Daily Health Policy Report

Friday, July 25, 2014

Last updated: Fri, Jul 25

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Medicaid

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

A Reader Asks: How Can I Get Health Coverage For My Grandchildren?

Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (7/25). Read her response.

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Political Cartoon: 'Harpoon-Chondriacs?'

Kaiser Health News provides a fresh take on health policy developments with "Harpoon-Chondriacs?" by Joe Heller.

Meanwhile, here's today's haiku:

AN IMPASSE?

Our vets need health care
Our Congress likes to bicker
August recess looms
-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

Obama Administration Moves Forward On Employer Mandate

A signal came Thursday when the Internal Revenue Service posted drafts of forms that employers will have to fill out to comply with the requirement that they provide workers with health insurance.

The Wall Street Journal: Obama Administration Moves Ahead With Employer Insurance Forms
The Obama administration on Thursday released draft forms for employers and individuals to use when reporting their health coverage to the Internal Revenue Service starting next year despite calls for delaying the requirement. The Affordable Care Act requires most big employers to offer health benefits that are deemed affordable, or to pay fines starting at $2,000 per worker if they don't (Radnofsky, 7/24).

Politico: IRS Prepping For Obamacare Employer Mandate In 2015
The Obama administration signaled Thursday it’s not backing down from the controversial health law employer mandate that has been delayed twice and is the centerpiece of the House’s lawsuit against the president. The IRS posted drafts of the forms that employers will have to fill out to comply with the Obamacare requirement that employers provide health insurance to workers (Haberkorn and Snell, 7/24).

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Health Law's 'Uninsurance' Fine Capped At $2,448 For Individuals

The cap for a family of five is set at $12,240 -- an amount equal to the national average annual premium cost of a bronze level plan.  

The Hill: Uninsured Face Fine of Nearly $2,500
The Internal Revenue Service said Thursday individuals who fail to get health insurance this year will be fined a maximum of $2,448 and families with five or more members can be fined up to $12,240. Under the Affordable Care Act’s individual mandate, people are either required to obtain health insurance or risk a tax penalty from the IRS (Al-Faruque, 7/24).

The Associated Press: Federal Officials Cap Fines for Not Buying Health Insurance
Federal officials have capped the amount of money scofflaws will be forced to pay if they don't buy insurance this year at $2,448 per person and $12,240 for a family of five. The amount is equal to the national average annual premium for a bronze level health plan. But only those with an income above about a quarter of a million dollars would benefit from the cap. Those making less would still have to pay as much as 1 percent of their annual income (7/24).

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For Consumers, Some Pitfalls In Obamacare Coverage Could Lie Ahead

Stateline reports that automatic re-enrollment of health plans bought through the state and federal exchanges could mean that people pay more than they would if they comparison shopped. In addition, The Associated Press reports that inconsistent subsidy amounts are leading some people to go without insurance.   

Stateline: Pitfalls Emerge In Health Insurance Renewals
For the 8 million people who persevered through all the software trapdoors in the new health insurance exchanges and managed to sign up for coverage in 2014, their policies will probably automatically renew come November when open enrollment begins. Seems like good news after all the headaches consumers endured after the program's launch last year. Except that renewing the same policy may not be the best choice. Many may end up paying far more than they need to and with policies that don’t best fit their individual circumstances. "(Automatic re-enrollment) could conceivably mean people will pay more in premiums unless they proactively take steps to comparison shop," said Jenna Stento, a senior manager at Avalere Health, a health care research and consulting firm (Ollove, 7/25).

The Associated Press: Varying Health Premium Subsidies Worry Consumers
Government officials say [Linda] Close — and other consumers who have received different subsidy amounts — probably made some mistake entering personal details such as income, age and even ZIP codes. The Associated Press interviewed insurance agents, health counselors and attorneys around the country who said they received varying subsidy amounts for the same consumers. As consumers wait for a resolution, some have decided to go without health insurance because of the uncertainty while others who went ahead with policies purchased through the exchanges worry they are going to owe the government money next tax season (Kennedy, 7/24).

