KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

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Political Cartoon: ‘War Chest?’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘War Chest?’" by Steve Kelley and Jeff Parker, from 'Dustin'.

Here's today's health policy haiku:


It is no surprise
That few hospitals ranked high
On new star ratings.

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Health Law Issues And Implementation

Florida Governor Vows To Sue Obama Administration Over Hospital Funding

Gov. Rick Scott says the federal government is illegally trying to coerce Florida into expanding its Medicaid program by withholding funds for hospitals.

The New York Times: Florida Governor to Sue Obama Administration Over Medicaid Expansion
A standoff over expanding Medicaid in Florida escalated on Thursday after Gov. Rick Scott, a Republican, said he planned to sue the Obama administration for using what he called “coercion tactics” to try to pressure the state into adopting the program, a centerpiece of the president’s contentious Affordable Care Act. In a letter this week, the federal government made clear that unless the Republican-controlled state legislature moved forward with Medicaid expansion, it could lose as much as $2.1 billion in federal dollars to help hospitals care for the uninsured. The federal aid is scheduled to expire June 30. (Alvarez, 4/16)

The Associated Press: Florida Governor Says He'll Sue Obama Over Hospital Money
Florida Gov. Rick Scott said Thursday he is suing the Obama administration for withholding federal money for hospitals that serve the poor, saying they are doing so because the state won't expand Medicaid. The announcement is another twist in what has been a gritty yearlong battle with the feds over roughly $1 billion in funds for Florida hospitals. The fight has come to a head as the state Legislature works to finalize a state budget before May 1. (Kennedy and Fineout, 4/16)

The Wall Street Journal: Florida Plans Legal Action Over Health Fund
A spat between Florida officials and the Obama administration about the future of a fund providing more than $1 billion a year for hospitals escalated Thursday when Republican Gov. Rick Scott said he would take legal action. ... Federal officials say they have concerns over the structure and management of Florida’s fund and want the state to make changes to it before agreeing to continue funding it. Mr. Scott has accused Washington of trying to withhold the money to force the state to expand Medicaid eligibility under the Affordable Care Act. (Radnofsky, 4/16)

Reuters: Florida Governor Fights Obama Administration Over Healthcare Funding
Scott singled out a letter in which federal officials acknowledged this week a connection between Medicaid expansion and negotiations over the state's "Low Income Pool." Florida stands to lose about $1 billion annually in federal funding to pay hospitals for treating needy patients. The Democratic president is "crossing the line into a coercion tactic" in violation of a 2012 Supreme Court ruling allowing each state to decide on expansion, Scott contended. (Cotterell and Stein, 4/16)

Politico: Florida To Sue Over Obamacare Medicaid Expansion
The Obama administration quickly accused Scott of misconstruing that court decision because the state is not being forced to do anything. And White House spokesman Josh Earnest blasted the governor for putting politics above people. “It’s difficult to explain how somebody would think that their political situation and their political interest is somehow more important than the livelihoods of 800,000 people,” Earnest said. (Caputo and Pradhan, 4/16)

Miami Herald: Gov. Rick Scott Sues Feds Over Healthcare Money, Medicaid Expansion
The legal maneuver, which comes amid a tense standoff between the House and Senate over Medicaid expansion, was simultaneously lauded and lambasted. It also complicates negotiations over this year’s budget. ... “From where I sit, it is difficult to understand how suing CMS on day 45 of a 60-day session regarding an issue the state has been aware of for the last 12 months will yield a timely resolution to the critical healthcare challenges facing our state,” said Senate President Andy Gardiner, R-Orlando. The suit, which has yet to be filed, is only the latest round in an ongoing feud between Scott and CMS in connection with the LIP. (McGrory and Bousquet, 4/16)

Meanwhile, former Florida Gov. Jeb Bush was asked about the dispute while he was exploring a run for president.

Tampa Bay Times: Jeb Bush: Feds, Tallahassee Should 'Try To Forge A Compromise' On Medicaid Expansion, Hospital Funding
Bush hadn't heard of the yet-to-be-filed lawsuit, but suggested all sides sit down and find a solution. "The feds and the executive branch and representatives from the House and Senate ought to get together and try to forge a compromise," he said. But would such a compromise involve expanding Medicaid, as proposed under the Affordable Care Act and rejected by the GOP-controlled Florida government in the past? "I don't know," Bush said. "That's their job, frankly. Expanding Medicaid without reforming it is not going to solve our problems over the long run." (Mazzei, 4/16)

Enforcement Of Birth Control Mandate Temporarily Halted For Pa. Catholic Groups

The Supreme Court stopped enforcement of the health law's birth-control mandate against several Catholic organizations in Pennsylvania, pending a response from the Obama administration. Meanwhile, a Kaiser Family Foundation report finds that some women are paying hefty fees for contraception, despite a health law requirement that insurers provide no-cost access to FDA-approved methods.

