KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Alaska Doctors Overwhelmed By New Federal Rules

The new requirements for electronic medical records and other technological upgrades can be a heavy burden for Alaska’s small medical practices and aging physician workforce. (Annie Feidt, Alaska Public Radio Network, 11/24)

Political Cartoon: 'Unfriendly Skies?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Unfriendly Skies?'" by Randall Enos.

Here's today's health policy haiku:

WHAT DOES LAS VEGAS SAY?

How many sign-ups?
Politicians are cautious
Wall Street is bullish

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

HHS Eyes Auto Renewal Into Cheaper Plans

The proposed rules would also set up a permanent enrollment window that would run from Oct. 1 through Dec. 15 every year. Meanwhile, the administration is tightening rules about how insurers go about charging women for abortion coverage to ensure that federal money isn't used to cover the procedure.

The Wall Street Journal: Health Officials Propose Setting Fall Sign-Up Window Under Federal Health Law
The sign-up period for coverage under the federal health law will start Oct. 1 and run through Dec. 15 next year, and every year after, the Obama administration proposed in a rule released late Friday. The timing of the health law’s enrollment window has been the subject of debate. In the first year of the law’s exchanges, it started Oct. 1, 2013 and ran through March 31, 2014. This year, it started Nov. 15 and will run through Feb. 15, 2015. Some academics and supporters of the law have criticized the decision to schedule the period around the holidays, when consumers’ attention and wallets are stretched. Tax preparers have also said they could help more people sign up if the period included the spring. (Radnofsky, 11/21)

Bloomberg: Obamacare Users Would Move To Low-Cost Plans Under U.S. Proposal
Obamacare customers who choose to re-enroll in insurance plans would automatically default to cheaper coverage during sign-up periods, protecting them from price increases, under rules proposed by the U.S. government. The rules, which wouldn’t apply until the 2016 benefit year, were released yesterday by the Centers for Medicare and Medicaid Services. The changes, which also include requirements for insurers on the transparency of their rate increases, are open to public comment. (Harrison, 11/22)

Kaiser Health News: HHS Formally Moves To Close Loophole Allowing Plans Without Hospital Benefits
The Obama administration took another step to close what many see as a health-law loophole that allows large employers to offer medical plans without hospital coverage and bars their workers from subsidies to buy their own insurance. “It has come to our attention that certain group health plan designs that provide no coverage of inpatient hospital services are being promoted,” the Department of Health and Human Services said in proposed rules issued late Friday. Under the new standard, companies with at least 50 workers “must provide substantial coverage of both inpatient hospital services and physician services” to meet the Affordable Care Act’s threshold for a “minimum value” of coverage, the agency said. (Hancock, 11/24)

The Hill: CMS Reminds Insurers That ObamaCare Money Can't Pay For Abortions
The Obama administration is seeking to tighten how insurers segregate funds for abortion coverage on the ObamaCare exchanges after a scathing government investigation found the rules have been widely ignored. The Centers for Medicare and Medicaid Services (CMS) provided additional detail Friday about how health plans should go about charging women for abortion coverage that is handled separately from their other health benefits obtained on the exchanges. (Viebeck, 11/21)

Kaiser Health News: Wall Street Is Bullish On 2015 Obamacare Enrollment
A group of Wall Street analysts predicted Friday that enrollment in health law insurance plans will be higher than the 9 million projected by the Obama administration because insurers are aggressively courting new customers and more small businesses are likely to send workers to the online exchanges in 2015.(Appleby, 11/21)

In addition, publications look at what people need to know about the tax penalty for going without insurance -

Huffington Post: Obamacare Penalty Could Cost More Than You Expect
As you’ve probably heard, Obamacare requires most U.S. residents to obtain some form of health coverage, either from a job, a private insurance company or a government program like Medicaid. Failing to do so could mean taking a hit on your taxes. There’s been a lot of attention paid to the $95 tax penalty for people who are uninsured this year. But in reality, few people will pay that little, and high-income households could owe thousands of dollars when they file their 2014 taxes. Plus, the minimum penalty more than triples for the 2015 tax year. (Young, 11/21)

House GOP Sues Obama On Health Law

The suit says the administration acted unlawfully when it postponed penalties in the law for larger employers who don't offer health insurance, among other things.

