Daily Health Policy Report

Wednesday, July 30, 2014

Last updated: 9:50 AM

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

Quality

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Expert Panel Recommends Sweeping Changes To Doctor Training System

Kaiser Health News staff writer Julie Rovner reports: “An expert panel recommended Tuesday completely overhauling the way government pays for the training of doctors, saying the current $15 billion system is failing to produce the medical workforce the nation need” (Rovner, 7/29). Read the story.

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California Makes Significant Progress In Enrolling Previously Uninsured, Survey Finds

Kaiser Health News staff writer Anna Gorman reports: “A significant portion of previously uninsured Californians gained medical coverage through the nation’s health care law – about six in 10 during the state’s first open enrollment, according to a survey released Wednesday. All told, about 3.4 million people who didn’t have health insurance before sign-ups began last fall are now covered, according to the survey by the Kaiser Family Foundation” (Gorman, 7/30). Read the story.

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As Ballet Stretches Her Body’s Limits, Insurance Brings Peace of Mind

Kaiser Health News staff writer Heidi de Marco reports: “The annual injury rates at ballet companies run between 67 and 95 percent, according to a study by the American Journal of Sports Medicine. But ballerinas and their male counterparts often dance through the pain. … Despite her tough-it-out training, she’d prefer to have insurance. So by the time the Affordable Care Act took effect, allowing her ballet company to buy a plan, Noelle was eager to sign up” (de Marco, 7/20). Read the story or watch the related video, also by de Marco.

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Capsules: Survey Finds 1 In 5 Uninsured Don’t Want Coverage; Moving Children From CHIP To Exchange Plans Would Increase Costs: Study; Rx For Clarity: Calif. Considers Bilingual Drug Labels

Now on Kaiser Health News’ blog, Phil Galewitz reports on a new survey regarding the uninsured: “Though millions of people gained health coverage this year as a result of the Affordable Care Act, millions more remain unaware of their options or have no interest in getting insured, a new survey has found” (Galewitz, 7/30). 

In addition, Mary Agnes Carey reports on a study regarding CHIP and Medicaid coverage for kids: “Cost sharing would increase and the number of child-specific services covered would decline if millions of low-income children now enrolled in the Children’s Health Insurance Program (CHIP) were forced to receive coverage through the health law’s insurance exchanges, according to a study released Tuesday” (Carey, 7/29). 

Also on the blog, KQED’s April Dembosky reports on a move toward bilingual drug labels in California: “This week California’s Board of Pharmacy will discuss new regulations that would require all pharmacies in California to provide translated labels on prescription drug bottles. Statewide, 44 percent of Californians speak a language other than English at home. New York approved a similar rule last year to make it easier for non-English speakers to take their medications properly and avoid costly mistakes” (Dembosky, 7/30). Check out what else is on the blog.

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Political Cartoon: 'Pie Chart?'

Kaiser Health News provides a fresh take on health policy developments with "Pie Chart?" by Lee Judge.

Meanwhile, here's today's haiku:

SURVEYING THE GOLDEN STATE

California picks
the low-hanging uninsured
Some still out of reach
-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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Capitol Hill Watch

Senate Unanimously Approves McDonald To Lead The VA

Robert A. McDonald, the 61-year-old former chief executive of Procter & Gamble and graduate of the U.S. Military Academy at West Point, will take over the embattled VA after a scandal related to wait-time data led to the resignation of Eric Shinseki.

The New York Times: Senate Confirms Obama’s Choice To Lead V.A.
The Senate voted unanimously on Tuesday to confirm Robert A. McDonald, the 61-year-old former chief executive of Procter & Gamble, to take the helm of the sprawling and embattled Department of Veterans Affairs after a scandal over the manipulation of patient wait-time data led to the ouster two months ago of Eric Shinseki (Oppel Jr., 7/29).

The Wall Street Journal: Senate Confirms McDonald As VA Secretary
The Senate confirmed Robert McDonald to head the Department of Veterans Affairs on Tuesday, one day after congressional leaders cobbled together a $17 billion funding bill to help reform the agency and expand care. Mr. McDonald takes over as VA secretary after little debate or opposition and a 97-0 confirmation vote on the Senate floor. Last week, he faced a friendly hearing before the Committee on Veterans' Affairs where he fielded few questions and was lauded by many on the panel (Kesling, 7/29).

The Washington Post: Senate Unanimously Confirms Robert McDonald As VA Secretary
Tuesday’s vote represented a rare example of swift, bipartisan action by the Senate to address pressing problems. Obama nominated McDonald on June 30, and the Senate Veterans Affairs gave him a warm reception during his confirmation hearing last week (Hicks, 7/29).

Politico: Senate Approves Robert McDonald For VA
He’ll take the post from acting VA Secretary Sloan Gibson, who was elevated in May when former secretary Eric Shinseki resigned over reports that the department was manipulating records to hide that veterans were at times waiting months to see doctors (French, 7/29).