The Hill: Supreme Court Halts Birth Control Mandate For Groups
The Supreme Court is temporarily halting the enforcement of ObamaCare’s contraception mandate against several Catholic organizations in Pennsylvania. In a ruling issued late Wednesday, Justice Samuel Alito said the mandate is “recalled” pending a response from the federal government. (Ferris, 4/16)

The Washington Examiner: Birth Control Mandate Falling Short
A new study confirms what women's advocates have long suspected: Insurers still place lots of limits on covering birth control despite the healthcare law's requirements to do so. Kaiser Family Foundation researchers found many health plans don't include all types of federally-approved contraception or they collect co-pays or require other steps before covering it, in a review of contraceptive coverage by 20 different plans in California, Georgia, Michigan, New Jersey and Texas. As a part of the Affordable Care Act, insurers are required to cover all types of birth control approved by the Food and Drug Administration without charging a co-payment, according to rules issued by the Obama administration. But researchers found that not all insurers are in full compliance, especially when it comes to intrauterine devices, implants, patches or rings. (Cunningham 4/16)

NPR: Study: Insurers Fail To Cover All Prescribed Contraceptives
Some women may be paying hefty fees for birth control pills, vaginal rings and emergency contraception, despite a federal requirement that insurers pay their full cost. And some women only have coverage for a less effective type of emergency contraception, according to a report released Thursday by the Kaiser Family Foundation. The analysis looked at 20 health insurers in five states and found companies that provided limited or no coverage for some forms contraception. In some cases, the insurers imposed copays or required women to pay the full cost of a drug. (Kelto, 4/16)

Meanwhile, a secret shopper survey in Washington finds that insurers are giving women incorrect information -

Obamacare Draws Praise, Criticism In Appalachia

USA Today and The Louisville Courier-Journal examine how the Affordable Care Act has put down roots in Floyd County, Ky., in ways both surprising and expected. And Kaiser Health News notes there's still time to avoid next year's tax penalty for not having health insurance.

USA Today/Louisville Courier-Journal: 'Obamacare' Takes Root In Remote Appalachia To Mixed Reviews
Obamacare flooded into these remote Appalachian hills last year like the War on Poverty had a half-century earlier — another government program promising to save some of America's most vulnerable citizens. Since then, it has given many of the poor and sick a key to long-neglected health care. It's also brought skepticism and fear, and some business owners argue it's stunting their growth in a region that can't afford another economic blow. (Ungar and Kenning, 4/17)

Study Shows Steep Drop In Uninsured In Medicaid Expansion States

Also, news outlets examine efforts in Utah and Alaska to implement Medicaid expansions, while in Minnesota advocates are worried about GOP plans to cut back a health program that also serves low-income residents. And Politico checks in on a program championed in Florida by Marco Rubio to help expand insurance coverage.

The Hill: Uninsured Rate Falls By Half In States That Expanded Medicaid
The number of people lacking health insurance dropped by half in the 29 states that expanded Medicaid under ObamaCare, far more than states that did not agree to the expansion, according to new data. While all states saw major increases in coverage under ObamaCare, the biggest differences were seen in states that accepted federal dollars to expand eligibility for Medicaid, according to new figures from the Urban Institute’s Health Reform Monitoring Survey. (Ferris, 4/16)

The Associated Press: Utah Governor Plans Washington Visit For Medicaid Talks
Gov. Gary Herbert said Thursday that he and some Republican state lawmakers are planning a trip to Washington, D.C., at the end of April with the hope of working toward a Medicaid expansion deal. Herbert, a Republican, said at his monthly televised news conference on KUED-TV that the group, which includes Senate President Wayne Niederhauser and House Speaker Greg Hughes, is working to set up a meeting with federal health officials. (Price, 5/16)

Alaska Dispatch News: Even Alaska Conservatives Support Medicaid Expansion, Pollster Says
Alaskans from every region of the state support expansion of Medicaid, said pollster Ivan Moore, putting new pressure on legislators who oppose expansion and say they are reflecting their constituents' views. "Even in the most conservative, Republican areas of the state, Fairbanks and the Mat-Su, it's still 2-1 in favor," Moore said. Moore's poll, part of his company's quarterly Alaska survey, showed 65 percent of Alaskans in favor of expansion, with 22 percent opposed. That's close to a poll conducted for the Republican-led House majority caucus a few weeks ago that showed 60 percent in favor. (Forgey, 4/16)

Alaska Dispatch News: Question In Juneau: Combine Medicaid Expansion With Reforms, Or Reforms Alone?
Trying to understand the four Medicaid bills working their way through the Alaska Legislature? Good luck, unless you have a graduate degree in public health. The changes proposed by Gov. Bill Walker and Republican lawmakers to the complex, $600 million-a-year state-federal health care program have generated significant confusion and consternation both inside and outside the Legislature. Recent efforts to explain them have included hasty fax messages sent to hundreds of doctors, a sharp response from the state’s health commissioner, and even an analogy comparing the federal government to Darth Vader, the infamous masked villain in the Star Wars movies. (Herz, 4/16)

The Pioneer Press: If MinnesotaCare Goes, Here's What's At Stake
In 49 states, there are basically two options for public health insurance programs: Medicaid for the very poor, and subsidized private health insurance on the Affordable Care Act's exchanges for everyone else. Minnesota is the exception. Unlike every other state, it has a third option in the middle: MinnesotaCare. (Montgomery, 4/16)

Minnesota Public Radio: GOP Health Plan Would End MinnCare, Shift Payments
Republicans in the Minnesota House took the wraps off a health and human services budget bill Thursday that cuts about $1 billion over the next two years, money Republicans want to use to help pay for tax cuts. The bill ends MinnesotaCare, shifts payments to insurance companies to future years, cuts Human Services Department spending and adds money for nursing homes. (Richert, 4/16)

Politico: Rubio-Backed Insurance Market Covers 80 People
In 2008, while Democrats were declaring that the time was right for national health care reform, Marco Rubio, the speaker of the Florida House, had a ready response: Florida should build a market-based system that would help contain the cost of insurance and make it more available. ... Florida Health Choices, which finally opened last year, now covers 80 people. Obamacare, which Rubio wants to repeal, covers 1.6 million in Florida alone. And 93 percent of them are subsidized. ... Rubio spokeswoman Brooke Sammon said the senator continues to support a “true free-market exchange,” and she blamed Obamacare’s subsidies for luring buyers away from Florida Health Choices. (Pradhan, 4/17)

Administration News

Government OKs Financial Incentives, Penalties For Workplace Wellness Programs

In a victory for business groups, federal regulators proposed new rules for workplace wellness programs that would allow employers to use significant financial incentives to push workers to participate. The Equal Employment Opportunity Commission also proposed safeguards for employees, but consumer advocates say they don't go far enough.