Los Angeles Times: House Republicans Sue Obama Over Affordable Care Act Enactment
After searching for months to find an attorney who would take their case, House Republicans made good on their threat to sue the Obama administration Friday, filing a lawsuit challenging the president's authority to enact key parts of the Affordable Care Act. The case has been considered a long shot by legal scholars, as the Supreme Court has repeatedly rebuffed members of Congress suing on constitutional grounds. (Levey, 11/21)

The New York Times: House G.O.P. Files Lawsuit In Battling Health Law
The suit accuses the Obama administration of unlawfully postponing a requirement that larger employers offer health coverage to their full-time employees or pay penalties. (Larger companies are defined as those with 50 or more employees.) ... The suit also challenges what it says is President Obama’s unlawful giveaway of roughly $175 billion to insurance companies under the law. According to the Congressional Budget Office, the administration will pay that amount to the companies over the next 10 years, though the funds have not been appropriated by Congress. (Parker, 11/21)

Politico Pro: House Lawsuit Goes After ACA Cost Sharing
The House’s lawsuit against the Obama administration’s implementation of Obamacare includes a new charge against the law’s cost-sharing provisions. The suit says the administration has no authority to make payments to insurers to fund the cost-sharing program, as it began doing in January. The complaint contends the health care law requires cost-sharing payments from the insurers — presumably with the understanding that the government would repay them — but doesn’t make those payments contingent on the government and Congress appropriating the funding. (Haberkorn, 11/21)

The Wall Street Journal: House GOP Files Lawsuit Over Health Law
House Speaker John Boehner (R., Ohio) said in a statement that lawmakers had an obligation to act to protect the Constitution. “Time after time, the president has chosen to ignore the will of the American people and rewrite federal law on his own without a vote of Congress. That’s not the way our system of government was designed to work,” he said. (Crittenden and Kendall, 11/21)

CNN: Boehner: House GOP Files Obamacare Suit
The move was expected for months -- the GOP-controlled House of Representatives voted to approve the lawsuit in July. But Boehner had trouble retaining a law firm that would take the case because of the political furor over the controversial health care law. (Walsh and Bash, 11/21)

Politico: House Files Obamacare Lawsuit
The White House dismissed the lawsuit Friday as meritless and as a waste of money. “Instead of passing legislation to help expand the middle class and grow the economy, Speaker Boehner and House Republicans are spending hundreds of thousands of taxpayer dollars pursuing a lawsuit that is without any sound legal basis,” White House spokeswoman Brandi Hoffine said. (Gerstein and French, 11/21)

State Marketplaces Must Soon Prove That They Can Succeed Financially

The federal funding to get the marketplaces up and running will end soon, The Associated Press reports. Other outlets examine enrollment and outreach efforts in California, Connecticut, New York, North Carolina and Florida.

The Associated Press: Health Exchanges' Finances Face Test In 2nd Year
The federal government shelled out billions of dollars to get health insurance marketplaces going in the 14 states that opted to run their own. Now they must act like true marketplaces and start paying for themselves. Under President Barack Obama's Affordable Care Act, state-run health insurance exchanges need to be financially self-sustaining starting in January. Some appear to be on that path, while others have shaky funding models or even none at all. (Niedowski, 11/23)

Los Angeles Times: Immigration Overhaul Could Boost Latino Enrollment In Obamacare
President Obama's new immigration overhaul could increase Latino enrollment under his signature health law by reducing the threat of deportation and making more Californians comfortable signing up for coverage they already qualify to get. Over time, the initiative may also pave the way for more Californians to become eligible for state-funded Medi-Cal coverage. Friday, state officials were noncommittal about that idea, and said they would have to assess the effect of the president's immigration proposal. (Terhune and Brown, 11/22)

Connecticut Mirror: Access Health Says It Has 11,604 New Medicaid And Insurance Customers
In the first week of open enrollment, 2,659 new customers signed up for private insurance plans and 8,945 people signed up for Medicaid through Access Health CT, the state’s health insurance exchange. The figures include people who had not previously had coverage through Access Health. The exchange did not release the number of people who currently have coverage through the exchange and signed up for 2015 coverage. (Levin Becker, 11/21)

CNBC: Mount Sinai Chief: Obamacare Is Working
The first week of the second enrollment period for the federal health insurance marketplace established by the Affordable Care Act, better known as Obamacare, is nearing an end. Yet despite the endless controversies dogging the program, at least one person believes the legislation is meeting a lot of its goals. "We've improved access," said Dr. Kenneth Davis, CEO of New York's Mount Sinai Health System. "There are more patients than there were ever before." (Kramer, 11/22)

