KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

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Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Alive And Well?'" by Paul Fell.

Here's today's health policy haiku:


Affordable care.
Treatment that we all deserve.
But what does it cost?

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Medicare Releases Trove Of Data On Drug Spending, Doctor Prescribing

The release marks the most specific breakdown ever provided by the Centers for Medicare & Medicaid Services regarding the prescription claims of Medicare beneficiaries.

The New York Times: Medicare Releases Detailed Data On Prescription Drug Spending
The data was the most detailed breakdown ever provided by government officials about the prescription claims of Medicare beneficiaries. It included information about 36 million patients, one million prescribers and $103 billion in spending on drugs under the program’s Part D in the year 2013, the most recent year available. The data did not take into account rebates that the drug manufacturers pay to the insurers that operate the Medicare beneficiaries’ drug plans. (Thomas and Pear, 4/30)

The Associated Press: Medicare Data Show Contrast In Generic, Brand Prescribing
The most-used medicines in Medicare’s prescription drug program are generics, but the program spends the most on brand-name drugs, led by the heartburn treatment Nexium, according to an unprecedented release of government data on Thursday. That contrast sheds light on prescribing practices and how they might be used to save money, specialists say. (Neergaard, 4/30)

Bloomberg: AstraZeneca’s Nexium Tops Spending In Medicare Drug Program
AstraZeneca Plc’s treatment for heartburn attracted the most spending of any single drug under Medicare’s drug benefit program, making up 2.4 percent of expenses. Spending on Nexium was $2.53 billion in 2013, the Centers for Medicare and Medicaid Services said Thursday, followed by GlaxoSmithKline Plc’s asthma treatment Advair Diskus at $2.26 billion. (Tracer and Chen, 4/30)

ProPublica: Government Releases Massive Trove Of Data On Doctors’ Prescribing Patterns
The federal government released detailed data today on nearly 1.4 billion prescriptions dispensed to seniors and disabled people in the Medicare program in 2013, bringing more openness to the medication choices of doctors nationwide. The data release comes two years after ProPublica reported that the Centers for Medicare and Medicaid Services had done little to detect or deter hazardous prescribing in its drug program, known as Medicare Part D. ProPublica analyzed several years’ worth of prescription data, obtained under the Freedom of Information Act, and created a tool called Prescriber Checkup that lets users compare individual physicians to others in the same specialty and state. (Ornstein, 4/30)

Politico Pro: Medicare Details $100B In Drug Spending
CMS opened up a trove of Medicare Part D prescription drug data for public inspection on Thursday, the agency’s latest effort to invite outside scrutiny of spending in the massive federal health care program. (Norman, 4/30)

Health Law Issues And Implementation

Study Finds Hospitals In Medicaid Expansion States Are Better Off

Hospitals lose less money on charity care when the states have expanded the health coverage for low-income residents. Also, news outlets look at developments in the Medicaid debates in Kansas, Maine, Louisiana and Arkansas.

NPR: Expanding Medicaid Trims Hospitals' Costs Of Caring For Uninsured
When patients show up in the hospital without health insurance, they often receive charity care — the hospital treats the person and then swallows some or all of the costs. ... Hospitals are able to recoup some of the costs of this care, but it can still put a financial strain on some systems. One of the goals of the Affordable Care Act was to reduce the burden of charity care, which totaled nearly $85 billion in 2013. A new study by the nonprofit Kaiser Family Foundation suggests that Medicaid — a government health insurance program that covers many people who don't make much money — might be doing just that. (Kelto, 4/30)

Wichita Eagle: Catholic Bishops Endorse Medicaid Expansion In Kansas
Catholic bishops in Kansas are calling on lawmakers to expand Medicaid. Expanding the program would provide health coverage for 130,000 low-income Kansans who are uninsured now, a statement from the bishops said Thursday. “We, the Catholic Bishops of Kansas, support expanding Medicaid to cover these individuals,” the statement reads. “Indeed, many of our brothers and sisters who cannot currently afford health insurance would gain access to it, bringing an end to the uncertainty and fear that the uninsured of our society must live with daily.” (Lowry, 4/30)

Maine Public Radio: Medicaid Expansion Proponents Make Their Case To Maine Lawmakers - Again
Maine's Health and Human Services Committee is considering several bills that would expand Medicaid coverage under the Affordable Care Act. From flat-out expansion, to various compromises, to putting the issue to referendum, they're the latest attempts in a now-annual battle to extend insurance coverage to about 20,000 low-income Mainers. ... Proponents of expansion ranged from uninsured Mainers, to a sheriff lamenting the need for coverage for mental health and substance abuse services, to providers, like Dr. Amy Madden of Belgrade. (Wight, 4/30)