Meanwhile, in the news from Florida -

Health News Florida: Hispanic Health Advocates Push For Votes
Advocates for health insurance are calling on Hispanics to get insured under the Affordable Care Act. And they're asking those same people to vote against lawmakers who oppose Obamacare. Latino community leaders in Central Florida say more than 200,000 Hispanic Floridians are uninsured. They're urging state lawmakers to accept federal funding and expand health care for all Floridians. Josephine Mercado of Hispanic Health Initiatives called it a human rights issue. Betsy Franceshini, a Florida-based representative of the Puerto Rican government, says many uninsured Hispanics work in industries like hospitality (Green, 7/24).

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Consumers In States Around The Country To Get Premium Rebates

Local news outlets report on a federal announcement Thursday showing how much money will be sent back to people and employers under rules that say insurers must spend at least 80 percent of premium payments on medical care.

The Oregonian: Three Health Insurers Will Pay Rebates In Oregon
Three health insurers in Oregon owe rebates to consumers under a federal rule limiting administrative expenses for carriers. According to the U.S. Department of Health and Human Services, 49,412 people will benefit from refunds averaging $101 per family covered. Only about 23,000 people who purchased their own policy directly, in the individual market, will see a check, however. Rebates for employer-provided insurance will be send to the businesses that purchased the policy (Budnick, 7/24).

Georgia Health News: Insurers To Pay $11 Million In Georgia Rebates
A federal rule on health insurers’ spending will bring $11 million in rebates to Georgia individuals and employers this summer. Federal figures released Thursday show that 304,000 Georgians will benefit from the refunds, with an average rebate of $53 per family, as a result of the “Medical Loss Ratio” (MLR) rule on 2013 insurance plans. Created by the Affordable Care Act, the MLR standard generally requires health insurers to spend at least 80 percent of the premium dollars they collect on medical care or activities to improve the quality of health care (Miller, 7/24).

The Denver Post: Coloradans Could See $2.7 Million in Premium Refunds From ACA Rule
Health and Human Services on Thursday announced that 52,277 consumers in Colorado will get $2.7 million in refunds, an average of $93 a family, from insurance companies this summer because of the Affordable Care Act's 80/20 rule (Draper, 7/24).

The Baltimore Sun: Marylanders Received $17M In Insurance Refunds Under Health Reform Rule
Health insurers refunded more than $17 million to Marylanders last year because of a rule in the Affordable Care Act limiting the amounts the companies can spend on overhead costs as opposed to providing care, according to federal data. About 206,000 consumers in Maryland received the refunds, an average of $140 per family, according to a report from the Department of Health and Human Services released Thursday (Dance, 7/24).

Des Moines Register: $1.8M In Health Insurance Rebates Ordered In Iowa
About 3,500 Iowans will receive rebates from their health insurer, thanks to a rule that is part of the Affordable Care Act. Another 11,100 Iowans will have rebates sent to their employers. The consumers receiving direct rebates purchased individual health insurance policies from Wellmark Blue Cross & Blue Shield. The other affected Iowans obtained Coventry Health Care policies via their employers. The rebates, totaling nearly $1.8 million, are going to people whose insurance plans didn't spend as much as required last year on health-care services. The rules, which are part of the Affordable Care Act, require that policies covering individuals or small businesses spend at least 80 percent of premium dollars on medical services instead of on administrative costs or profit. Large-group plans must spend at least 85 percent of premiums on medical care (Leys, 7/24).

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New Mexico Likely To Decide Health Exchange Plan Today

Also in the news, Colorado's health exchange chief executive announced she will leave her post to become president of Cigna's private exchange business.

The Associated Press: New Mexico Set To Decide On Health Exchange Plan
The governing board of New Mexico's health insurance exchange is to consider Friday whether to continue relying on a federal online system for enrolling individuals in medical plans. Board vice chairman Jason Sandel said Thursday that he expected members to decide at a meeting in Santa Fe how to handle the next round of enrollment, which will start in November (7/24).

The Denver Post: Colorado Health Insurance Exchange CEO Patty Fontneau Leaves for Cigna
The state health insurance exchange's chief executive, Patty Fontneau, announced Thursday she will leave Connect for Health Colorado to take a job as president of Private Exchange Business for Cigna. She will leave her post in mid-August. The exchange's board of directors said they plan to name an interim CEO within a week. (Draper, 7/24).

