people in need of free and discounted care continues to rise (Doyle, 9/5).

The Lund Report: Pfizer, Eli Lilly And Genetech Pour Money Into State Elections
Nineteen drug companies have spent a combined half a million dollars since 2011 trying to influence elections and legislation, led by Pfizer, Eli Lilly and Genentech. Pfizer, known for Viagra, Zoloft and Xanax, is the world's largest drug company by revenue, and Eli Lilly is the world's largest manufacturer of psychiatric medications, such as Prozac (Gray, 9/4).

Denver Business Journal/Health Policy Solutions (a Colo. news service): Court Hears Challenge To Foundation's Sale Of HealthOne Assets To HCA
It’s been almost two years since the Colorado Health Foundation sold its share in the HCA-HealthOne system, but opponents of the deal still are trying to get the transaction nullified. Former board members of the state’s largest foundation argued in the Colorado Court of Appeals Wednesday that Attorney General John Suthers erred in allowing the $1.45 billion sale to HCA Holdings Inc. to go through in October 2011, saying that the transaction fundamentally altered the oversight of a seven-hospital system that had been run jointly by the foundation and Nashville-based HCA (Sealover, 9/4).

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Weekend Reading

Longer Looks: The Bittersweet Decision To Donate Organs

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

Forbes: City Surgeon: Can The Cleveland Clinic Save Its Hometown?
Delos M. "Toby" Cosgrove arrived at the Cleveland Clinic in 1975 as an "incredibly poor" 34-year-old dreaming of a life as a cardiac surgeon. … As the years passed he became well-known for pioneering the replacement of heart valves, eventually assuming the chair of the department of cardiothoracic surgery. Concurrently he created the clinic’s office that oversaw the licensing of medical devices like surgical clamps and spine screws to companies like Medtronic and Boston Scientific. In 2003 he started looking for a second career, maybe as a venture capitalist in California, figuring that at 62 he was too old to operate. ... Then he was offered the job as the clinic's chief executive. The rough old neighborhood is a distant memory, replaced by a gleaming testament to modern medicine stretching out over 46 buildings and covering 167 acres. Protected by a dedicated 141-trooper force of state police, there is a conference center, a fancy hotel and a farmers' market. Over Cosgrove's tenure the clinic’s revenues have nearly doubled to $6.2 billion (Matthew Herper, 9/4).

The Washington Post: For One Family, Organ Donation Offers A Bittersweet Ending
My 55-year-old brother-in-law, Vince, had arrived at Howard County General Hospital's intensive care unit late Saturday night. Sunday morning, the police called us: Vince was in critical condition, and we needed to come to the hospital. … Over the next few days, family members and friends kept a vigil at Vince's bedside. Nurses came and went, changing bags that fed the IV lines, drawing blood, checking his vitals. It was becoming clear that we would soon be faced with decisions not about his future but about whether to end life support. Like so many Americans, Vince had no advance directive and had not named a health-care decision-maker. In such situations, Maryland law designates decision-makers, starting with next of kin. In his case, that meant the responsibility would fall to his only child, Tory, who at the time was only 23 (Janice Lynch Schuster, 9/2).

Stanford Magazine: Mind Over Misery
The patient looks around frantically. She is sobbing, panicking, overwhelmed by anxiety. She says she can't breathe; her lungs are about to collapse; her heart is about to stop. She feels like she is going to die. Listening to this, Stanford psychiatrist David D. Burns calmly asks, "Do you think you could exercise strenuously right now?" Uncomfortable, nervous laughter breaks out among the 100 psychologists, psychiatrists, social workers, and family and marriage counselors watching the scene unfold on a large video screen. It's part of Scared Stiff!—a two-day seminar on fast, drug-free treatment for anxiety and depression that Burns, MD '70, is giving in a nondescript hotel ballroom outside Chicago.  … Before showing the video, Burns warned that participants might find his approach "threatening or even disturbing." That he would challenge deeply held beliefs and the conventional wisdom they were taught. Particularly touchy is his long-held conviction that—except for those suffering from clear-cut mental illnesses such as schizophrenia, bipolar disease and severe depression—many pharmaceutical treatments have little or no effect (Robert L. Strauss, 9/2013).

The New York Times: In California, Intense Debate Over Home Care
An important struggle over home health care is playing out in California, the nation's most populous state, including nearly five million residents age 65 and older. Unions and organizations representing the elderly have joined together to push for legislation that would license agencies, certify workers and create a publicly accessible caregiver registry. Home care agencies are pushing back, saying they favor regulation but oppose the measures under consideration. ... An estimated 1,400 home care agencies and 120,000 paid caregivers would be affected by the proposed legislation, which is essentially an effort to bring consumer protections to an industry that has been likened to the Wild West. "It's just not right that I can check the license status of an air-conditioning repairman but I can't do so for someone coming into my home to care for a loved one," said Assemblywoman Bonnie Lowenthal, a Democrat and the bill's sponsor (Judith Graham, 8/30).