Reuters: Obama Administration To Remove Hurdle To 'Wellness' Penalties
In what would be a significant and hard-fought victory for U.S. businesses, the Obama administration on Thursday said it will propose new rules for workplace wellness programs that would treat as voluntary programs that penalize workers thousands of dollars for not participating. (Begley, 4/16)

The Associated Press: Financial Incentives OK'd For Workplace Wellness Programs
In a victory for business, federal regulators said Thursday that employers can continue to use financial penalties and rewards to nudge staff to participate in fast-growing workplace wellness programs. But the Equal Employment Opportunity Commission — which enforces laws against discrimination — also proposed some safeguards for employees. Those include limits on the size of financial incentives, confidentiality of employee medical information and prohibitions against firing workers who decline to participate or denying them access to the company health plan. (Alonso-Zaldivar, 4/16)

The Wall Street Journal: EEOC Issues Proposal For Wellness Programs
The Equal Employment Opportunity Commission on Thursday released a long-awaited preliminary rule to help companies design their employee-wellness programs. The agency will accept public comments until June 19, and then issue a final regulation. The EEOC suggests in its proposal that employers can offer incentives — or, conversely, penalties — amounting to no more than 30% of the total cost of an employee-only health plan to participate in their wellness plans. If a worker is on a family plan that costs $12,000, for example, but the individual plan costs $6,000, the incentives or penalties must max out at $1,800. (Weber, 4/16)

Politico Pro: EEOC Wellness Rule Raises More Questions
The EEOC set out to clarify when participation in a wellness program might be deemed “voluntary” under the Americans with Disabilities Act. But the regulation it proposed Thursday raises more questions than it answers. (Levine, 4/16)


Obama Signs 'Doc Fix' Bill Overhauling How Medicare Pays Doctors

The signing brings to an end years of last-minute fixes and contentious debate over how Medicare pays doctors while also tying doctors' compensation to the quality of care they provide. The law also continues funding for the Children's Health Insurance Program for two years.

The Associated Press: Obama Signs Overhaul Of How Medicare Pays Doctors
Ending years of last-minute fixes, President Barack Obama on Thursday signed legislation permanently changing how Medicare pays doctors, a rare bipartisan achievement by Democrats and Republicans. The bill overhauls a 1997 law that aimed to slow Medicare's growth by limiting reimbursements to doctors. Instead, doctors threatened to leave the Medicare program, and that forced Congress repeatedly to block those reductions. (Kuhnhenn and Fram, 4/16)

USA Today: Obama Signs 'Doc Fix' Bill In The Rose Garden
The president praised congressional leaders from both parties for the "doc fix" bill that includes provisions for a children's health care program. He said the plan will make the health care system "smarter," without denying service. "This was a bipartisan effort, Republicans and Democrats coming together to do something that's smart and common sense," Obama said. "My hope is it becomes a habit." He declined to take questions, including one about how the bill might affect the budget deficit. (Jackson, 4/16)

Reuters: Obama Signs Bill Fixing Medicare Doctors' Pay
U.S. President Barack Obama signed a bill into law on Thursday that repairs the formula for reimbursing Medicare physicians after Congress, in rare bipartisan fashion, passed a fix earlier this week to prevent a 21 percent cut in doctors' pay. (4/16)

Few Hospitals Get Five Stars For Patient Satisfaction

National and regional media outlets analyze the newly released star ratings for hospitals based on patient satisfaction surveys.

Chicago Tribune: Few Chicago-Area Hospitals Shine In Government's New Patient Star Ratings
In Illinois, the Chicago area stood out for having some of the lowest-rated hospitals — six received just one star — along with a handful of highly rated facilities that have focused on making hospital visits less unpleasant. Of the 65 hospitals rated in Cook and the collar counties, just one received the top score of five stars: Midwestern Regional Medical Center, a cancer treatment center in Zion. Fourteen received four stars, according to Medicare data posted Thursday to the federal Hospital Compare site. (Venteicher, Hirst and Rau, 4/16)

Philadelphia Inquirer: 12 Local Hospitals Score High In Medicare's New Star System
The mind-bogglingly complex American health-care system took a step toward user-friendliness Thursday when the federal government assigned star ratings - 1 to 5, like restaurant and movie reviews - for patient satisfaction at thousands of U.S. hospitals. ... Many leading hospitals received middling ratings, while comparatively obscure community hospitals and others that specialize in lucrative surgeries frequently received the most stars. In the Philadelphia region, for example, just two hospitals - Physicians Care Surgical Hospital in Montgomery County and Cancer Treatment Centers of America's Eastern Regional Medical Center in Crescentville - scored five stars. Ten, including the highly regarded Hospital of the University of Pennsylvania, received four stars. (Sapatkin, 4/16)