Reuters:  U.S. Senate Unanimously Confirms McDonald To Head Veterans Agency
McDonald, 61, replaces former Army general Eric Shinseki, who resigned in late May amid a scandal over cover-ups of long waiting times for health care appointments at VA hospitals and clinics across the country. The 97-0 vote to confirm McDonald comes a week after he pledged to bring corporate-style discipline and accountability to the agency, refocusing its 341,000 employees on serving veterans. McDonald, a graduate of the U.S. Military Academy at West Point who served as P&G CEO from 2009 to 2013, is widely expected to start his new job with an extra $17 billion at his disposal to reduce months-long health care wait times in new legislation slated for passage by Congress this week (7/29).

Meanwhile, legislation to address the veterans' health care issues is making progress, though negative press reports about the system continue -

The Associated Press: Bill To Overhaul VA Heads To Full House, Senate
House and Senate negotiators have approved a $17 billion compromise bill to overhaul the Department of Veterans Affairs. The vote by the 28-member conference committee late Monday sends the bill to the full House and Senate, where approval is expected later this week. The bill is intended to help veterans avoid long waits for health care, hire more doctors and nurses to treat them, and make it easier to fire executives at the VA (7/19).

USA Today: VA Manipulated Vets’ Appointment Data, Audit Finds
Internal VA documents show the depth of fraudulent scheduling, manipulation of data and in some cases intimidation of staff to hide delays in medical care to veterans in the 6-million patient national system. Auditors found at least one appointment scheduler at 109 VA medical centers who said wait times for veterans had been falsified, according to a USA TODAY analysis of internal VA survey data made public Tuesday. To keep evidence of delayed care out of the VA's official electronic tracking system, secret lists were maintained at 110 facilities, the analysis shows (Zoroya and Hoyer, 7/30).

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Health Reform

Legal Challenge To Health Law Taxes Rejected By Appeals Court

The lawsuit brought by the Pacific Legal Foundation and a small business owner argued that the overhaul was in violation of the Constitution's Origination Clause.

The Associated Press: Appeals Court Rejects Tax Challenge To Obamacare
Rejecting the latest effort to sidetrack “Obamacare,” a federal appeals court turned away a challenge by a conservative group that said Congress imposed new taxes unconstitutionally when it created the Affordable Care Act. Pacific Legal Foundation and a small-business owner, Matt Sissel, argued that the Affordable Care Act is a bill for raising revenue and that it violated the Origination Clause of the Constitution because it began in the Senate, not the House. The Constitution requires that legislation to raise revenue must start in the House (7/29).

Politico: Court Throws Out An Obamacare Tax Law Challenge
Obamacare watchers broadly expected the suit to fail, although its profile was raised this spring after the Washington Post’s George Will wrote a column saying it would doom Obamacare (Norman, 7/29).

Meanwhile, in news about other challenges to the health law -

Bloomberg:  West Virginia Sues Over Obamacare Non-complying Plan Rule
West Virginia’s attorney general sued the Obama administration over the Patient Protection and Affordable Care Act, claiming rules for the health-care law’s transition rendered millions of insurance plans unlawful. Patrick Morrisey, a Republican, faulted President Barack Obama for an “administrative fix” last year that burdens states with the cancellation or approval of health-care plans that don’t comply with the new law. Shifting that responsibility to states violates provisions of the health-care overhaul and constitutional limitations on the powers of the U.S. government, according to the complaint filed yesterday in federal court in Washington (Rosenblatt, 7/30).

The Associated Press: GOP-Led House Ready to OK Lawsuit Against Obama
Republicans are ready to muscle legislation through the House authorizing an election-year lawsuit against President Barack Obama that accuses him of exceeding his powers in enforcing his health care law. A party-line vote — and plenty of sharp partisan rhetoric — were expected when the GOP-led chamber considers the measure Wednesday. Democrats dismiss the proposal as a legally groundless exercise that could end up costing taxpayers millions of dollars in legal fees and other expenses (Fram, 7/30).

The Washington Post: Obama To Lash Out At Republicans Over ‘Stunt’
President Obama will lash out at House Republicans on Wednesday for their plans to sue him over his use of executive authority, the White House said, in what appears to be part of a burgeoning effort to highlight what Democrats see as outlandish acts by Republicans in an election-year. The White House and Democratic candidates have been showering attention on the potential lawsuit by House Republicans and chitchat in Washington over potential impeachment proceedings as a way to portray the GOP as out-of-touch with the concerns of ordinary voters and infatuated with political theatrics (Goldfarb, 7/30).

Fox News: Emails Show White House Adviser Intervened on Obamacare ‘Bailout’ After Industry Appeals
Newly released emails show a key White House adviser intervened on behalf of the health insurance industry after an executive repeatedly warned that massive premium hikes were coming unless the administration expanded an ObamaCare program that Republicans call an industry "bailout." The insurance industry ultimately got a more "generous" offer from the administration -- one that Republicans warn could transfer potentially billions of taxpayer dollars into the Affordable Care Act to bail out insurance companies (Berger, 7/29).

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Survey Offers Progress Report On California's Enrollment Efforts

The survey of uninsured people within the state, conducted by the Kaiser Family Foundation, found that nearly six of 10 gained insurance during the first open enrollment period -- but reaching the remaining holdouts will become more difficult.