Health News Colorado: Exchange Boss Resigns To Join Cigna
Patty Fontneau, the executive who has been synonymous with Colorado’s health exchange and both its successes and shortcomings, is leaving to join the insurance industry. Fontneau announced Thursday that she will resign as CEO and executive director of Connect for Health Colorado in mid-August. She plans to join Cigna where she will become president of its private exchange business (McCrimmon, 7/24).

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States Could Opt To Operate Their Own Exchanges To Blunt Impact Of Recent Federal Appeals Court Decision

Of course, CQ Healthbeat reports, this scenario is still a long shot, but it offers a possible workaround if the recent ruling that consumers could not use health law subsidies to buy insurance on healthcare.gov becomes law.  

CQ Healthbeat: States’ Access to Federal Website Could Be Critical Under Subsidy Challenge
A dozen or more states now lacking their own health law insurance exchanges may create the marketplaces in order to maintain the flow of subsidy dollars if they are able to use the federal website healthcare.gov for eligibility and enrollment, said Larry Levitt, senior vice president of the Kaiser Family Foundation. Doing so would blunt the expected impact on coverage expansion from the federal appeals court ruling handed down Tuesday in Halbig v Burwell. It’s a long shot but still a possibility, that the ruling by a three judge panel of the U.S. Court of Appeals for the District of Columbia will become the law of the land (Reichard, 7/24).

In related news -

The Wall Street Journal: The Lawyer Who Helped Spark This Week's Affordable Care Act Rulings
Months after the Affordable Care Act became law, employment benefits lawyer Thomas Christina paced in his Greenville, S.C., office with its oil portrait of a greenhouse. He was reading the statute to learn its impact on clients. By his reading, the wording only allowed health insurance subsidies to be provided through state exchanges. It began to dawn on him that he'd stumbled on something big (Armour, 7/24).

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Capitol Hill Watch

House Panel Backs Lawsuit Against Obama On Health Law

The Rules Committee approved a resolution challenging whether the president has constitutional authority to delay provisions of the law. The full House will likely consider it before its August recess begins.

Politico: House Panel Backs Obama Lawsuit
The lawsuit has deepened the tension and mistrust between House Republicans and the White House. Republicans say they’re simply holding the president accountable for circumventing Congress on a major policy change related to the implementation of Obamacare. Obama and congressional Democrats have dismissed the suit as little more than election year theater (French, 7/24).

Modern Healthcare: House Plan to Sue Obama Over Employer-Mandate Delay Moves Forward
A resolution authorizing the U.S. House of Representatives to sue President Barack Obama for exceeding his constitutional authority by delaying the employer mandate in the federal healthcare law, cleared the House Rules Committee Thursday. The legislation passed on a party-line 7-4 vote. The full House is expected to take up the measure next week prior to its August recess (Demko, 7/24).

Meanwhile, what does the public think?

CNN: Majority Say No To Impeachment And Lawsuit
There’s not a lot of public appetite for a Republican push to sue President Barack Obama, or for calls by some conservatives to impeach him, according to a new national survey. A CNN/ORC International poll released Friday morning also indicates that a small majority of Americans do not believe that Obama has gone too far in expanding the powers of the presidency (Steinhauser, 7/25).

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GOP And Dems' Feud Over Funding Threatens Bill To Fix VA

With only a week before the August recess, negotiations broke down over how much money to spend and how to pay for it.

The Wall Street Journal: VA Talks At Impasse In Congress As Negotiators Feud Publicly
Congressional negotiations to address problems at the Department of Veterans Affairs devolved into a public feud on Thursday, amplifying concerns that lawmakers won't be able to complete legislation before leaving for their August break. The lead House and Senate negotiators criticized each other publicly while suggesting that the two chambers remain apart on legislation intended to respond to widespread mismanagement and long wait times at VA hospitals. While Rep. Jeff Miller (R., Fla.) and Sen. Bernie Sanders (I., Vt.) said they still hope to overcome the impasse, both suggested it could be difficult with only a week left before lawmakers leave Washington for a five-week recess (Crittenden and Kesling, 7/24).

Politico: VA Reform Hits Stalemate
When revelations surfaced earlier this summer that the Department of Veterans Affairs provided poor health care to veterans -- leading to some deaths -- a genuine scandal erupted and Congress promised to impose big changes. But staring down the August recess, the effort to overhaul the agency is on the verge of collapse (Everett and French, 7/24).