The Charlotte Observer: Charlotte-Area Hospitals Rank Good To Average In New Ratings
In an effort to make evaluating hospitals more like comparing refrigerator models and restaurants, the federal government has awarded its first star ratings to hospitals based on patients’ appraisals. Like many of the nation’s leading hospitals, most Charlotte-area hospitals received middling ratings. By comparison, some obscure hospitals and others that specialized in lucrative surgeries frequently received the most stars. (Rau and Garloch, 4/16)

The Baltimore Sun: No Maryland Hospital Gets Five Stars Under New Federal Rating System
Maryland hospital, not even world-renowned Johns Hopkins Hospital, earned a top score under a new, simplified ranking system for patient satisfaction released Thursday by federal health care authorities. The new system — which assigns one to five stars — is based on patient surveys and aims to make it easier for consumers to digest information, according to the U.S. Centers for Medicare and Medicaid Services, which publishes the survey information as well as some safety measurements on its Hospital Compare website. (Cohn, 5/16)

Public Health And Education

E-Cigarette And Hookah Use By Teens Sharply Increases

While traditional smoking rates are declining, the number of high school students who used e-cigarettes or water pipes jumped to 13 percent, according to a CDC report. About one in four teens use some form of tobacco product.

Los Angeles Times: Teen Use Of E-Cigarettes Continues To Soar, Alarming Many Experts
The use of electronic cigarettes by high school students tripled from 2013 to 2014 — a surprising boom that threatens to wipe out hard-won gains in the fight against teen smoking, a new government report says. The percentage of American high school students who smoked traditional cigarettes on a regular basis dropped from 15.8% in 2011 to 9.2% in 2014, according to a study by a team from the Centers for Disease Control and Prevention. But that drop has been more than offset by increases in e-cigarette use, which increased from 1.5% of high school students in 2011 to 13.4% in 2014, the study says. (Kaplan and Brown, 4/16)

The New York Times: Use of E-Cigarettes Rises Sharply Among Teenagers, Report Says
E-cigarettes have arrived in the life of the American teenager. Use of the devices among middle- and high school students tripled from 2013 to 2014, according to federal data released on Thursday, bringing the share of high school students who use them to 13 percent — more than smoke traditional cigarettes. The sharp rise, together with a substantial increase in the use of hookah pipes, led to 400,000 additional young people using a tobacco product in 2014, the first increase in years, though researchers pointed out it fell within the margin of error. (Tavernise, 4/16)

NPR: Use Of E-Cigarettes Triples Among U.S. Teens
A national survey confirms earlier indications that e-cigarettes are now more popular among teenage students than traditional cigarettes and other forms of tobacco, federal health officials reported Thursday. The findings prompted strong warnings from Dr. Tom Frieden, head of the Centers for Disease Control and Prevention, about the effects of any form of nicotine on young people. "We want parents to know that nicotine is dangerous for kids at any age," Frieden said. (Stein, 4/16)

The Washington Post: E-Cigarette Use Triples Among Middle And High School Students, Study Says
Not everyone sees such cause for alarm in the new numbers. “The CDC should really be jumping for joy at the fact that smoking rates are declining. This is a huge success,” said Michael Siegel, a professor and tobacco-control specialist at Boston University’s School of Public Health. “Instead, they are using this as another opportunity to demonize e-cigarettes.” Siegel said he agrees that minors shouldn’t have access to any tobacco product. But he said the CDC numbers suggest that rather than serving as a gateway to cigarette smoking, e-cigarettes actually might be diverting teens from traditional cigarettes. (Dennis, 4/16)

The Wall Street Journal: E-Cigarette, Hookah Use Rises Among U.S. Teens As Cigarette Use Falls
Electronic cigarette use tripled and hookah use doubled among U.S. teenagers in 2014, even as fewer of them light up traditional cigarettes, according to a government survey published Thursday. For the first time, more high-school students puffed on e-cigarettes last year—13.4%—than regular smokes—9.2%. They also tried hookahs, or water pipes, as often as traditional cigarettes for the first time, according to the Centers for Disease Control and Prevention. (Esterl, 4/16)

Veterans' Children Struggle To Handle The Wounds Of War

The Washington Post examines how families work to restore normal lives after veterans return from Iraq and Afghanistan.

The Washington Post: When Veterans Return, Their Children Also Deal With Invisible Wounds Of War
In households nationwide, hundreds of thousands of wounded parents have come home from the wars in Iraq and Afghanistan, and their children are struggling to navigate the invisible wounds — traumatic brain injuries and post-traumatic stress disorder, which together afflict an estimated 30 percent of the 2.7 million former troops. The everyday toll on children is unprecedented, advocates for veterans’ families say, because their parents have complex injuries that would have ended their lives in wars past, before recent medical advances, and suffer from the psychic scars of multiple deployments. (Wax-Thibodeaux, 4/16)

Also in the news is a story about how families cope with the difficulties of a loved-one's Alzheimer's disease.

The Associated Press: Families Make Videos To Reassure Patients With Dementia
For 94-year-old Louise Irving, who suffers from dementia, waking up every day to a video with a familiar face and a familiar voice seems to spark a flicker of recognition. "Good morning, merry sunshine, how did you wake so soon?" Irving's daughter, Tamara Rusoff-Hoen, sings in a video playing from a laptop wheeled to her mother's nursing home bedside. (Fitzgerald, 4/17)

Capitol Hill Watch

McConnell Says GOP Will Use Spending Bills To Extract Policy Concessions

The Senate's majority leader says his party is eager to cut back on government regulations. Also, Sen. Harry Reid, the Democratic leader, pledges to fight hard to get past the abortion debate to a vote on Loretta Lynch's nomination for attorney general.