New Orleans Times-Picayune: Medicaid Expansion Hope Fades: Review The Arguments For And Against It
The Louisiana Legislature once again refused measures to expand Medicaid, a component of President Barack Obama's health care overhaul that would provide coverage for 290,000 Louisianans without insurance. ... with Gov. Bobby Jindal's commitment to squash expansion, anyway, many Republican lawmakers who may have considered accepting the federal dollars decided to put off expansion of the program until a governor who's open to the idea takes office, [expansion supporter Rep. John Bel] Edwards said. The issue is seen as highly partisan -- some Republicans do not want to risk casting a vote some might view as aligning them with the Affordable Heath Care Act. (Lane, 5/1)

Politico Pro: Arkansas Legislator Looks Beyond The 'Private Option'
A 40-year old state lawmaker, the architect of Arkansas’s “private option,” is plotting the transformation of American health care in a cramped, windowless office here in the State Capitol. In a series of interviews with POLITICO, David Sanders tries to set the record straight about the future of the state’s unique Medicaid expansion. His short answer: It will live on beyond its sunset in 2016 as part of a broader Medicaid overhaul, even though many of his fellow Republicans claimed their vote a few months ago on the program served the purpose of shutting it down in less than two years. (Wheaton and Pradhana, 4/30)

Also in local health news, Colorado is getting a new chief for its health insurance marketplace.

Health News Colorado: New Exchange CEO Prepares For ‘Turnaround’
When Kevin Patterson saw Colorado’s health exchange board floundering earlier this month as their only CEO finalist backed out and the search for a new leader was failing, he decided he might be able to provide some answers. ... Currently [Gov. John] Hickenlooper’s chief administrative officer, Patterson will wrap up that job and take over as interim CEO at the exchange on May 8. He’s clear on his mission. “It’s a turnaround. We’ve got to make sure we’re going in the right direction,” Patterson said. “We can do this, but it’s going to be hard work.” (Kerwin McCrimmon, 4/30)

Fla. Lawmakers, Governor At Odds On How To Solve Budget Stalemate Over Medicaid Expansion

The Republican leader of the Senate has proposed a timetable for a special session to hammer out a deal, but it's not yet clear if House leaders, who adamantly oppose expanding Medicaid, will agree.

Tampa Bay Times/Miami Herald: Sharply Divided Legislature And Gov. Rick Scott Can't Agree On Next Step
Gov. Rick Scott and a bitterly divided Legislature darted in four different directions Thursday as Scott called for budget talks, senators suggested a special session in June, the House did not favor either idea and Democrats sued the House. As Senate President Andy Gardiner, R-Orlando, proposed a three-week session starting June 1 to craft a state budget, Senate Democrats marched to the Florida Supreme Court with an emergency petition that asks justices to rule on whether the House violated the state Constitution by adjourning Tuesday afternoon. Senators say it's unconstitutional for one chamber to shut down for more than 72 hours without the other's consent. (Bousquet and McGrory, 4/30)

Orlando Sentinel: Lawmakers Move Toward Special Session
Lawmakers took the first step Thursday toward a special session to resolve their bitter budget impasse over health-care spending for the poor. Senate President Andy Gardiner, R-Orlando, proposed a three-week special session beginning June 1, giving the federal government enough time to determine whether to extend a billion-dollar program that pays hospitals for care for the poor and uninsured, a major sticking point in the stalemate. (Rohrer, 4/30)

Orlando Sentinel: Gov. Scott: Take Up Budget Without LIP, Medicaid Expansion
Gov. Rick Scott weighed in on the essentially dead legislative session Thursday, saying he will set up a commission to look at taxpayer support for hospitals, as well as how to reduce health care costs and increase access. He reiterated his opposition to Medicaid expansion under Obamacare and suggested lawmakers should pass a budget without it or the $1.3 billion in federal Low Income Pool funds. The federal government has not extended the Medicaid program paying hospitals for care for the poor and uninsured. (Rohrer, 4/30)

Miami Herald: Florida Healthcare Agency Hits The Road For Feedback On Its Proposed Extension Of Hospital Funding Program
With the Florida Legislature at a healthcare impasse, the state Agency for Health Care Administration took to the road Thursday to hear public comments on its request to continue a $2.1 billon federal program that may help solve some of Florida’s healthcare money issues — for now. ... The agency’s proposal includes extending the program until June 30, 2017, and redesigning portions of it .... The redesign would aim to distribute funds more equally and allow more hospitals to benefit, as well as reduce the link between local government contributions and the money distributed to each hospital. (Herrera, 4/30)

Republicans Mull Next Move If High Court Voids Subsidies

One option would continue federal exchange subsidies through the 2016 presidential election in exchange for concessions from the president to end the individual and employer insurance mandate. Meanwhile, the 2015 special enrollment period ends in most states today.