The New York Times: More Californians Sign Up For Health Plans, Survey Says, But Holdouts May Be Hard To Get
While a new survey of the uninsured in California shows that nearly six out of 10 people were able to obtain coverage in the last year, the findings offer fresh insight into just how difficult it may be to sign up the people who remain uninsured, even after the introduction of the new state marketplaces (Abelson, 7/30).

Kaiser Health News: California Makes Significant Progress In Enrolling Previously Uninsured, Survey Finds
A significant portion of previously uninsured Californians gained medical coverage through the nation’s health care law – about six in 10 during the state’s first open enrollment, according to a survey released Wednesday. All told, about 3.4 million people who didn’t have health insurance before sign-ups began last fall are now covered, according to the survey by the Kaiser Family Foundation (Gorman, 7/30).

Los Angeles Times: Number Of Californians Without Health Insurance Drops Sharply
A Kaiser Family Foundation survey examining the state's progress under the federal medical care overhaul said more than 80% of those still uninsured hadn't had coverage in two or more years, including 37% who reported never having coverage before. Foundation Chief Executive and President Drew Altman said though large numbers of Californians gained insurance during the first open enrollment period, “expanding coverage gets harder from here” (Karlamangla, 7/29).

The Sacramento Bee: Survey: In California, More Than 3 Million Newly Insured In Health Coverage
About 3.4 million previously uninsured adults have obtained health insurance coverage in California in the past year, according to a new survey by the Kaiser Family Foundation. It found that nearly 60 percent of residents who lacked coverage reported signing up for health insurance since last summer. ... While most of the formerly uninsured were able to acquire coverage through Medi-Cal (25 percent), 12 percent got it through an employer and 9 percent through the state exchange, called Covered California, the survey said (Cadelago, 7/29).

Politico Pro: Survey Looks At California Coverage Gains, Challenges
About 6 in 10 Californians who were uninsured last summer now have health coverage, according to a survey released Wednesday by the Kaiser Family Foundation. That amounts to 3.4 million newly insured Californians, most of whom talk positively about their plans. But signing up the remaining uninsured may be tough, the survey indicates. Many people have never had coverage or haven’t had it in several years. Many are also undocumented immigrants whose legal status is a separate barrier (Villacorta, 7/30).

KHN looks into the experience of one Californian who gained coverage in 2014 -

Kaiser Health News: As Ballet Stretches Her Body’s Limits, Insurance Brings Peace of Mind
The annual injury rates at ballet companies run between 67 and 95 percent, according to a study by the American Journal of Sports Medicine. But ballerinas and their male counterparts often dance through the pain. … Despite her tough-it-out training, she’d prefer to have insurance. So by the time the Affordable Care Act took effect, allowing her ballet company to buy a plan, Noelle was eager to sign up (de Marco, 7/20).

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California Health Premiums Soar, Leading To Health Law Talk And Statewide Ballot Initiative

State insurance commissioner Dave Jones predicts that insurers and the California health exchange will take steps to temper premium increases for the coming year.

Los Angeles Times: Health Premiums Soared, Insurance Commissioner Dave Jones Says
The cost of health insurance for individuals skyrocketed this year in California, with some paying almost twice what they did last year, the state's insurance commissioner said. But Insurance Commissioner Dave Jones predicted that insurers will ease up in the coming year to prevent California voters from approving tough new rate controls on the November statewide ballot as Proposition 45 (Pfeifer, 7/29).

The Associated Press: California Health Premiums Rose Significantly in 2014
California's insurance commissioner released a report Tuesday showing the cost of health-care premiums increased significantly this year, as he pushes for more authority to regulate those costs. California's four largest insurers raised premiums for individuals from at least 22 percent to as much as 88 percent, depending on factors such as age and location, according to the annual report released by Commissioner Dave Jones, a Democrat first elected in 2010. Those figures were calculated comparing the price of an insurer's mid-quality standard plans in 2014 to the insurer's most popular plans in 2013 (Nirrapil, 7/29).

The Sacramento Bee: Jones: Fearful Of Voters, Insurers Will Temper Health Rate Hikes
California Insurance Commissioner Dave Jones, who is pushing a ballot measure to give him the power to regulate health insurance rates, released an analysis Tuesday showing that health insurance costs for individuals increased dramatically over the last year. But Jones said he suspects health insurers and the California health exchange, Covered California, will temper premium increases for the coming year in an effort to to avert possible public outcry as the Nov. 4 election approaches. “I fully anticipate that the degree of increases will be modest at best … because Proposition 45 is on the ballot and they are very concerned about creating any sort of backlash from Californians,” Jones said Tuesday. “But after 2015, I think, essentially, the sky is the limit (Cadelago, 7/29).