The Wall Street Journal: McConnell Vows ‘Big Fights Over Funding’
Senate Majority Leader Mitch McConnell (R., Ky.) vowed “some big fights over funding the bureaucracy,” saying his party would use spending bills now being written in the GOP-controlled Congress to extract policy concessions from President Barack Obama. ... “Whether it’s health care, whether it’s financial services—literally an assault on anybody in the country who’s making a profit, with the view that if you’re making a profit you must be up to no good,” Mr. McConnell said about federal regulations in an interview this week with The Wall Street Journal after the completion of his first 100 days running the Senate. (Hughes and Peterson, 4/16)

Politico: Harry Reid Threatens Hardball Tactics To Get Lynch Vote
Senate Minority Leader Harry Reid is warning he will use hardball floor tactics to force a vote on stalled attorney general nominee Loretta Lynch if Republicans don’t call her up for a vote “very soon.” ... Majority Leader Mitch McConnell (R-Ky.) has tied Lynch’s nomination to a stalled trafficking bill, thereby delaying her confirmation and infuriating Democrats. Although talks picked up Thursday on how to resolve a dispute over the trafficking bill’s abortion language, which Democrats strongly oppose, an agreement remained elusive. (Everett, 4/16)


UnitedHealth Reports 29% Increase In Earnings Last Quarter, Share Values Soar

The largest health insurer in the U.S. raised its 2015 forecast after experiencing lower medical costs and diversifying its business beyond insurance.

The Wall Street Journal: UnitedHealth Raises Full-Year Guidance
UnitedHealth Group Inc. reported a 29% increase in quarterly earnings and raised its full-year guidance as the health insurer benefits from growth in its health-services business and a lower impact from medical costs. Shares of UnitedHealth, up 50% over the past year, rose 3.7% to $121.60 Thursday. The stock fell 2.2% Wednesday after hospital operator HCA Holdings Inc. reported a better-than-expected outlook for the March quarter, raising concerns about higher health-care costs for insurers. (Chen and Wilde Mathews, 4/16)

The Associated Press: UnitedHealth Hits All The Notes, Shares Head For New Heights
UnitedHealth hiked its 2015 forecast after soaring past Wall Street's first-quarter expectations with a performance fueled in part by growth outside health insurance. ... Health insurance is UnitedHealth's largest business, but the company has been spreading its focus by expanding its Optum segment, which also offers data technology services and runs clinics and doctor's offices. That's good for the parent company because the Optum business generally offers better profitability than the health insurance side, BMO Capital Markets analyst Jennifer Lynch said. (Murphy, 4/16)

Some Worry Trade Deal Will Make It Harder To Bring Generic Drugs To Market

Patient advocate groups and some pharmaceutical firms are watching a trade deal closely to see how its provisions could impact big drug makers' ability to block generic versions of blockbuster drugs. Elsewhere, the Food and Drug Administration approves a generic version of a popular multiple sclerosis drug.

The New York Times: Generic Version of Copaxone, Multiple Sclerosis Drug, Is Approved
The Food and Drug Administration on Thursday approved the first generic substitute for Copaxone, a widely used drug for multiple sclerosis and the biggest-selling product for Teva Pharmaceutical Industries. The approval of the generic, which was developed by the team of Sandoz and Momenta Pharmaceuticals — could bring some price competition to the market for multiple sclerosis drugs. Prices for those drugs have tripled in the last several years, to over $60,000 a year, even as more products have come to market. (Pollack, 4/16)

State Watch

State Highlights: Iowa's Plans For Medicaid Managed Care; Rural Access Troubles In Texas; Medical Issues Common For 9/11 Workers

News outlets cover health care issues in Iowa, Texas, New York, California, Connecticut, Missouri, Minnesota, Massachusetts, North Carolina, Maryland and Kansas.

Des Moines Register: Jochum Worries Private-Run Medicaid Will Be 'Disaster' For Iowans
Iowa Senate President Pam Jochum said Thursday she's worried that vulnerable Iowans face a "disaster" as the state implements a cost-saving plan to hire a private business to manage the Medicaid health insurance program. Jochum, a Dubuque Democrat who has an adult daughter with severe developmental disabilities, said her family has the financial resources to care for her daughter if necessary. But she feels obligated to speak on behalf of other Iowa families who don't have enough money to care for their loved ones if Medicaid services aren't available. (Petroski, 4/16)

The Associated Press: Fraud Case Highlights Closure Of Rural Texas Hospitals
Access to medical care has long been a dilemma for rural Americans. In some pockets of Texas, the problem has grown even worse after a doctor's Medicaid and Medicare fraud scheme decimated a chain of rural medical centers that provided health care not easily found for hundreds of miles. The sentencing this week of Dr. Tariq Mahmood concludes a legal saga that included the closure of four rural hospitals he operated. But for the communities now facing a gaping void in medical care, the problems are far from over. (Warren, 5/16)

USA Today: Health Problems Are Common Among 9/11 Medical Crews
Emergency medical service workers who went to Ground Zero after the World Trade Center attacks in 2001 have suffered from an usually high number of health problems, a new study shows. Previous research has documented the health problems suffered by firefighters who worked at Ground Zero, but the new study is the first to examine the health consequences of the toxic dust and emotional stress on workers such as paramedics and emergency medical technicians. (Szabo, 4/16)