The Washington Post: A Young Geriatrician On The Struggles Of Alzheimer’s Patient – And Their Caretakers
I walked into the examining room and found my new patient, an 83-year-old woman, silently occupying the blue plastic seat of a wheelchair. Despite her neatly groomed appearance, her eyes were uncomprehending. She muttered some words, but they were devoid of meaning. Glaucoma and macular degeneration had taken her eyesight, and Alzheimer's disease had ravaged her mind. … They had driven an hour to consult a geriatrician, a doctor who focuses on the care of medically complex older adults. An internist getting specialized geriatrics training, I knew there would be no straightforward cases when I chose this field (Ariel Green, 9/2).

The New England Journal Of Medicine: Prescription-Drug Coupons – No Such Thing As A Free Lunch
Visit nearly any official website for a brand-name drug available in the United States and, mixed in with links to prescribing and safety information, you'll find links to drug "coupons," including copayment-assistance programs and monthly savings cards. Most offers are variations on "Why pay more? With the [drug] savings card, you can get [drug] for only $18 per prescription if eligible" or "Get a free 30-capsule trial of [drug] with your doctor's prescription and ask your doctor if [drug] is right for you." Why do manufacturers offer drug coupons? Are they good for patients in the long run? Are they even legal? (Dr. Joseph S. Ross and Dr. Aaron S. Kesselheim, 8/28).

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Editorials and Opinions

Viewpoints: Texas And Florida Should Concentrate On Uninsured; Health Law's Costs To Young Adults Being Overlooked; Obscure Case Could Impact Abortion Issues

The New York Times: Uninsured In Texas And Florida
A new Census Bureau report documents the alarming percentages of people in Texas and Florida without health insurance. Leaders of both states should hang their heads in shame because they have been among the most resistant in the nation to providing coverage for the uninsured under the Affordable Care Act, the law that Republicans deride as "Obamacare" (9/4). 

Politico: Burn Your Obamacare Card
The biggest weakness in President Obama's controversial health-care scheme is the individual mandate, an incredibly regressive tax imposed on young healthy people that forces them to buy health-insurance plans that they can’t afford and don’t need, or pay a fine. ... What would Jerry Rubin, the Yippie war protester, do? He would torch his Obamacare card without a moment's hesitation, chanting "Hell no, we won't go" (Matt Kibbe, 9/5).

The New Republic: Bill Clinton Explains Obamacare (He Does It Better Than Obama Does)
The Secretary of Explaining Stuff is back on the job. On Wednesday, former President Bill Clinton gave a speech about Obamacare—why it was necessary, how it will work, and what it will do in the future. ... But it's simply not possible to fix a dysfunctional health care system without some adverse effects. The best you can do is limit the disruptions, undo or repair the damage, and maximize the benefits. According to Clinton, Obamacare is doing just that. And he makes a good case (Jonathan Cohn, 9/4).

The Hill: Defunding Is Loser Strategy For GOP
Back in May, Democratic pollster Mark Mellman, my counterpart here in the pages of The Hill, correctly argued that Republicans are on the right side of the polls when it comes to disapproval of ObamaCare but then squander any political advantage gained from opposing the Affordable Care Act by advocating for something that is even less popular than the president's folly — that being the complete defunding of the healthcare plan. It's all there in the Kaiser Family Foundation Health Tracking Poll results, with several confirmatory waves having been conducted since Mellman last reviewed the data (David Hill, 9/3).

The New York Times: Opinionator: The Next Abortion Case Is Here
Justice Anthony M. Kennedy, author of the 5-to-4 opinion in June that struck down the Defense of Marriage Act, may well be a hero to the gay rights community, and deservedly so. But he's also the author of the 5-to-4 opinion that upheld the federal ban on so-called partial birth abortion back in 2007, and abortion-rights advocates have viewed with something close to dread the prospect that he could play a similarly decisive role in the Supreme Court's next abortion case. That case has arrived (Linda Greenhouse, 9/4). 

Health Policy Solutions (a Colo. news service): Safety Net Clinics A Crucial Community Resource
There's nothing simple about the state of health care in America, and many people have already made up their minds about who [is] to blame for it being broken. But as important health care reform is debated and implemented, doctors and health care practitioners quietly continue to make a difference every day in Denver's communities. For instance, the Inner City Health Center provides health care services to anyone regardless of ability to pay. It's done on a modest budget without any federal funding. Last year alone, the doctors, nurse practitioners and other health care providers (some of them volunteers) provided more than 24,000 patient-visits to people who had few options for care (Sharon Adams, 9/4).

Health Policy Solutions (a Colo. news service): Drug Innovation Drives Colorado's Economy
These new weapons in the battle against skin cancer represent just a couple of the many powerful drugs now in development. But medical innovation doesn't happen by accident. For Coloradans and all Americans, it's crucial that legislators craft a favorable regulatory environment that enables and supports new drug research (Richard Duke, 9/4).

The Lund Report: For The Convenience Of The Tobacco Companies
Oregon holds the dubious distinction of ranking number one in the country for retailers illegally selling cigarettes to underage kids. Moreover, we have ranked number one three out of the past five years and ranked in the top five the other two years. Tobacco companies know very well that if you don't start smoking before age 18, chances are you never will. That's why their advertising is aimed directly (although often imperceptibly to the unknowing public) at teenagers (Rick North, 9/4).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.