Meanwhile, in Connecticut -

The CT Mirror: Insurance Department Rejects Anthem Rate Hike, Lowers Others
The Connecticut Insurance Department has rejected proposals by two insurance companies to raise health insurance premiums next year, and rejected the rates proposed by a third company new to the individual market. Regulators approved plans the insurer HealthyCT to lower its rates. In the case of Anthem Blue Cross and Blue Shield, the department deemed the proposal to raise rates by an average of 12.5 percent to be excessive, and directed the carrier to submit new rate proposals for review. Similarly, the department asked UnitedHealthcare to submit new proposals for plans it intends to sell in 2015. The company doesn’t sell policies in the state’s individual market this year (Becker, 7/29).

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Hawaii Weighs Efforts To Fix Online Health Marketplace

The state set up its own exchange, but it's losing money, and officials are considering options for a long-term fix or a switch to the federal marketplace instead. Also, new reports examine how the uninsured view the marketplaces and young adults' deliberations on health insurance.

The Associated Press: Hawaii Health Care Faces Federal Threat
The problem starts with the Hawaii Health Connector, a federally mandated insurance marketplace that's losing money. A temporary funding plan went into effect this month, but once that money runs out, lawmakers will need to settle on a long-term fix that officials characterize as a choice between propping up a failing system at the expense of taxpayers, or turning control over to federal authorities at the risk of unravelling the state's comprehensive Prepaid Health Care Act (Bussewitz, 7/29).

Kaiser Health News: Capsules: Survey Finds 1 In 5 Uninsured Don't Want Coverage
Though millions of people gained health coverage this year as a result of the Affordable Care Act, millions more remain unaware of their options or have no interest in getting insured, a new survey has found (Galewitz, 7/30).

Fox News: Cost Trumps 'Invincibility' For Millenials Enrolling In Obamacare
During the 2014 enrollment period, a big question mark hung over the success of the law: would young people's [invincibility-mentality] discourage them from signing up? Turns out, the price tag was more of a deterrent. According to a new report from Deloitte, costs played a more important role in the decision-making process among enrollees ages 18 to 34 when signing up for coverage than the invincibility factor (Rogers, 7/29).

In other news, a report on how hospital emergency departments are faring under the health law -

Marketplace: ERs Are Still Busy, Affordable Care Act And All
One of the arguments in favor of the Affordable Care Act was that it would reduce dependency on emergency rooms by covering more people with basic preventive care. Now, millions of people are newly covered by Obamacare. So are emergency departments seeing a slowdown? Not so much (Wallace, 7/29).

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Advocates Press Fla. Lawmakers On Medicaid Expansion To Help Working Poor

About 800,000 residents of the state are stuck in a "coverage gap" because they earn too much to qualify for Medicaid since the state did not expand its program under the health law but they don't earn enough to qualify for federal tax credits.

Miami Herald: Florida's Working Poor Fall Into Affordable Care Act 'Coverage Gap'
Angel Cardenas is one of about 800,000 Floridians who are stuck in the so-called "coverage gap," in which they earn too much to qualify for Medicaid but not enough to be eligible for federal tax credits under the ACA. She took part Tuesday in a conference call, part of an effort by healthcare advocates to persuade Florida legislators to expand the state’s Medicaid program, which now sets an annual income eligibility ceiling of roughly $6,930 for a family of three and denies any assistance to individuals and families without dependent children, regardless of how low their income may be. Under the ACA, Medicaid could be expanded to Florida residents with incomes up to 138 percent of the federal poverty level, or $27,310 for a family of three. So far, Florida legislators have declined to act (Madigan, 7/29).

In other Medicaid news -

Kaiser Health News: Capsules: Moving Children From CHIP To Exchange Plans Would Increase Costs: Study
Cost sharing would increase and the number of child-specific services covered would decline if millions of low-income children now enrolled in the Children’s Health Insurance Program (CHIP) were forced to receive coverage through the health law’s insurance exchanges, according to a study released Tuesday (Carey, 7/29).

Modern Healthcare: Uninsured Rate Drops Faster In States That Expanded Medicaid
Americans lacking insurance coverage are becoming more concentrated in states that have opted not to expand Medicaid, according to the latest survey data from the Urban Institute's Health Policy Center. Residents of southern states, Spanish-language speakers and high school dropouts are also a growing portion of the uninsured. As of June, 60.4% of individuals lacking coverage lived in the 25 states that have opted not to expand Medicaid eligibility to residents with incomes up to 138% of the federal poverty level, as encouraged under the Patient Protection and Affordable Care Act (Demko, 7/29).

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Health Care Marketplace

Several Insurers Report Lower Profits

WellPoint and Humana say higher expenses kept profits down in the second quarter.

The Wall Street Journal: WellPoint Profit Slips, But Boosts Outlook
WellPoint Inc. on Wednesday said its second-quarter profit slipped as the health insurer recorded higher expenses, masking a boost in revenue and enrollment. Still, the company again raised its earnings outlook for the year, saying it now expects adjusted per-share profit to top $8.60, compared with its prior forecast for earnings of more than $8.40 a share. WellPoint reiterated its expectation for operating revenue above $73.5 billion. WellPoint in January said the people enrolling in new health-law plans were skewing older than its previous individual consumers, but they appeared to match the less-healthy pool the company predicted when it set its prices (Prior, 7/30).