The Charlotte Observer: North Carolina's Rising Health Insurance Rates Demand Smart Strategies
People renewing health insurance bought on the Affordable Care Act exchange are seeing higher rate increases in Charlotte and North Carolina than most places across the country, a flurry of national analyses show. For instance, a Kaiser Family Foundation look at the largest city in each state found that only Anchorage, Alaska, had higher rates and bigger increases than Charlotte. North Carolina’s results vary with studies using different methods, but the state consistently comes out high. Enrollment for 2015 began Nov. 15 and runs through Feb. 15. As national policy analysts began crunching numbers, local customers got a look at their new rates. (Doss Helms, 11/21)

Health News Florida: Small Firms May Not Want SHOP
Brooke and Andrew Lee can't imagine being without health insurance. So for the past seven years, that's meant digging deep into the earnings of their video production agency in St. Petersburg. It’s expensive, but Brooke Lee says the alternative is worse. They would love to have company benefits and are curious about a feature of the Affordable Care Act called the Small Business Health Options Program, or SHOP. It offers tax credits for up to half of the premium costs an employer covers. (Shedden, 11/21)

Health Law In Jeopardy At Supreme Court Because Of Gridlock In Washington

Congress will not fix technical issues in the law, forcing the Supreme Court to rule on the legality of a part of the law that many say is merely a typo.

The New York Times: In Partisan Washington, Health Law Faces Grave Legal Technicalities
Today the Affordable Care Act faces grave danger before the United States Supreme Court because ... legislative repair work, once routine, has grown impossible. The challenge in King v. Burwell, the case that the court recently accepted, rests on a part of the law creating taxpayer subsidies for the purchase of health insurance through marketplaces “established by the state.” That phrase, the plaintiffs argue, prohibits subsidies for purchasers using marketplaces established by the federal government for the 37 states that do not have their own. ... A simple technical corrections bill, specifying that consumers using the federal marketplace would receive subsidies as well, would resolve the ambiguity. But his fellow Republicans, [Ron] Haskins says, will not “lift a finger” to fix a law they loathe. (Harwood, 11/23)

USA Today: Four Words That Could Deep-Six Obamacare
The most serious challenge to President Obama's health care law since it survived the Supreme Court by a single vote in 2012 isn't a balky website, public opinion or the Republican takeover of Congress. It's the Supreme Court — again. In a case likely to be heard in March and decided in June, the justices will dissect the meaning of four words on page 95 of the 906-page Patient Protection and Affordable Care Act — four words that could render health insurance premiums unaffordable for millions of Americans. Here's a look at the issues in King v. Burwell. (Wolf, 11/22)

TennCare Director Speaks About Political Difficulties Of Expanding Medicaid

Darin Gordon, in remarks to medical students, points to the state's experience 20 years ago when it tried on its own to expand TennCare. The state found that it could not support the program and scaled it back. Also, Medicaid expansion news from Virginia, New York and Kansas.

The Tennessean: TennCare Director Tries To Thread Needle On Medicaid Expansion
TennCare Director Darin Gordon gave medical students insight this week on a difficult task — finding a way for Tennessee to benefit from federal tax dollars already being collected from state residents. ... He said the discussions were ongoing, including dialogue this week. But he noted that an expansion would be a hard sell in Tennessee given the state’s experience in the mid-1990s, when it opened up TennCare under “the most ambitious expansion of health insurance the country had ever seen” — a program the state could not financially support and had to scale back. (Wilemon, 11/20)

The Washington Post: Puckett’s Senate Exit Undid McAuliffe’s Secret Plan For Medicaid Expansion
[Former Virginia State Sen. Phillip P. Puckett's] resignation exacerbated an increasingly partisan atmosphere in Richmond. Its reverberations are likely to make it more difficult for [Gov. Terry] McAuliffe to work with a GOP-controlled legislature to get anything done during the remainder of his term. The Washington Post interviewed more than a dozen people and reviewed scores of e-mails and text and voice messages to piece together new details about how Puckett’s resignation unfolded. (Vozzella, 11/22)

The Associated Press: NY's Poor Gain From Health Insurance Changes
A year into New York's operation of a medical insurance exchange, more than half of the people with new coverage qualified for Medicaid — the federal program for the poor — and many didn't know they were eligible until the push under the Affordable Care Act. Overall, 370,604 people were enrolled with commercial and nonprofit insurers, 525,283 in Medicaid; and 64,875 in the state's Child Health Plus coverage for families with moderate incomes. That's a total of 960,762. (Matthews and Thompson, 11/22)