Modern Healthcare: Competing New VA Bills In Congress Cloud Prospects For Any Deal
The chairmen of the House and Senate Veterans Affairs' committees have released new competing proposals on how to address the waitlist woes currently plaguing the VA. The House version provides $10 billion in immediate emergency VA funding, while the Senate version would cost $25 billion over the next three years, and is only partially offset by $3.3 billion in savings from other areas of VA (Dickson, 7/24).

NBC News: Congress So Far Unable to Compromise on Veterans Bill
The disagreement now centers on how much money should be spent to fix widespread delays in care that led to a number of veterans dying before they could receive proper care. But the breakdown in negotiations is personal. Sanders became visibly angry as he detailed how his counterpart in the Republican House, Rep. Jeff Miller, R-Calif., called him at 10 p.m. the night before to announce his own version of veterans legislation and declare he wanted to vote on it the next day. "That is not democracy. That is not negotiation," Sanders said (Hunt, 7/24).

Reuters:  VA Bill Hits Deadlock In U.S. Congress Over $15B Gap
Negotiations over legislation to ease the Veterans Affairs health-care crisis broke down on Thursday as leaders of the House and Senate veterans committees rolled out competing proposals with a $15 billion gap between them. Instead of working out their differences, Senator Bernie Sanders, an independent, and Republican Representative Jeff Miller criticized each other in public statements for failing to negotiate. Miller hastily called a meeting of negotiators to introduce his bill but it was boycotted by Democrats, who called it a "stunt" aimed at pushing his plan through quickly (Lawder, 7/24).

Also in the news is a new poll of veterans --

Fox News: VA Health Care Works Once Vets Get Seen
A survey of Iraq and Afghanistan combat veterans finds that most who are receiving mental health care are "overwhelmingly satisfied" with the care, no matter if it's from the Department of Veterans Affairs or an outside provider. The finding is included in the 2014 survey of Iraq and Afghanistan Veterans of America released on Thursday during a press conference and panel discussion at the National Press Building in Washington, DC (Jordan, 7/24).

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Medicaid

Expensive Hepatitis Drug Challenges Medicaid Programs' Funding

State officials are nervous about how to afford the new medicine, which can run $84,000 for treatment. Also in Medicaid news, federal data show children using emergency room treatment at night or weekends are often on Medicaid.

The Washington Post's Wonkblog: The Drug That's Forcing America's Most Important – And Uncomfortable – Health-Care Debate
Expensive specialty drugs aren't new to health care. But Sovaldi stands out because it is aimed at helping millions of Americans who carry hepatitis C, and a large share of those infected are low-income and qualify for government coverage. Its arrival also coincides with the aggressive expansion of Medicaid and private coverage under the Affordable Care Act, whose purpose was to extend health care to tens of millions Americans who previously couldn't afford it (Millman, 7/24).

CQ Healthbeat:  More Medicaid Families Sought Emergency Room Care, Statistics Show
Three-fourths of children treated in emergency rooms in 2012 were taken at night or on weekends, according to federal statistics released Thursday. The figures also showed that families on Medicaid were more likely than those with private insurance or without any coverage to use the emergency department. The frequency with which people use pricey emergency department care is getting attention as policymakers struggle to find ways to lower federal health spending. Lawmakers want to persuade people to use less expensive outpatient care whenever possible. The Centers for Disease Control and Prevention statistics released Thursday suggests that families still use the emergency room in part because of convenience, and that Medicaid families may need help in finding a primary care physician or understanding when an emergency visit is necessary (Adams, 7/25).

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State Watch

N.C. Senate Votes For Managed Care Medicaid Overhaul

The move would offer a set amount of money per patient to managed care companies and would set up a new department run by a politically appointed board.

Raleigh News & Observer: NC Senate Votes For Medicaid Overhaul
A major Medicaid overhaul that largely disregards the wishes of health care providers, the state House and Gov. Pat McCrory won overwhelming support in the state Senate on Thursday in a 28-17 vote. The overhaul would introduce to the state commercial managed care for Medicaid patients, a move that doctors and hospitals are fighting. But after several years of overruns, legislators crave “budget predictability” for Medicaid (Bonner, 7/24).