The Hill: GOP Prepares List Of Demands If Justices Rule Against ObamaCare
Republicans believe a Supreme Court ruling against ObamaCare this summer would give them leverage to force President Obama to scrap the healthcare law's central pillars. Sen. John Barrasso (R-Wyo.), who is leading the Senate GOP’s response to King v. Burwell, said Republicans will be willing to strike a deal with Obama to ensure that the 7.5 million people who stand to lose their subsidies are protected, at least until the 2016 elections.

 But in return, they would demand that Obama to do something he has long resisted: nix the employer and individual mandates for insurance coverage. (Ferris, 5/1)

The Associated Press: GOP Divided As Supreme Court Ruling On Health Care Law Nears
Sen. Ron Johnson was elected to Congress in 2010 as an adamant foe of President Barack Obama’s health care overhaul. Yet facing a Supreme Court decision that could disrupt how that law functions, the Wisconsin Republican is among many in the GOP who want Congress to react with caution. ... “Neither politically nor practically can we end those” subsidies, said Johnson, who faces a potentially tough re-election next year. “So let’s just recognize those realities. Let’s set up the 2016 election as the contest, the discussion, the debate” over repealing the law. (Frum, 4/30)

Capitol Hill Watch

House Passes GOP Compromise Budget Blueprint; Takes Aim At Obamacare

In addition to paving the way for the Republican-controlled Congress to send a health law repeal measure to the president’s desk, the budget framework also includes $430 billion in cuts to Medicare as well as trims to Medicaid, food stamps and other safety net programs. The Senate is expected to consider the combined budget next week.

The Hill: House Passes Budget In Win For GOP
Republican leaders have pointed to the budget framework, which balances in a decade by cutting more than $5 trillion from spending, as yet more proof that an all-GOP Congress is governing effectively. The Senate is expected to pass the combined budget next week. ... Republicans also seek $430 billion worth of cuts to Medicare, though the joint framework drops the controversial plan from Rep. Paul Ryan (R-Wis.) that offered seniors the chance to use subsidies to purchase private insurance. Medicaid, food stamps and other safety net programs would face cuts as well under the GOP plan. But for many conservatives, the major draw of the plan was the chance to repeal the Affordable Care Act through a budgetary maneuver known as reconciliation, which requires only 51 votes in the Senate. (Becker, 4/30)

Politico: House Passes Final Budget Deal
The chamber passed the framework, 226-197. It would balance the budget in 10 years without raising taxes, and pave the way for sending an Obamacare repeal to the president’s desk. The Senate will take up the measure next week. (Bade, 4/30)

The Washington Post: Budget Plan Calls For $194 Billion In Unidentified Cuts To Federal Workforce
The joint budget agreement calls for cutting that amount over 10 years from programs under the House Oversight and Government Reform Committee. It oversees federal employee issues in its broad portfolio. But the agreement gives no instructions on reaching the budget savings. Just where the ax might fall remains to be seen. Given the committee’s oversight, however, federal pension benefits and the Federal Employees Health Benefits program are likely targets. (Davidson, 4/30)

D.C. Abortion Rights Law Blocked By The House

Late Thursday night, the House approved -- on a largely party-line vote -- a Republican-backed measure that overturns a D.C. law prohibiting workplace discrimination based on reproductive health choices.

The Hill: House Votes To Overturn DC's Reproductive Health Law
The House voted late Thursday night to overturn the District of Columbia's law prohibiting workplace discrimination based on reproductive health choices. Passage of the resolution formally disapproving of Washington's local law fell mostly along party lines on a vote of 228-192. Thirteen Republicans joined the opposition, and three Democrats voted in favor. It marked the first time either chamber of Congress has passed legislation to stop a D.C. law since 1991, when the House voted to disapprove of the city council's action to amend a law that restricts the height of the District's buildings. (Marcos, 4/30)

CNN: Hillary Clinton Campaign Blasts GOP Abortion Bill
Hillary Clinton is accusing congressional Republicans of planning to "overrule the Democratic process" in Washington with a Thursday night vote to block a D.C. law banning discrimination by employers against employees who have had abortions. (Jaffe, 4/30)


Gilead's Costly Hep C Drugs Continue To Rack Up Profits

The medications brought in $4.5 billion in the first quarter, far exceeding Wall Street expectations. Insurer Cigna also reported better-than-expected profit growth while hospital operator HealthSouth saw profits fall and Assurant announced it would sell or close its health insurance division.