The Kansas Health Institute News Service: Voter Opposition To Obamacare Led Dems To Shy Away From Medicaid Expansion
Post-election soul-searching by Kansas Democrats includes disagreement over whether Medicaid expansion should have been a larger part of the party’s strategy. The Democrats lost all statewide races for the second straight time and lost another five House seats to drop their number in that chamber to 27. The defeats were part of a national wave of Republican election wins, but they have nonetheless led to talk within the Kansas Democratic Party about what could have been done differently. (Marso, 11/21)

House Oversight Panel Calls On Gruber, Tavenner To Testify On Health Law Claims

The MIT economist and the CMS administrator have been called by Rep. Darrell Issa, R-Calif., to testify about "repeated transparency failures" on the health law.

Politico: Push For More Openness After Obamacare Data Mix-Up
Controversy over inflated Obamacare enrollment numbers has renewed demands for the administration to be far more open about sign-up data and other crucial aspects of the health care law. ... The [House Oversight Committee] has called CMS Administrator Marilyn Tavenner and former Obamacare adviser Jonathan Gruber — the center of a separate flare-up over the law’s passage — to testify next month about the “repeated transparency failures and outright deceptions.” (Norman and Pradhan, 11/22)

The Wall Street Journal: House Committee Calls Gruber To Testify At Obamacare Hearing
Jonathan Gruber, an MIT economist under fire for comments he made about the Affordable Care Act, is being asked to testify next month before Congress in a probe of the health law. The House Oversight and Government Committee has requested that Mr. Gruber and Marilyn Tavenner, administrator of the Centers for Medicare and Medicaid Services, appear Dec. 9 to testify about “transparency failures and outright deceptions” surrounding the Affordable Care Act, according to a press release issued Friday. (Armour, 11/21)

CNN: Issa Summons Jonathan Gruber To Capitol Hill Hearing
House Republicans are seizing on the opportunity to tie MIT economist Jonathan Gruber to President Barack Obama after a videos surfaced of Gruber insulting voters and saying Americans were mislead into supporting the President's signature health care law. (Peligri, 11/21)

The Washington Post: North Carolina Fires Gruber After Obamacare Remarks
North Carolina’s state auditor on Thursday terminated a contract with Jonathan Gruber, the MIT economics professor and health-care expert whose comments on the Affordable Care Act have generated fury among conservatives. Auditor Beth Wood (D) had hired Gruber to analyze the state’s Community Care of North Carolina program, which provides managed care to the poor and disabled. Gov. Pat McCrory (R) and state lawmakers involved in reforming the state’s Medicaid system were studying whether to include the Community Care program in the reformed system. (Wilson, 11/21)

Marketplace

Patients' Costs Mount When Oncologists Work For Hospitals

Many oncologists are selling their practices to hospitals, and consumers are finding that treatments suddenly cost more, with higher co-payments for patients and higher bills for insurers. Meanwhile, some experts are challenging the notion that the U.S. faces a growing doctor shortage.

The New York Times: Private Oncologists Being Forced Out, Leaving Patients To Face Higher Bills
When Dr. Jeffery Ward, a cancer specialist, and his partners sold their private practice to the Swedish Medical Center in Seattle, the hospital built them a new office suite 50 yards from the old place. The practice was bigger, but Dr. Ward saw the same patients and provided chemotherapy just like before. On the surface, nothing had changed but the setting. But there was one big difference. Treatments suddenly cost more, with higher co-payments for patients and higher bills for insurers. Because of quirks in the payment system, patients and their insurers pay hospitals and their doctors about twice what they pay independent oncologists for administering cancer treatments. (Kolata, 11/23)

Kaiser Health News: Some Experts Dispute Claims Of Looming Doctor Shortage
You hear it so often it’s almost a cliché: The nation is facing a serious shortage of doctors, particularly doctors who practice primary care, in the coming years. But is that really the case? Many medical groups, led by the Association of American Medical Colleges, say there’s little doubt. 'We think the shortage is going to be close to 130,000 in the next 10 to 12 years,' says Atul Grover, the group’s chief public policy officer. But others, particularly health care economists, are less convinced. (Rovner, 11/24)

And in Alaska, small physician practices say they're overwhelmed by federal rules -