Reuters: Humana Says Profit Fell On Health Reform, Drug Costs
U.S. health insurer Humana Inc said on Wednesday that second-quarter profit fell due to investments in the exchanges created under President Barack Obama's healthcare reform law as well as costly new hepatitis C drug treatments. Humana said membership growth and a lower share count due to stock buybacks had helped offset some of the new costs. The company said net income fell to $344 million, or $2.19 per share, from $420 million, or $2.63 a share, a year earlier. That was in line with analysts' estimates. Most of Humana's revenue is from Medicare Advantage and Medicare Part D, the privately run medical and drug plans under the government health program for older people and the disabled. Humana said revenue rose 18 percent to $12.2 billion. Both Medicare Advantage and Medicare Part D added new customers, and the company's individual customer base increased 122 percent to more than 1.1 million members (Humer, 7/30).

The Wall Street Journal: Benefit Costs Pare Humana's Profit
Earnings met analysts' expectations, but the top line exceeded them. Humana said its profit declined, as expected, because of its investments in health care exchanges and state-based contracts, while higher costs associated with specialty hepatitis C treatments also weighed on results (Calia, 7/30).

Reuters: Aetna Says Medical Costs Rose, Insurer Shares Dropped
Aetna Inc., the third-largest U.S. health insurer, reported a rise in medical costs on Tuesday, raising investor concerns that a long run of low growth in such costs might be ending and pushing shares in the industry lower. U.S. insurer profits have benefited from several years of relatively low use of medical services by their members due to an economic downturn and higher out-of-pocket costs for patients. Aetna said its medical spending rose in the second quarter due to an expensive new treatment for hepatitis C made by Gilead Sciences and the higher costs of covering patients who bought insurance under President Barack Obama's healthcare law for the first time (Humer, 7/29).

A major hospital company also reported its earnings -

The Wall Street Journal: HCA Holdings Profit Rises 14%
In a recent preview of its second-quarter results, HCA had said admissions to its hospitals rebounded and that greater-than-expected benefits from the health-care reform law contributed to the company's performance. At the time, HCA also raised its estimate of the Affordable Care Act's benefit to adjusted earnings this year by one percentage point, from to 2% to 3%. HCA Holdings reported a profit of $483 million, or $1.07 a share, up from $423 million, or 91 cents a share, a year earlier (Stynes, 7/29).

The Associated Press examines the pricing of the hepatitis drug that insurers are concerned about -

The Associated Press: $1,000 Sovaldi Now Hepatitis Treatment Of Choice
Even with insurers reluctant to pay, Sovaldi prescriptions have eclipsed those for all other hepatitis C pills combined in a matter of months, new data from IMS Health indicate. The promise of a real cure, with fewer nasty side effects, has prompted thousands to get treated. But clinical and commercial successes are also triggering scrutiny for the drug’s manufacturer, California-based Gilead Sciences Inc., which just reported second-quarter profits of $3.66 billion, or a net margin of 56 percent. Two senators have unearthed documents that suggest the initial developers of Sovaldi considered pricing it at less than half as much. The health insurance industry is publicly scolding Gilead, and state Medicaid programs are pushing back (Alonso-Zaldivar, 7/29).

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Quality

IOM Study Finds U.S. Medical Training May Not Be Meeting Needs For Care

The comprehensive report calls for major changes in doctor training and points out that it is difficult to track how the $15 billion spent by the federal government is being used.

The Washington Post’s Wonkblog: The U.S. Spends $15B A Year To Train Doctors, But We Don't Know What We Get In Return
If you were spending $15 billion, you'd probably want to know what you were getting as a return on that investment. Especially if it was on something as important as the nation's health care. Yet, a new comprehensive report finds that we don't have a good system of tracking the $15 billion the United States spends each year on training new doctors — a particularly pressing topic as 11,000 baby boomers become Medicare-eligible each day and about 25 million uninsured are projected to gain new coverage in the next few years under the Affordable Care Act. Further, our publicly financed program for training doctors doesn't ensure that the new crop of physicians will be positioned to meet changing demands for care, according to independent experts at the Institute of Medicine (Millman, 7/29).

Kaiser Health News: Expert Panel Recommends Sweeping Changes To Doctor Training System
An expert panel recommended Tuesday completely overhauling the way government pays for the training of doctors, saying the current $15 billion system is failing to produce the medical workforce the nation needs  (Rovner, 7/29). 

Bloomberg:  Tighter Rules Urged On $15B For Doctor Training
Tighter oversight is needed for more than $15 billion spent yearly on doctor training in the U.S., according to a new report that’s already under fire from medical centers that provide the education. The report, by the U.S. Institute of Medicine, calls for per-resident funding based on outcomes that address strategic needs in health care, such as the looming shortage of family doctors in some areas ... The Association of American Medical Colleges, which represents 400 of the nation’s more than 1,000 teaching hospitals, opposes the recommendations, saying they would funnel federal dollars away from Medicare patients, and create uncertainty for their members (French, 7/29).