The Associated Press: Physicians Want Dr. Oz Gone From Columbia Medical Faculty
Columbia University has not removed TV celebrity doctor Mehmet Oz from his faculty position as a group of top doctors has demanded, citing his "egregious lack of integrity" for promoting what they call "quack treatments." "Dr. Oz has repeatedly shown disdain for science and for evidence-based medicine," said a letter the 10 physicians sent to a Columbia dean earlier this week. They say he's pushing "miracle" weight-loss supplements with no scientific proof that they work. The New York Ivy League school responded Thursday, issuing a statement to The Associated Press saying only that the school "is committed to the principle of academic freedom and to upholding faculty members' freedom of expression for statements they make in public discussion." (Dobnik, 4/16)

Los Angeles Times: L.A. Spends $100 Million A Year On Homelessness, City Report Finds
Los Angeles spends more than $100 million a year coping with homelessness, including as much as $87 million that goes to arrests, skid row patrols and mental health interventions, according to a report released Thursday. ... Many departments rely on emergency response teams from the Los Angeles Homeless Services Authority, a city-county agency, to respond to community complaints. But the teams, drawn from just 19 people covering the entire county and supported by $330,000 in city general fund money, are ill-equipped to respond adequately, the report said. (Holland, 4/16)

North Carolina Health News: NC Smoking Rule Tabled
A proposed rule that would have kept cigarette smoke away from infants in foster care was tabled Wednesday during a meeting of the House Health Committee at the North Carolina General Assembly. This is the fourth time Rep. Tricia Cotham (D-Matthews) has proposed a rule to protect foster children from smoke, and the fourth time she has faced pushback by her fellow representatives. (Ferris, 4/16)

The Washington Post: Kansas Bans Welfare Recipients From Seeing Movies, Going Swimming On Government’s Dime
Republican Gov. Sam Brownback signed House Bill 2258 into law Thursday. The measure means Kansas families receiving government assistance will no longer be able to use those funds to visit swimming pools, see movies, go gambling or get tattoos on the state’s dime. Those are just a few of the restrictions contained within the law that aims to tighten regulations on how poor families spend their government aid. It will go into effect July 1. (Holley and Izadi, 4/16)

Health Policy Research

Research Roundup: Staying 'Mentally Sharp'; Meeting The Potential Of ACOs; Drug Shortages

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Institutes of Medicine: Cognitive Aging: Progress In Understanding And Opportunities For Action
For most Americans, staying "mentally sharp" as they age is a very high priority. Declines in memory and decision-making abilities may trigger fears of Alzheimer's disease or other neurodegenerative diseases. However, cognitive aging is a natural process that can have both positive and negative effects on cognitive function in older adults -- effects that vary widely among individuals. ... [This report] assesses the public health dimensions of cognitive aging with an emphasis on definitions and terminology, epidemiology and surveillance, prevention and intervention, education of health professionals, and public awareness and education. This report makes specific recommendations for individuals to reduce the risks of cognitive decline with aging. (Blazer, Yaffe and Liverman, 4/14)

Health Affairs: Are Shortages Going Down Or Not? Interpreting Data From The FDA And The University Of Utah Drug Information Service
[M]anufacturers are now required to notify the FDA of impending production disruptions in certain prescription medications. These early notifications give the FDA and manufacturers more time to take actions .... Once companies began to increase reporting of anticipated or in-progress production disruptions, the trend in new shortages reversed. ... the FDA helped prevent almost 80 percent of impending shortages in 2013, up from about 45 percent in 2011. ... But another key data source on drug shortages, the University of Utah Drug Information Service (UUDIS), shows a 47 percent drop in new shortages between 2011 and 2014. ... we discuss how the FDA’s list of shortages represents a subset of a broader list of supply disruptions listed by the UUDIS. (Wosinska, Fox and Jensen, 4/8)

Health Affairs: Changes Needed To Fulfill The Potential Of Medicare’s ACO Program
The Medicare Shared Savings Program (MSSP), Medicare’s main program for accountable care organizations (ACOs), has grown rapidly since it began in 2012. It added 89 new provider organizations earlier this year, bringing the total to over 400 .... however, the potential still mostly remains to be realized. As we noted in a recent post, early results show that the Medicare ACOs have achieved high quality in many areas, while only a quarter of the MSSP ACOs have been able to reduce spending enough to share in savings generated from their efforts so far. ... Given the high expectations and the many startup issues around Medicare ACOs, it is no surprise that the recent proposed rule for reforming the MSSP received a lot of attention. ... we review the major areas of proposed changes along with our views and some notable comments submitted by other groups. (McClellan, Kocot and White, 4/8)

AARP Public Policy Institute: Observation Status: Financial Implications For Medicare Beneficiaries
Doctors who cannot quickly diagnose patients in the emergency room sometimes place them “under observation” .... This report, which uses data from a sample of 2009 Medicare claims, reveals that rules for observation status are having a notable impact on the cost of health care for many Medicare beneficiaries, and perhaps also on their decisions about whether or not to seek additional recommended follow-up care. ... For example, our findings show that 1 in 10 observation patients (about 167,000) spent more for hospital services than they would have spent if they were admitted as inpatients. We found that nearly a third of all those referred to a skilled nursing facility after receiving observation services (50,000) forewent that care, perhaps because of the anticipated costs. (Lind et al., 4/14)

The Kaiser Family Foundation: Medigap Enrollment Among New Medicare Beneficiaries
[The legislation to replace Medicare's payment system for doctors] includes a provision that would prohibit Medicare supplemental insurance (Medigap) policies from covering the Part B deductible for people who become eligible for Medicare on or after January 1, 2020. This provision is designed to make future Medigap purchasers more price-sensitive when it comes to medical care, which could lead to a reduction in the use of health services and Medicare spending. ... If this policy had been implemented in 2010, it would have affected Medigap coverage for roughly 10 percent of all 65-year old Medicare beneficiaries. Based on declining Medigap enrollment trends among 65-year olds, a smaller share of new Medicare beneficiaries can be expected to be affected by this policy in the future. (Jacobson, Neuman and Damico, 4/13)