WRAL: Senate Votes To Overhaul Medicaid
The proposal, House Bill 1181, would remove Medicaid from the Department of Health and Human Services, setting it up as an independent agency called the Department of Medical Services governed by an independent, although politically appointed, board. Under the proposal, the state would end its direct fee-for-service management of the program, contracting it out to managed care and accountable care organizations. The contracts would be "capitated," offering a set amount of money for care per patient (Leslie, 7/24).

North Carolina Health News:  Senate Moves Medicaid Reform Bill, But Objections Abound
If a majority of members of the North Carolina Senate get their way, the state’s Medicaid program is up for big changes. A bill that passed the Senate Thursday afternoon would speed up implementation of both provider-led plans and commercial managed care plans to compete to cover patients in Medicaid, the state and federally funded program that provides health care coverage for low-income children, pregnant women, low-income elderly and people with disabilities. The bill would also carve the Division of Medical Assistance – which runs Medicaid – out of the Department of Health and Human Services and create a freestanding executive Department of Medical Benefits, which would be run by a seven-member board (Hoban, 7/25).

Elsewhere, a report examines the state's "Medicaid gap" --

Raleigh News & Observer: Many Low-Income N.C. Workers Are Locked Out Of Medicaid
They’re construction workers, waitresses and cashiers. They care for our children and elderly parents, clean our offices and bathrooms. But they go without health insurance because their incomes aren’t high enough to qualify for federal subsidies and too high to qualify for North Carolina’s current Medicaid program for low-income and disabled citizens. More than half of the 689,000 uninsured adults North Carolinians who fall into this so-called “Medicaid gap” are employed in jobs that are critical to the state’s economy, according to a report released Thursday by the North Carolina Justice Center, the North Carolina Community Health Center Association and Families USA (Garloch, 7/25).

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State Highlights: Public Comments On Mass. Hospital Deal; Wash. Insurance Case Brings Allegations

A selection of health policy stories from Massachusetts, Washington state, Missouri and Pennsylvania.

WBUR: In Public Comments, Partners-Coakley Deal Brings Praise And Protest
Quite an “only in Massachusetts” moment. Patriots owner Robert Kraft and leaders of Raytheon, Suffolk Construction and Putnam Investments have all filed letters in support of an anti-trust agreement that would not normally see the light of day before a judge approves the deal. The opposition includes public health professors, a group of top economists and politicians battling Attorney General Martha Coakley in the governor’s race. This show of force is weighing in on a deal Coakley negotiated with Partners HealthCare. It would let the state’s largest hospital network expand its market power, but with constraints, some of which would last for 10 years (Bebinger, 7/24).

Seattle Times: Investigator: Children’s Hospital Ex-Hearing Judge Was Untruthful, Investigator Says 
Patricia Petersen, the state insurance office’s top administrative-law judge suspended in May over a messy set of dueling allegations, was misleading and untruthful in her characterizations of events surrounding a high-profile insurance case, an independent investigator has concluded. In a rebuttal and memo released Thursday with the investigation report, her lawyers accused the investigator of cherry-picking facts in an error-filled effort to wrongly castigate a judge who stood up for “judicial independence.” For example, her lawyers said, the investigator concluded that Petersen should have told lawyers in a case before her involving Seattle Children’s hospital that her husband had been a medical resident there. But that was over three decades ago, they noted, and he had no current financial interest in the hospital (Ostrom, 7/24).

Kansas Health Institute News Service: New Missouri Law Pays Dividends For Kansas City Clinic
A year and a half ago, a local safety net clinic underwent one of the most significant changes in its more than four decades of serving the metropolitan area: It went from a purely free provider to one that also accepted paying patients covered by insurance. Known for years as the Kansas City Free Health Clinic, the organization became the Kansas City CARE Clinic to reflect that its donation-based operation had evolved to a fee-based, sliding-scale system with a minimum payment of $10. The shift promised hundreds of thousands of dollars in new revenue for the clinic, at 3515 Broadway in Kansas City, Mo., but lawmakers first needed to fix a glitch in a state statute. That finally occurred last week when Missouri Gov. Jay Nixon signed legislation shepherded through the General Assembly by State Sen. Jolie Justus, a Kansas City Democrat (Sherry, 7/24).