Also, another news story looks at osteopathic medical training -

The New York Times: The D.O. Is In Now
Inside, [the Touro College of Osteopathic Medicine] seems indistinguishable from a conventional medical school — what doctors of osteopathic medicine, or D.O.s, call allopathic, a term that some M.D.s aren't much fond of. A walk through the corridors finds students practicing skills on mannequins hard-wired with faulty hearts. They dissect cadavers. They bend over lab tables, working with professors on their research. And, unlike their allopathic counterparts, they spend roughly five hours a week being instructed in the century-old techniques of osteopathic medicine, manipulating the spine, muscles and bones in diagnosis and treatment (Berger, 7/29).

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State Watch

Federal Court Rejects Miss. Law Targeting State's Only Open Abortion Clinic

A federal appeals court blocked a Mississippi law from taking effect that would have caused the state's only abortion clinic to close because it would impose "an undue burden" on women.

The Wall Street Journal: Federal Court Blocks Mississippi Law Threatening Abortion Clinic
A federal appeals court on Tuesday blocked a Mississippi abortion law from taking effect, a ruling that appears to conflict with a decision earlier this year by the same court. Combined with other legal challenges of similar state laws, the move could set the stage for the Supreme Court to revisit the issue of abortion rights, legal experts said (McWhirter, 7/29).

NPR: Court Rejects Law Threatening Mississippi's Last Abortion Clinic
A federal appeals court has rejected a Mississippi law that would have forced the state's only abortion clinic to close. In a 2-1 decision, a panel of the 5th U.S. Circuit Court of Appeals on Tuesday turned aside arguments that women seeking to have an abortion could have the procedure done in a neighboring state (Greenblatt, 7/29).

Politico: Ruling Keeps Mississippi’s Only Abortion Clinic Open
Mississippi’s only remaining abortion clinic will stay open following a federal appeals court ruling Tuesday against a state law that requires abortion providers to have admitting privileges at a local hospital. After doctors at the Jackson Women’s Health Organization sought and were denied admitting privileges at seven area hospitals, the state notified the clinic that its license would be revoked. A three-judge panel of the U.S. Court of Appeals for the Fifth Circuit ruled that by forcing the facility to be closed, the law would impose an “undue burden” on a woman’s right to seek an abortion in Mississippi (Winfield Cunningham, 7/29).

The New York Times: Judges Block Abortion Curb In Mississippi
By a 2-to-1 vote, the panel of the United States Court of Appeals for the Fifth Circuit ruled that by imposing a law that would effectively end abortion in the state, Mississippi would illegally shift its constitutional obligations to neighboring states. The ruling is the latest at a time when states, particularly in the South, are increasingly setting new restrictions that supporters say address safety issues and that critics say are intended to shut clinics (Robertson and Eckholm, 7/29).

The Associated Press: U.S. Appeals Panel Strikes Down Mississippi Anti-Abortion Law
A U.S. appeals court panel ruled Tuesday that a Mississippi law that would close the state’s only abortion clinic is unconstitutional. The case is the latest in the decades-long struggle by some social conservatives to chip away at a woman’s constitutional right to have an abortion. The issue remains one of the country’s most sensitive, politically and otherwise, with various challenges in a number of states (Wagster Pettus, 7/30).

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State Highlights: New York Faces $1.3B Medicaid Payback Problem

A selection of health policy stories from California, North Carolina, Iowa, Massachusetts and Illinois.

The New York Times: De Blasio’s Plans To Reduce Worker Health Costs Have A Carrot And A Stick
When Mayor Bill de Blasio announced his first labor agreements with New York City unions this spring, he was sharply criticized for granting long-awaited wage increases in exchange for promises of unspecified though sizable savings on health care expenses (Greenhouse and Stewart, 7/29).

The Wall Street Journal: State's $1.3 Billion Medicaid Problem
The federal government has demanded that New York state pay back nearly $1.3 billion in Medicaid money distributed in 2010, prompting a rebuke from Gov. Andrew Cuomo's administration and a promise to appeal the decision. At issue are the costs of caring for about 1,300 developmentally disabled people—about $2 million per patient in 2013—in nine state facilities from Staten Island to Rochester. New York's Medicaid program is among the nation's most expensive (Kravitz, 7/29).

Los Angeles Times: County Wants Plan Before Funding Ways To Divert Mentally Ill From Jail
The proposal — suggested by Supervisor Mark Ridley-Thomas — comes as the county is under federal pressure to improve treatment of mentally ill jail inmates and as it embarks on a $2-billion overhaul that includes a new Men's Central Jail centered around treatment beds for mentally ill inmates (Sewell, 7/29).

Kaiser Health News: Capsules: Rx For Clarity: Calif. Considers Bilingual Drug Labels
This week California’s Board of Pharmacy will discuss new regulations that would require all pharmacies in California to provide translated labels on prescription drug bottles. Statewide, 44 percent of Californians speak a language other than English at home. New York approved a similar rule last year to make it easier for non-English speakers to take their medications properly and avoid costly mistakes (Dembosky, 7/30).