Brookings: The Internal Revenue Service Meets The Affordable Care Act
Given the staff limitations of the IRS and the complexity of reporting and reconciling the government subsidies in the law with people’s income there is likely to be confusion, frustration and, most important, a lot of people who find out that their tax refund is a great deal smaller than they anticipated. Massachusetts has had a tax penalty for not having health insurance since the passage of the state’s 2006 health care reform law. ... Massachusetts has had great success in citizens’ compliance with health reform and new tax filing procedures. ... However, one should be cautious before assuming this high-rate of compliance will be easily replicated at the federal level on tax day (Kamarck, 4/10)

Georgetown University Center for Children and Families/Kids Well Florida: Many Working Parents And Families In Florida Would Benefit From Closing The Coverage Gap
In Florida, uninsured parents with children present in the home account for 28 percent of the population potentially eligible for health coverage if the state expands Medicaid. A significant coverage gap exists for parents whose income exceeds Florida’s extremely low eligibility threshold for Medicaid but don’t earn enough to receive tax credits for coverage through the federal health insurance marketplace. A parent in a family of three working more than 18 hours a week in a minimum wage job would earn too much to get Medicaid coverage under Florida’s stringent guidelines. Of those parents that could benefit from extended Medicaid eligibility, 63 percent are employed and many of them are in jobs supporting Florida’s service based, tourist-dependent economy. (Alker and Chester, 4/13)

Centers for Disease Control and Prevention: Assessment Of Epidemiology Capacity In State Health Departments
Data on state-level epidemiology capacity from surveys conducted by the Council of State and Territorial Epidemiologists (CSTE) since 2001 indicate that capacity in many areas previously peaked in 2004, a time of peak federal funding for public health preparedness, and then diminished to especially low levels by 2009. ... Data from the most recent CSTE survey indicate that overall state-level epidemiology capacity and the epidemiology capacity in many program areas has increased markedly since 2009. The number of epidemiologists, the percentage of state health departments with substantial-to-full capacity for three essential public health services, and the percentage with substantial-to-full epidemiology capacity for eight of 10 program areas were at their highest level since assessments began in 2001. However, >50% of states reported minimal-to-no epidemiology capacity in occupational health, oral health, substance abuse, and mental health. Most health departments still lack critical technology capacity. (Hadler et al., 4/17)

Here is a selection of news coverage of other recent research:

Medscape: USPSTF Evidence Review Supports Prediabetes Screening
Screening asymptomatic people for type 2 diabetes does not improve mortality after 10 years of follow-up, but detection and treatment of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT) could delay progression to diabetes. Those were among the conclusions from a systematic literature review performed by an independent panel to inform upcoming guidelines from the United States Preventive Services Task Force (USPSTF). (Tucker, 4/13)

Reuters: U.S. Emergency Rooms Getting Better-Prepared For Kids
U.S. emergency departments are better prepared these days to care for young patients, a new study shows. The average readiness score for emergency departments responding to a survey in 2013 was about 69 percent, compared to an average score of about 55 percent in 2003, researchers say. (Seaman, 4/13)

Reuters: Detecting Diabetes In Children Before Symptoms Appear
Doctors may be able to detect type 1 diabetes in children before they exhibit any symptoms of the disease, new research from Sweden shows. Type 1 diabetes is an autoimmune disease that often appears in childhood and is the result of the body being unable to produce the hormone insulin. (4/9)

Medscape: Postacute Care Important In Medicare Spending Imbalance
Differences in Medicare spending for episodes of hospital and postacute care are driven by both hospital-based and regional factors, a new study concludes. Peter S. Hussey, PhD, from RAND Corporation, Boston, Massachusetts, and colleagues used claims for all Medicare fee-for-service beneficiaries in 2008 and compared hospital vs regional variation in Medicare payments for hospital and postacute care (nursing homes, home health, and inpatient rehabilitation) for 10 common conditions. Results were published online April 13 in a JAMA Internal Medicine research letter. (Frellick, 4/14)

The New York Times: The Right Dose Of Exercise For A Longer Life
Exercise has had a Goldilocks problem, with experts debating just how much exercise is too little, too much or just the right amount to improve health and longevity. Two new, impressively large-scale, studies provide some clarity, suggesting that the ideal dose of exercise for a long life is a bit more than many of us currently believe we should get, but less than many of us might expect. The studies also found that prolonged or intense exercise is unlikely to be harmful and could add years to people’s lives. (Reynolds, 4/15)

NPR: Is That Corporate Wellness Program Doing Your Heart Any Good?
Odds are your employer has a wellness program that prods you to exercise and eat healthy. But that program may not be doing all that much for your health, according to the American Heart Association, and attempts to measure the benefits of wellness programs often fail. When it comes to improving cardiovascular health, "most of the programs appear to be falling short," says Dr. Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles, and lead author of the scientific statement, which was published Monday in the journal Circulation. (Shute, 4/14)

St. Louis Public Radio: Length Of Cigarette Addiction Linked To Common Gene Marker, But Treatments Available
Can’t stop smoking? Your genes might be part of the problem. After a case review of 24 studies involving 29,000 participants, researchers at Washington University in St. Louis determined that smokers who carried a relatively common genetic marker tend quit smoking four years later on average than those without. The genetic variation was also linked to earlier diagnoses for lung cancer. (Bouscaren, 4/15)