Kaiser Health News: Alaska Doctors Overwhelmed By New Federal Rules
Dr. Oliver Korshin is a 71-year-old ophthalmologist in Anchorage – and he is not happy about the federal government’s plan to have all physicians use electronic medical records or face a Medicare penalty. A few months ago when he applied for an exemption to the latest requirement, he had to pick an exemption category that fit. "The only one that possibly applied to me was disaster," Korshin says. "So I picked disaster and I described my disaster as old age and I submitted as my supporting document a copy of my passport." (Feidt, 11/24)

Public Health And Education

After Kaci Hickox Furor, No One Else Flying To N.Y.C. Area Has Been Quarantined

The New York Times: Notable Absence Of New Ebola Quarantines At New York Area Airports
A day after a doctor who had returned from Guinea about a week earlier became New York’s first Ebola case, the governors of New York and New Jersey announced that they would begin quarantining travelers who had been in contact with Ebola patients in West Africa. ... But since Kaci Hickox, a nurse, flew into Newark’s airport on Oct. 24 and was kept at a hospital for three days, no one else has been caught up in the quarantine dragnet at the New York and New Jersey airports. (Hartocollis, 11/23)

Reports Depict Failed Mental Health System

Tens of thousands of people with severe mental health problems go without care and many end up on the street, as well as in jails and shelters, reports The Denver Post. Meanwhile, a report on Newtown Elementary School shooter Adam Lanza cites his parents' denial about the extent of his problems and missed opportunities to intervene by educators, mental health professionals and doctors.

The Denver Post: A Broken Mental Health System
Dee Fleming tried to protect her son from the voices in his head, the ones that told him he should die. One day last April, when he was oddly quiet and confused, almost catatonic, Fleming took him to Swedish Medical Center’s emergency room and told doctors he was suicidal. They sent him home. Two days later, Fleming’s son downed dozens of prescription medications and household cleaning supplies, doused himself with gasoline and set himself on fire in her front yard. He lived only because a neighbor called 911 to report something smoldering on the lawn. A police officer who knew him kept him conscious until an ambulance arrived. What came next for the Fleming family was almost as shocking, a battle for treatment that epitomizes the massive breakdown in care for mental illness in Colorado and the nation. (Brown, 11/22)

The Wall Street Journal: Report On Newtown Shooter Adam Lanza Cites Unaddressed Signs Of Trouble
The parents of Adam Lanza failed to comprehend and address the depths of his mental illness even as his Connecticut schools, pediatricians and psychiatrists struggled to coordinate their increasingly fraught efforts to help him, according to a report released Friday. In December 2012, Mr. Lanza shot and killed 20 children and six staff members at Sandy Hook Elementary School in Newtown before committing suicide. (De Avila, 11/21)

Los Angeles Times: New Report On Lanza: Parental Denial, Breakdowns, Missed Opportunities
A report released Friday by the Office of the Child Advocate pointed to the Yale episode as one of dozens of red flags, squandered opportunities, blatant family denial and disturbing failures by pediatricians, educators and mental health professionals to see a complete picture of Adam Lanza's "crippling" social and emotional disabilities. Although the report does not draw a line between the events in Adam Lanza's young life and the massacre, it points out repeated examples in which the profound anxiety and rage simmering inside Lanza was not explored in favor of attempts to manage his symptoms. (Griffin and Kovar, 11/21)

USA Today: Sandy Hook Killer Carefully Planned Attack, Study Says
The investigation delved deeply into Lanza's past, noting that his mental condition had gotten worse in his 10th grade, when he withdrew from most classes. It said he "progressively deteriorated in the last years of his life, eventually living in virtual social isolation." At the time of his death, the 6-foot tall Lanza was anorexic, weighing only 112 pounds, the report said. (Stanglin and Bello, 11/21)

Scrutiny Of Morcellator Tool Halts Its Use

The Wall Street Journal looks at the history of the tool used during hysterectomies and reports that some doctors continued it even after the risks of it spreading cancer were known.