Raleigh News & Observer: NC Budget Deal Includes Teacher Raises, But No Medicaid Overhaul
House and Senate budget writers reached agreement Tuesday on a $21.3 billion state spending plan that averts significant cuts to Medicaid but leaves unresolved a major overhaul of the health insurance program for the poor. The budget compromise, legislative leaders said, cuts $135 million from the state’s Medicaid program but makes no changes to eligibility and no shift in how the care is provided. The Senate had previously approved a budget that called for major changes to Medicaid – including a proposal to cut eligibility for thousands of elderly and disabled people – but the House and Gov. Pat McCrory opposed the plan. The issue became a sticking point in the budget negotiations that stretched a month and derailed the legislative session (Frank, 7/29).

North Carolina Health News: Health Care Advocates Anxiously Await Details Of Medicaid Budget Or Cuts
After two long months of negotiating and haggling over lottery numbers, Medicaid and teacher pay, Speaker of the House Thom Tillis and Senate President Pro Tempore Phil Berger came together Tuesday to present a compromised “budget framework.” Though Tillis and Berger discussed major points of the budget – including a 7 percent raise for teachers, preservation of current Medicaid eligibility and a 1 percent cut to Medicaid provider rates – specific details of the budget have yet to be released on Jones Street (Namkoong, 7/29).

Des Moines Register: Medicare Touts $12M Drug Cost Savings For Iowans
Iowa seniors and disabled people have saved nearly $12 million on medications this year because of a reduction in the "doughnut hole" in Medicare's prescription-drug program, federal officials estimated today. Medicare administrators said 16,150 Iowa participants have saved an average of $728 so far this year because of the change, which is part of the Affordable Care Act. U.S. Sen. Tom Harkin, an Iowa Democrat who helped pass the Affordable Care Act in 2010, applauded the report's findings. "Improving coverage for Medicare beneficiaries and shifting the program's focus to keeping people healthy is at the heart of the health reform law," he wrote in a prepared statement (Leys, 7/30).

WBUR: As Mass. Lawmakers Take Up Addiction Bill, What’s Most Effective Treatment?
As Massachusetts lawmakers work on differences in the $20 million bill designed to address the state’s opioid crisis, questions remain about which treatments are best. Several business and insurance leaders have written to Gov. Deval Patrick saying that some parts of the bill may not encourage the most effective addiction treatment. Essentially, they say, more beds may not be the answer, but more medication and longer outpatient care might be better (Becker, 7/29). 

The Associated Press: Illinois Warns Insurers Of Discrimination Ban
Illinois regulators issued a reminder to health insurers that it is illegal to deny coverage to someone because they are transgender, drawing praise from the gay rights community. The bulletin, which was dated Monday and announced Tuesday, notes that both new and amended policy filings should comply with provisions in the Affordable Care Act, the Illinois Human Rights Act and the Illinois Mental Health Parity Act — which prohibit discrimination against transgender persons because of general identity or health conditions (Lester, 7/29).

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Editorials and Opinions

Viewpoints: Narrow Networks 'Here To Stay;' Gun Owners Challenge Doctor Privileges In Fla.

The New York Times' The Upshot: A Health Trade-Off That's Here To Stay: Lower Cost, Limited Choice
The federal government will begin tightening its rules to make sure that narrow networks don’t get too narrow. There is some precedent for the reaction: In the 1990s, cheaper narrow-network H.M.O. plans proliferated in the employer market, but they disappeared after mass public outcry. But even if the skinniest plans are widened by regulation, narrow plans are probably here to stay this time. The whole idea of the marketplaces was to give insurers an opportunity to compete for customers on price. And as long as price continues to drive shopping decisions and the old tactics are out, insurers have every motivation to keep these plans on the market (Margot Sanger-Katz, 7/29). 

The New York Times' Taking Note: Mississippi's Only Abortion Clinic: Still Standing
An underhanded effort to close Mississippi's sole abortion clinic and deny women access to safe and legal abortion care in their home state has suffered a major setback (Dorothy J. Samuels, 7/29). 

Los Angeles Times: Court Blocks Mississippi From Closing States Last Abortion Clinic
The law required that all physicians associated with an abortion clinic have admitting privileges at a local hospital. The state's last clinic, Jackson Women’s Health Organization, had filed a suit challenging the law, in part because none of the seven hospitals in the Jackson area were willing to grant the physicians admitting privileges (Alana Semuels, 7/29). 

Los Angeles Times: Call Yourself 'Pro-Choice' Or Not, Your Abortion Rights Are Under Attack
With every aspect of the abortion issue controversial these days, why wouldn't the labels be as well? Apparently some abortion rights advocates are retiring the term "pro-choice" to describe what they do. "I just think the 'pro-choice' language doesn't really resonate, particularly with a lot of young women voters," Cecile Richards, the president of the Planned Parenthood Federation of America, said in a New York Times article Tuesday (Carla Hall, 7/29).