Reuters: Mid-Pregnancy Maternal Diabetes Tied To Child's Autism Risk
When mothers develop diabetes during the first 26 weeks of pregnancy, the child they’re carrying may be at increased risk of autism, according to a new study. Kids exposed to so-called gestational diabetes before the third trimester were at higher risk compared to those whose mothers did not develop diabetes during pregnancy, developed it later in pregnancy or had type 2 diabetes before pregnancy, researchers found. (Doyle, 4/14)

Editorials And Opinions

Viewpoints: 'Passing The Buck' On Medicaid; Sharing Patient Records; Rick Scott's Lawsuit

A selection of opinions on health care from around the country.

The Washington Post: Passing The Buck And Hurting The Poor
Limiting federal funding on Medicaid spending would indisputably accomplish one objective: Limiting federal funding on Medicaid spending. But that’s it. It won’t make the growing costs of the program magically disappear. It would just dump them onto someone else’s doorstep, in this case the states’, which are likely less equipped to deal with complex management and cost control given their smaller scale. State governments would either have to contribute more of their own funds or, more likely, institute deep cuts to poor beneficiaries and the providers that serve them. Medicaid already spends so little per beneficiary — about 27 percent less for children, and 20 percent less for adults, than private insurance does on similar patients — that further cuts would almost certainly cause providers to exit the program, reducing access to care. (Catherine Rampell, 4/16)

The Washington Post: Are Medicare Improvements Finally On The Horizon?
On the plus side, Congress did away with an outmoded and increasingly unrealistic formula for reimbursing doctors that had necessitated time-consuming annual “doc fixes.” And yes, lawmakers achieved this long-postponed reform on a bipartisan, bicameral basis, with the White House on board as well. But the legislation is hardly the hammer blow for fiscal responsibility that supporters claim; in fact, it will add $141 billion to the projected deficit over the next decade because the two parties could not agree on enough offsetting savings elsewhere within Medicare. ... Nevertheless, there is a kernel or two of incipient structural reform tucked into the measure. (4/16)

Bloomberg: Entitlement: Why The U.S. Can't Keep Costs Down
Here’s why it’s hard for the U.S. government to keep its costs down: Seniors and the very poor are entitled by law to almost half its money. Congress can trim other expenses, and automatic budget cuts and the cessation of two U.S. wars have slowed spending growth. But Social Security, Medicare and Medicaid are exempt from budget wrangling and are growing. (Toluse Olorunnipa and Roger Runningen, 4/16)

The New York Times: Roadblocks To Sharing Medical Records
The ability to transfer electronic medical records from one doctor or hospital to another is essential to the smooth functioning of the health care system and to providing the best possible care to patients. Yet all too often these transfers are being blocked by developers of heath information technology or greedy medical centers that refuse to send records to rival providers. (4/16)

The Washington Post Plum Line: Rick Scott Has An Easy Way Out Of His Medicaid Mess
[Florida Gov. Rick] Scott is demanding that the federal government continue the LIP program, and is professing outrage that the feds may withdraw funding that would give “poor families access to the safety net health care services they need.” But he won’t accept the Medicaid expansion money that might accomplish that goal more effectively: LIP money does not give people insurance; it largely pays hospitals for care sought by people who can’t pay for it. Scott claims the feds might not make good on their promise to fund the Medicaid expansion, but Scott previously backed the expansion, and state Senate Republicans say their proposal to expand Medicaid would explicitly end the program if the feds reneged. (Greg Sargent, 4/16)

Arizona Republic: New Arizona Law Puts Subsidized Health Insurance At Risk
[Gov. Doug] Ducey last week signed House Bill 2643, which forbids Arizona setting up its own Affordable Care Act health exchange. The bill has little immediate impact on the Arizona residents who get coverage through the federal marketplace, but it could have a big impact in a few months. In June, the U.S. Supreme Court is expected to rule in King vs. Burwell, a case that examines whether subsidies are allowed for people who buy health insurance through the federal marketplace or should be limited to states that run their own insurance exchanges. (Alltucker, 4/16)

Los Angeles Times: A Sensible Cap On Costly Prescription Drugs
To help [patients with chronic medical conditions] spread out their bills in a more manageable way, the state's insurance exchange, Covered California, may require insurers to cap the monthly cost of each expensive specialty prescription at $500. That's a step in the right direction, but it doesn't go far enough to make sure those ailing Californians can afford the medicines they need. Lowering the cap to $200 would provide significantly more help, and given the limited number of people who need the help, the cost to other policyholders is expected to be minimal, according to a report by an independent actuary. (4/16)

New England Journal of Medicine: Protection Or Harm? Suppressing Substance-Use Data
What if it were impossible to closely study a disease affecting 1 in 11 Americans over 11 years of age — a disease that's associated with more than 60,000 deaths in the United States each year .... These questions are not rhetorical. In an unannounced break with long-standing practice, the Centers for Medicare and Medicaid Services (CMS) began in late 2013 to withhold from research data sets any Medicare or Medicaid claim with a substance-use–disorder diagnosis or related procedure code. This move — the result of privacy-protection concerns — affects about 4.5% of inpatient Medicare claims and about 8% of inpatient Medicaid claims from key research files ... impeding a wide range of research evaluating policies and practices intended to improve care for patients with substance-use disorders. (Austin B. Frakt and Nicholas Bagley, 4/16)