The Wall Street Journal: A Medical Device Is Sidelined, But Too Late For One Woman
Dozens of cases have come to light this year of women whose cancers rapidly worsened after morcellation. The U.S. Food and Drug Administration warned in April that the tools can worsen cancer. The top U.S. morcellator maker, Johnson & Johnson, halted sales in April, and many hospitals have curtailed their use. While the newfound scrutiny of the morcellator may save lives, women like Mrs. Interlichia and their families are still paying a grim price for decisions they and their doctors made not long before the alarms rang. (Levitz and Kamp, 11/21)

The Wall Street Journal: Cancer-Risk Debate Didn’t Halt Surgeries
Doctors at a prominent Boston hospital continued to use a surgical tool during hysterectomies for two years after compiling data in 2011 that questioned the safety of the device and discussing its risks, said hospital officials and doctors. Brigham and Women’s Hospital curtailed use of the device, the laparoscopic power morcellator in December 2013, acknowledging it had spread a dangerous cancer in two of its patients, one in 2012 and the other in 2013. In March, the Harvard University-affiliated hospital became one of the first in the nation to stop using the tool. (Levitz, 11/23)

The Wall Street Journal: How Surgical Robots Spurred Morcellator Use
But as hundreds of thousands of U.S. women chose robotic hysterectomies for benign diagnoses, some doctors opted to use a technology the Food and Drug Administration in April warned can worsen cancer: the power morcellator. With more robots, “you have a bigger bucket of people getting morcellation, and that is why we are seeing more unwanted side effects, including disseminated cancers,” said Dr. Jason Wright, Columbia University Medical Center’s division chief of gynecologic oncology. (Levitz and Kamp, 11/21)

Medicare

Lawsuits: Medicare Advantage Plans Boost Payments By Claiming Sicker Patients

Also, retirees of big companies are being moved off of health plans, and advocates help African Americans understand their elevated risk of Alzheimer's.

Modern Healthcare: Were Patients Really Sicker? Lawsuits Say Medicare Advantage Plans Inflated Diagnoses To Boost Payments
For an 82-year-old man with diabetes and rheumatoid arthritis, the CMS will pay a Medicare Advantage plan a certain amount of money each month. Add renal failure and hemiplegia to the list of maladies, and the CMS' monthly payment to his plan skyrockets. It could mean $2,282 a month versus $1,149, experts say.The CMS pays private Medicare Advantage plans under a severity-adjusted model designed to give insurers a financial incentive to take sicker enrollees. But critics, including HHS' Office of the Inspector General, say the severity-adjusted payment model is being abused by some plans and providers, costing taxpayers billions annually. (Schencker, 11/22)

Milwaukee Journal-Sentinel: Large Companies Moving Retirees Off Health Care Plans
Relatively few companies have opted to stop offering health benefits to retirees completely. But as health care costs have steadily risen and as people live longer, more firms have taken steps to limit the benefits. Among large employers — those with 1,000 or more workers — 60% have instituted caps on benefits for retirees eligible for Medicare, according to an annual survey by Towers Watson and the National Business Group on Health. (Boulton, 11/22)

The Washington Post: Alzheimer’s Risk Is Higher In African Americans, But Many Fear Clinical Studies
Studies show that older African Americans are almost twice as likely as whites to develop Alzheimer’s disease for genetic, biological and socioeconomic reasons. ... Yet relatively few African Americans want to talk about Alzheimer’s, which is the leading cause of dementia. For historical reasons, even fewer want to participate in clinical research trials that could deliver benefits to themselves and future generations. ... The effort to engage African Americans on Alzheimer’s comes as the U.S. population ages and becomes more diverse. (Kunkle, 11/23)

State Watch

State Highlights: Md. Medicaid To Provide Gender Transition Services; Ill. To Refund Retiree Health Care Money

A selection of health policy stories from Maryland, Iowa, California, Massachusetts, Illinois, Montana, Florida, Oregon, Minnesota and Wyoming.

The Baltimore Sun: Maryland To Expand Medicaid Coverage For Transgender Patients
Health officials in Maryland are moving for the first time to provide transition-related health care coverage to low-income transgender residents who receive Medicaid in the state. The action mirrors a similar move the state took this summer, amid negotiations with advocacy organizations, to provide state employees access to gender reassignment surgery, hormone therapy and other transition-related care under their state-provided health insurance plans. (Rector, 11/21)

The Associated Press: State To Refund Retiree Health Care Money
The state will refund money to about 75,000 state retirees who've been paying a portion of their pensions for health insurance over the last year and a half after a court hearing in Sangamon County. Judge Steven Nardulli on Friday scheduled a Dec. 18 hearing to establish how to distribute more than $60 million to the retirees. Attorneys estimate the money will be returned by spring. Retirees began paying a percentage of their annuity under a 2012 law. (11/21)