The New York Times' The Upshot: Do You Own a Gun? In Florida, Doctors Can't Ask You That
When pediatricians ask you about using car seats, they're trying to prevent injuries. When they ask you about how your baby sleeps, they're trying to prevent injuries. When they ask you about using bike helmets, they're trying to prevent injuries. And when they ask you about guns, they're trying to prevent injuries, too (Aaron E. Carroll, 7/29). 

The Washington Post: VA Bill Shows That Congress Can Work When It Faces A Powerful Constituency
House and Senate conferees have agreed on a $17 billion bill to address the scandal over poor health-care service at the Department of Veterans Affairs. The legislation is now on a fast track to pass Congress before its August recess, showing that Republican and Democratic lawmakers can still agree on their concern for those who served their country in uniform — and their fear of facing those same veterans in town halls and, eventually, at the polls (7/29). 

Los Angeles Times: Insurance Report Shows Premiums Increased, But Ignores Policy Changes
State Insurance Commissioner Dave Jones fired the first shot Tuesday in his campaign for more authority over health insurance premiums, releasing a report that showed a giant increase in premiums from 2013 to 2014 for those not covered by employer-sponsored plans. The only problem is that, unlike the usual analysis from Jones' office, it didn't look at how much insurers raised the prices of individual policies. It looked at how much more the most popular policies available in 2014 cost than the most popular ones in 2013, without trying to control for the differences (Jon Healey, 7/29). 

USA Today: Opposing Obamacare Rulings Not Red And Blue
When the District of Columbia Circuit ruled last week that the Obama administration was violating the Affordable Care Act (ACA) in authorizing billions in tax credits, it took little time for leading Democrats to respond. Senate Majority Leader Harry Reid promptly labeled the ruling in Halbig v. Burwell "absurd," simply the work of "activist Republican judges." Less than two hours later, Democratically appointed judges across the river in Virginia reached the opposite result in King v. Burwell. The response from the right was equally predictable: The judges were Democratic drones carrying the water for the White House (Jonathan Turley, 7/29).

The Washington Post's The Plum Line: Senate Documents And Interviews Undercut 'Bombshell' Lawsuit Against Obamacare
The most serious current legal challenge to the Affordable Care Act turns on the argument that the law did not actually make subsidies available to those obtaining coverage on the federal exchange. This argument is based on the language in the ACA that says subsidies go to those using the "exchange established by the state," which, it is said, cannot apply to the exchange established by the federal government. ... But documents from the Senate committees that worked on versions of the bill in 2009 — combined with a close look at the history of the phrase itself, and interviews with staffers directly involved in the drafting of the statutes — strongly undercut the argument (Greg Sargent, 7/29). 

The Wall Street Journal's Washington Wire: What If Obamacare Isn't The Reason Medicare Spending Slowed?
The trustees' report wasn't all doom and gloom. While Social Security is going broke faster than anticipated, Medicare's financial forecast has slightly improved. The reason? Expenditures on hospitalization have gone down. Some trustees say that Obamacare is one reason Medicare spending has slowed, but I have a different theory. In 2003, Congress passed and President George W. Bush signed into law a Medicare modernization bill that included a benefit that aimed to keep older patients out of the hospital by providing them with prescription drugs (John Feehery, 7/29). 

Forbes: Will Governor Pence Walk Away From His Medicaid Expansion? 5 Things To Watch
Indiana Gov. Mike Pence (R) recently submitted his ObamaCare expansion plan to federal bureaucrats for approval. He promises to walk away if the Obama administration tries to water his plan down, but he also promised that he would oppose ObamaCare before he decided to expand Medicaid. Pence’s ObamaCare expansion plan is bad policy. ... So the real question will be: if the Obama administration does try to water down Pence’s already-weak proposal, will he keep his word? Will he simply walk away? Or will he cave to the pressure and expand ObamaCare, anyway, like Gov. Branstad of Iowa? (Josh Archambault and Jonathan Ingram, 7/30). 

Fort Wayne Journal Gazette: A Widening Gap: Medicaid Backlog A Bad Omen For HIP 2.0
In a wider sense, the Medicaid-application crunch must be a wake-up call for state health care officials. Gov. Mike Pence has asked the federal government to approve a huge expansion of the Healthy Indiana Plan that would cover Hoosiers in the so-called health care gap: roughly 350,000 people whose income is above Medicaid cutoffs but who are too poor to qualify for Obamacare tax credits. But if it's approved, implementing HIP 2.0 would mean processing about eight times as many people as the current program is serving (7/29).

Arizona Republic: Ralph Heap Rants About Medicaid, Then Collects From It
Ralph Heap is challenging that bastion of East Valley liberalism, state Sen. Bob Worsley -- one of 14 Republicans who voted to expand Medicaid in order to uphold the will of Arizona voters and save the state a few billion dollars. ... If elected, Heap vows to "block ObamaCare in every possible way at the state level." He might want to start with himself. Heap is an orthopedic surgeon, a doctor who has collected more than $130,000 in Medicaid funds since 2010, according to Jennifer Carusetta, spokeswoman for Arizona's Medicaid program, the Arizona Health Care Cost Containment System (Laurie Roberts, 7/30).

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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.