The Associated Press: Doctor Fires Back At Pennsylvania Hospital Gunman
A doctor told police that a patient fatally shot a caseworker at their hospital complex before the doctor pulled out his own gun and exchanged fire with him and wounded him, a prosecutor said Thursday night. Dr. Lee Silverman, a psychiatrist, was grazed in the temple during the gunfight in his office with patient Richard Plotts, according to Delaware District Attorney Jack Whelan (7/24).

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Weekend Reading

Longer Looks: The Economics Of Infertility; Placebos As Treatment Raises Ethical Dilemmas

Every week KHN reporter Marissa Evans finds interesting reads from around the Web.

Vox: States That Deny Anti-Psychotics To The Poor Have Lots Of Mentally Ill People Behind Bars
About a decade ago, Medicaid programs were struggling to keep up with skyrocketing prescription drug costs. Between 1997 and 2002, drug spending in the program for low-income Americans grew by about 20 percent annually. ... Medicaid directors began looking for ways to tamp down on those costs. One of the most popular policies was something called "prior authorization" for a new wave of more expensive, anti-psychotic drugs ,... These policies, in a sense, worked: they helped rein in how much Medicaid spent filling prescriptions. But in another sense, they may not have worked at all: a growing body of research has begun questioning whether restricting drug spending may have just shifted costs elsewhere — particularly, into the prison system (Sarah Kliff, 7/22). 

The Washington Post: They Want A Baby. The Economy Won't Play Along.
The languishing economy has caused people to doubt if they can afford to be parents. The barriers are even higher for Melissa and Rick [Myrick], among the 6 percent of U.S. married couples facing infertility. Living in Missouri, one of 35 states that doesn’t mandate insurance coverage for infertility, they are on the hook for related doctor’s visits or drugs. They face a huge upfront price tag — a cost that can't be pushed down the road, when their economic outlook might be brighter. That's frustrating to them. "Why should the economy play into my family planning?" Melissa asks (Todd C. Frankel, 7/21). 

The Pacific Standard: People Are Clueless About Placebos
Most people have a basic understanding of placebos and why they're necessary in scientific experiments. However, placebos are also viable options for treating patients in clinical settings. ... Despite their healing effects, the premise of prescribing placebos is ethically ambiguous. In some cases (but not all), patients can't know that they're taking a dummy drug, otherwise the placebo will have no effect. This deception means that both doctors and patients can feel uncomfortable with the idea of placebos as medical treatment (Bettina Chang, 7/21). 

The New York Times: Is Truvada, The Pill To Prevent H.I.V., 99 Percent Effective? Don't Be So Sure
Truvada, the once-a-day pill to help keep people from contracting H.I.V., is on the cover of this week's New York magazine, and Tim Murphy's cover story focuses on how the pill is changing sex by drastically reducing gay men’s fear of infection. It’s not hard to see why: Mr. Murphy writes, "When taken every day, it's been shown in a major study to be up to 99 percent effective." This is a claim I hear thrown around a lot among gay men in New York. And it's wrong. The 99 percent figure isn’t a study finding; it’s a statistical estimate, based on a number of assumptions that are reasonable, but debatable (Josh Barro, 7/16).

New York Magazine: Sex Without Fear
This summer—on social media, on Fire Island, at the Christopher Street pier, and in certain cohorts around the ¬country—what many gay men are talking about among themselves is Truvada. And what’s surprising them is how fraught the conversation can be. For some, like Jacobs, the advent of this drug is nothing short of miraculous, freeing bodies and minds. For doctors, public-health officials, and politicians, it is a highly promising tool for stopping the spread of HIV. But for others, a drug that can alleviate so much anxiety around sex is itself a source of concern. They worry that Truvada will invite men to have as much condom¬less sex as they want, which could lead to a rise in diseases like syphilis. Or they fret that not everyone will take it as religiously as they ought to, reducing its effectiveness and maybe even creating resistance to the drug if those users later become HIV-positive and need it for treatment (Tim Murphy, 7/13). 