The Des Moines Register: Wellmark Offers Health Incentives In New Plans
Iowa’s largest health-insurer will soon offer gift cards and fitness bracelets to members who participate in wellness efforts under a new set of insurance plans. Wellmark Blue Cross & Blue Shield is teaming with the UnityPoint Health system and Hy-Vee pharmacies to provide the “Blue Rewards” plans. Members will face smaller co-pays and deductibles if they obtain care at UnityPoint clinics and hospitals and if they have prescriptions filled at Hy-Vees than if they go to other providers. (Leys, 11/21)

Los Angeles Times: Medical And Tech Researchers See Smartphones As Health's Next Frontier
The West Hollywood club scene was just picking up as Charles Lea and other UCLA grad students fanned out along Santa Monica Boulevard. Their goal that evening: Find young black men, gay and bisexual, willing to participate in a study on how smartphone apps can help improve overall health and combat diseases such as AIDS and diabetes. ... The effort reflects both the potential and the challenges facing investors, medical experts and government officials who want to harness the reach and power of mobile phones to revolutionize healthcare. (Brown, 11/22)

WBUR: Baker Taps Marylou Sudders To Lead Health And Human Services Department
Gov.-elect Charlie Baker is choosing someone he worked with in the Weld administration to lead the largest agency in the state — the Department of Health and Human Services. Baker said Friday he tapped Marylou Sudders for the post in part because of her collaborative spirit. Several groups are praising his choice, citing Sudders’ work as the former state mental health commissioner and former head of the Massachusetts Society for the Prevention of Cruelty to Children. (Becker, Bebinger and Jolicoeur, 11/21)

Modern Healthcare: Growing Community-Based Doctors
Medical white-coat ceremonies don't usually get much media attention. But when the Billings (Mont.) Clinic held its white-coat ceremony this past July to welcome its inaugural class of 12 internal medicine residents, “our mayor was there, our board was there, all the papers, radio and TV stations were there,” said Dr. Roger Bush, the program's director. “That doesn't happen in Boston.” The ceremony was an important occasion for Billings, an integrated health system that includes a 240-physician group practice, a 285-bed hospital, a network of rural clinics and a nursing home. For the residents' first year, they'll spend most of their time close to the mother ship in Billings. But second- and third-year residents will spend more time at rural affiliates including a satellite clinic in Miles City, a farming community about 150 miles east. (Robeznieks, 11/22)

BrowardBulldog.org: FBI Probes Claim Of $130M Health Care Scam
Since being founded 64 years ago as a convalescent home for elderly Jewish people and war veterans, Plaza Health Network has nurtured a reputation for providing top-notch services to senior citizens of all denominations who can no longer take care of themselves. But a little-noticed whistleblower’s lawsuit filed in Miami federal court by an ex-Plaza executive alleges the non-profit company scammed the federal government for $130 million. (Alvarado, 11/21)

Reuters: Landmark Open Meeting On Agent Orange Held At Oregon VA Hospital
Vietnam War veterans on Saturday called for more research into the health effects of U.S. service members' exposure to Agent Orange, in a first of its kind open meeting at a VA hospital in Portland, Oregon, on the lingering effects of the chemicals. ... About 130 veterans attended the meeting at the U.S. Department of Veterans Affairs Medical Center in Portland. It was the first time the VA allowed the nonprofit Vietnam Veterans of America to hold an Agent Orange town hall at one of its hospitals, said Mokie Porter, spokeswoman for the group. (Sherwood, 11/22)

The Pioneer Press: Mother Of Low-IQ Sex Offender Worries About Loss Of Therapy Program
Although never charged with a crime, Clark Potter forced himself on his girlfriend at a group home for the mentally disabled some 20 years ago, his mother said. He later sexually assaulted a staff member's young child. As a result, he spent a year in a state psychiatric facility, followed by 20 years in group therapy. For three hours a day, up to five days per week, he has met with therapists and other low-IQ sex offenders at ABC Mental Health Therapy on Payne Avenue in St. Paul. That door is now closed. After losing a Ramsey County contract, the nonprofit officially called it quits Friday, capping nine years of running the "Onward" group therapy program in St. Paul. Metropolitan Community Mental Health Center ran Onward from 1970 to 2005 before it went out of business. (Melo, 11/23)

The Laramie Boomerang: Wyoming Small City Hospital Pushing To Recruit More Physicans
Officials at Ivinson Memorial Hospital in Laramie are pushing to recruit more physicians but say it's a tough thing to do in a small city in Wyoming. Hospital CEO Doug Faus says recruiting physicians to Laramie is tougher than getting them to consider bigger cities such as Fort Collins, Colorado. He says Ivinson has to make better offers to physicians than are made elsewhere. (Steere, 11/22)

Editorials And Opinions

Viewpoints: Dismantling Health Law 'Piece By Piece'; Democrats Are 'Own Worst Enemy'

A selection of opinions on health care from around the United States.