The Boston Globe: Honoring A Once-Scorned Voice For Medical Openness
Dr. Ernest Amory Codman was in his mid-40s when his golden career as a sought-after Harvard surgeon began to unravel. He had quit in exasperation from Massachusetts General Hospital, and when he took his dispute with hospital leaders public, colleagues turned against him. Many stopped sending him patients. It was the early 1900s, and Codman was impatiently pushing hospitals and doctors to adopt a practice many considered heretical at the time: Record the "end results’" for every patient — including harm caused by physicians’ errors — and make them public. A century later, many of Codman’s ideas are the bedrock of modern medicine (Liz Kowalczyk, 7/21).

NPR: A YouTube Video Is Doctor's Secret Weapon Against Back Pain
In my patient's case, I was confident that her back pain wasn't serious. A minor injury was the clear cause. And nearly all back pain like hers from a simple mechanical strain gets better on its own. I wanted to reassure her. I told her to go about her daily life. Keep exercising, but try to take it just a little bit easy until she felt better. At a minimum, I said, she should be walking 30 minutes a day. Also, try some ibuprofen, which helps with inflammation and doesn't require a prescription. But she wasn't buying it (Dr. John Henning Schumann, 7/20).

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Editorials and Opinions

Viewpoints: Ryan's 'Thoughtful Blueprint' To End Poverty; GOP Challenges After Health Law Rulilng

Bloomberg: Welcome Back, Paul Ryan
The Republican chairman of the House Budget Committee today released a thoughtful blueprint for overhauling $800 billion worth of U.S. anti-poverty programs. He doesn’t get every detail right, but [Rep. Paul] Ryan has put forth a politically brave and economically sound proposal. ... As the House Republicans' fiscal-policy expert, Ryan's budgets proposed deep cuts in Medicare, Medicaid, food stamps and other social programs to appeal to those in his party whose overriding desire seems to be to cut spending on social programs. This time, he has avoided such kowtowing (7/24).

Reuters: Paul Ryan’s Promising New Plan To End Poverty
Though Ryan is known for having devised budgets designed to shrink deficits by aggressively — some would say too aggressively — trimming the growth of Medicaid and domestic discretionary spending in the coming years, the first and most important thing to note about Ryan’s new anti-poverty agenda is that it is deficit-neutral. Rather than reduce anti-poverty spending in the immediate future, Ryan’s proposal aims to make anti-poverty spending more effective by leveraging the strengths of the federal government (the resources at its disposal) and of states, local governments, and private organizations (their local knowledge) (Reihan Salam, 7/24).

The Wall Street Journal: A 2014 Health-Care Strategy: Freedom
Contradictory rulings this week by the D.C. and Fourth Circuit Courts of Appeals mean that ObamaCare will probably return to the Supreme Court. The crucial issue is whether the government can subsidize premiums for health insurance bought on federal exchanges, though the Affordable Care Act's plain language authorizes subsidies only for policies purchased on "an Exchange established by the State." If the Supreme Court decides that ObamaCare must be implemented as written, Democrats will have to bring the legislation back to Congress. This gives Republicans an opportunity to develop a new strategy to rid the country of ObamaCare (Phil Gramm, 7/24).

The Wall Street Journal's Political Diary: GOP Governors And ObamaCare
Republican governors have been among the most vociferous critics of ObamaCare, but they ought to count themselves lucky that the Supreme Court won't be deciding the legal challenges to insurance subsidies for the 36 states participating in the federal exchange this year. A ruling that strikes down the subsidies would be victory for conservatives but could also trigger some political headaches (Allysia Finley, 7/24).

The Washington Post: Supreme Court May Not Protect Obamacare This Time
Don't be so sure that the Supreme Court is going to save Obamacare. Again. The question is enormously important: Are health-care consumers entitled to subsidies if they buy coverage on insurance exchanges established by the federal government, as they are with insurance from state exchanges? (Ruth Marcus, 7/24). 

Los Angeles Times: Obamacare Court Ruling Is Nonsensical And Cynical
At last count, more than 8 million people are getting healthcare through an Obamacare exchange. Almost three-quarters of them are using the federal exchange. These millions of Americans ought to be able to finally leave behind the stress of living with no insurance or inadequate or unaffordable insurance. But thanks to two cases decided by federal appeals courts Tuesday, their security and peace of mind remain at risk. The courts in those two cases, Halbig vs. Burwell and King vs. Burwell, reached opposite decisions, and the ultimate outcome will probably be determined by another contentious decision from the Supreme Court (Jill Horwitz and Samuel Bagenstos, 7/24). 