The New York Times: The Piecemeal Assault On Health Care
Now that they will dominate both houses of Congress, Republicans are planning to dismantle the Affordable Care Act piece by piece instead of trying to repeal it entirely. They are expected to hold at least one symbolic vote for repeal in the next session so that newly elected Republicans who campaigned against the law can honor their pledges to repeal it. ... All of the provisions they are targeting should be retained — they were put in the reform law for good reasons. (11/22)

Bloomberg View: Why Do Democrats Look Down on Voters?
I support many Democratic policy positions and want to see them succeed. The Affordable Care Act, in particular, is a worthy endeavor: Despite the botched rollout and a great deal of unfinished business, I want to see it prevail. Sometimes, though, [the party] is its own worst enemy. ... All salesmen sell -- but some respect their customers, whereas others look down on them. Too many Democrats fall into the second camp, and too few of those are any good at disguising it. In this respect, Gruber, who calls himself a "card-carrying Democrat," is typical of many in the party -- and Democrats are different from Republicans. (Clive Crook, 11/23)

Los Angeles Times: House GOP Lawsuit Wages Surprising Fight Over Federal Purse Strings
When the House GOP authorized a lawsuit accusing President Obama of overstepping his authority, the rationale it offered was a head-scratcher: the administration's move to delay the employer mandate, a requirement that House Republicans unanimously opposed. The lawsuit filed Friday devotes only half of its attention to that issue, however. The other half takes up a topic much more important to Republicans in Congress, and indeed to any lawmaker in a divided government: the power of the purse. (Jon Healey, 11/21)

The New York Times: Change In Health Care Law Would Take Aim At Consumer Inertia
People who bought Affordable Care Act health plans for 2014 but who don’t go back to shop again for 2015 will automatically keep the plan they first chose, even if its price goes way up. Now the federal government is proposing that when people sign up, they should get a choice of defaults for future years: to stay in the same plan, or switch to a cheaper one in the same category if theirs gets too pricey. The proposed regulation, published Friday, suggests phasing in the additional choice, first giving states with their own exchanges the option of offering it. (Margot Sanger-Katz, 11/21)

Toledo Blade: Medicaid Matters
Expanding Medicaid over the opposition of other Republicans marks Gov. John Kasich’s greatest first-term achievement. His top priority now must be to ensure that the health-care expansion for low-income Ohioans continues, even if he has to threaten, cajole, or beg members of the General Assembly. If facts or fear don’t move legislators, Mr. Kasich should bring the faces and stories of expansion inside the Statehouse walls and shame them into action. (11/23)

Tallahassee Democrat: Mental Health Issues Need Our Attention
Maybe now that we are again back in the national spotlight over violence resulting from untreated or misunderstood mental illness we can have a serious community conversation about mental health. ... Here we are again. Myron Deshawn May, 31, was shot to death by police after he opened fire Thursday morning in Florida State University's crowded Strozier Library. ... surely, we can all see the value in elevating the conversation about mental health and we urge our community leaders — city, county, school, law enforcement, Department of Health, the state Legislature and our colleges and universities — to come together, devoting more time and if needed resources. We can't simply shrug our shoulders and put the responsibility elsewhere this time. (11/23)

The New York Times: Will Texas Kill An Insane Man?
On Dec. 3, Texas plans to execute an inmate named Scott Panetti, who was convicted in 1995 for murdering his in-laws with a hunting rifle. There is no question that Mr. Panetti committed the murders. There is also no question that he is severely mentally ill, and has been for decades. (11/23)

The Washington Post: What Happens When Your Pregnant Sister-In-Law Is Paralyzed In An Accident — And Has No Insurance.
MIT political scientist Andrea Campbell is known for her research on Social Security, Medicare, and other safety-net policies. Yet when Campbell’s pregnant sister-in-law suffered a spinal cord injury, their family’s on-the-ground experience was more bewildering and difficult than Campbell expected. Her new book describes these experiences. Below is an edited and condensed transcript of our conversation. (Harold Pollack, 11/23)