The New York Times: Left Coast Rising
On health care, some people — basically healthy young men who were getting inexpensive insurance on the individual market and were too affluent to receive subsidies — did face premium increases, which we always knew would happen. Overall, however, the costs of health reform came in below expectations, while enrollment came in well above — more than triple initial predictions in the San Francisco area. A recent survey by the Commonwealth Fund suggests that California has already cut the percentage of its residents without health insurance in half. What's more, all indications are that further progress is in the pipeline, with more insurance companies entering the marketplace for next year (Paul Krugman, 7/24). 

The New York Times: The Phony 'Narrow Network' Scare
Republicans contend that the Affordable Care Act is a failure because many of the plans sold on the online health exchanges limit a consumer’s choice of doctors and hospitals. Many plans do, indeed, limit choice — deliberately so, to keep premiums down. But a vast majority of consumers can almost always buy a plan with a broad array of doctors, hospitals and other providers if they are willing to pay more for the policies (7/24). 

The Wall Street Journal: Beggar-Thy-Neighbor Medicine
To understand how ObamaCare is already bending the future of U.S. medical progress, consult the furor over specialty drug prices, as an alliance of convenience among third-party payers assails pharmaceutical innovation as too costly. Maybe patients should give up on cures and, as President Obama once put it, just take the painkiller. This new defeatism has been triggered by the fake crisis of one of the most successful drug launches in modern history, the Gilead Sciences therapy for Hepatitis C. About 3.2 million Americans are infected with this blood-borne disease of the liver, which kills about 80,000 people a year, or five times the death rate of AIDS. Now a biologic drug called Sovaldi cures the virus in at least nine of 10 patients, and perhaps even 98% (7/24). 

The Wall Street Journal: The ObamaCare-IRS Nexus
One of the big questions out of the IRS targeting scandal is this: How can an agency that engaged in such political misconduct be trusted to implement ObamaCare? This week's Halbig v. Burwell ruling reminded us of the answer. It can't. The D.C. Circuit Court of Appeals ruled in Halbig that the administration had illegally provided ObamaCare subsidies in 36 insurance exchanges run by the federal government. Yet it wasn't the "administration" as a whole that issued the lawless subsidy gift. It was the administration acting through its new, favorite enforcer: the IRS (Kimberley Strassel, 7/24).

Bloomberg: The Surprise Obamacare Ruling That Wasn't
Ryan Radia at the Competitive Enterprise Institute seems to have uncovered the closest thing we’re going to get to a smoking gun. Jonathan Gruber, an economics professor at the Massachusetts Institute of Technology, is widely known as one of the architects of both Romneycare and Obamacare. ... In January 2012, Gruber apparently gave a talk at some sort of conference .... At that talk, Gruber made the following observation: "What’s important to remember politically about this is if you're a state and you don’t set up an exchange, that means your citizens don't get their tax credits -- but your citizens still pay the taxes that support this bill. So you’re essentially saying [to] your citizens you’re going to pay all the taxes to help all the other states in the country. ..." Gruber, one of the law’s architects, clearly had an understanding of the provision that liberals now say no one shared (Megan McArdle, 7/24).

The Star Tribune: Obamacare Ruling: 2 Judges, 6 Words And Millions At Risk
How many Americans are anti-Obamacare hard-liners willing to harm in their war against the landmark health reform law? The answer — millions — became shamefully clear after a conflicting set of federal appellate rulings this week cast an unnecessary cloud over the Affordable Care Act’s future. About 4.6 million people who obtained private health insurance this year through Healthcare.gov, the federal insurance marketplace serving 36 states, received tax-credit subsidies to lower the cost of their monthly premiums. That number is expected to rise to 7.3 million over the next two years, according to a recent analysis by the Robert Wood Johnson Foundation and the Urban Institute (7/24).

CNN: Why Court’s Blow to Obamacare Won’t Stick
The D.C. Circuit's decision got basically everything wrong. It misunderstood the text, structure and purpose of the Affordable Care Act. The Justice Department has already indicated that it will ask the entire D.C. Circuit to review the Halbig v. Burwell decision, and when it does, it will no doubt reverse it (Brianne Gorod, 7/24).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.