The Wall Street Journal: Cigna Results Top Expectations
Cigna Corp. reported better-than-expected revenue and profit growth in its first quarter, as the health insurer benefited from higher premiums and fees. Shares, up 23.1% this year, gained 0.3% in premarket trading. The company also increased outlook on a key earnings metric for the year. (Dulaney, 4/30)

The Wall Street Journal: HealthSouth Profit Falls 9% On Bad Debt Provision
HealthSouth Corp. said Thursday its first-quarter earnings fell 9% on an increase in the company’s bad-debt provision and litigation-related expenses that offset revenue growth that was mostly fueled by a recent acquisition. Birmingham, Ala.-based HealthSouth operates inpatient rehabilitation hospitals, which serve patients recovering from serious conditions such as stroke, cardiac conditions and brain injuries. (Stynes, 4/30)

The Associated Press: Assurant Selling Or Closing Health Insurance Division
The parent company of Assurant Health said it will sell or shut down the insurer, which has struggled financially since the introduction of the federal Affordable Care Act. Assurant Health, headquartered in Milwaukee, is expected to report an operating loss of up to $90 million in the first quarter following a loss of $64 million last year. The company specializes in health insurance for small employers and individuals. (4/30)

Veterans' Health Care

White House Rejects Plan To Revamp TRICARE Health System

In related news, Bloomberg offers a bleak status check on efforts to fix the Veterans Affairs' health care system.

Bloomberg: A $15 Billion Cure Can't Fix Veteran Health Care
Leaders of the U.S. Department of Veterans Affairs asked Congress for more than $15 billion to end long wait times for medical care for tens of thousands of vets. They got the money, but little has changed. The agency has been slow to spend the funds, and instead of speedier care for the former soldiers the holdups have persisted. The centerpiece of the legislation Congress passed last year — a $10 billion program to allow veterans to seek care outside the VA system — has been so underused that the agency wants to divert some of the money to other purposes. (Miller, 5/1)

Coverage And Access

Declining Birth Rates Pose Challenge For Social Security, Medicare

A writer looks at the implications of declining birth rates for costly programs geared to the elderly. Meanwhile, Steven Brill blames health care costs on high prices in an appearance in Detroit.

The Kansas City Star: Social Security And Medicare Likely To Feel The Effects In The Future Of Today’s Declining Births
A new Urban Institute study shows “there has been a decline in birth rates between 2007 and 2012 for all American women ages 20 to 29.” It’s being called the biggest drop of any generation in U.S. history. The effect on Social Security and Medicare could mirror what the programs are facing now with more than 75 million baby boomers retiring in the coming years but there being fewer millennials paying into the retirement and health care systems to keep them afloat financially. Millennials, who also are having fewer children now largely because of the Great Recession and the relentlessly weak economy, may have to confront the same underfed Social Security and Medicare problem. (Diuguid, 4/30)

Detroit Free Press: Renowned Journalist Blames Health Care Costs On Prices
Renowned journalist and media entrepreneur Steven Brill came face to face in Detroit on Thursday with two high-level local executives within the industry -- health care -- that is lately in his crosshairs. With a mix of real life anecdotes and bold assertions, the founder of Court TV told a Detroit Economic Club audience why he believes health care costs are so high in the U.S. in comparison to other developed nations. (Reindl, 4/30)

State Watch

State Highlights: Data Breaches In Mass., Ore.; Hospitals In Fla. Agree To Settlement Over Medicare Fraud Allegations

News outlets cover health care issues in Massachusetts, Oregon, Florida, Connecticut, Texas, Minnesota, New York, Missouri, Iowa and Indiana.

The Boston Globe: Partners Data Breach Affects 3,300 Patients
Hackers may have accessed medical and personal information, including Social Security numbers, about 3,300 patients at Partners HealthCare, the health system said Thursday. The breach happened when some Partners employees responded to phishing e-mails, which allowed unauthorized access to their e-mail accounts. Some of the e-mails contained private patient information, including Social Security numbers, addresses, phone numbers, and information about medical treatments and health insurance. (Dayal McCluskey, 4/30)

The Oregonian: Oregon Health Insurer's Data Breach Alert Misfires, Sparks Do-Over
On Wednesday Sherwood residents Lester and Nora Brock were surprised to learn that personal data entrusted with their health insurer, Oregon's Health CO-OP, might be compromised. Even more surprising? They learned this not from a letter addressed to them, but from five different letters addressed to other people – each in separate envelopes delivered to the Brocks' address. (Budnick, 4/30)

The Wall Street Journal: Florida Hospitals Agree To Settle Medicare-Fraud Allegations
Nine hospitals in the Jacksonville, Fla., area and a local ambulance company agreed to pay a total of $7.5 million to settle civil allegations that they defrauded Medicare with ambulance rides that were medically unnecessary. The case could have national implications, federal prosecutors say, because hospitals around the country often rely on ambulances to ferry patients to and from their facilities, at times with little regard for the cost or medical need. (Carryrou, 4/30)

The Connecticut Mirror: Will Lawmakers Take Action On Changing Health Care Landscape?
There’s still a budget to settle, but to Senate Minority Leader Len Fasano, the sense of urgency as the legislative session approaches its final weeks lies in addressing the state’s health care landscape, particularly the growth of large health systems that control multiple hospitals and physician practices. At stake, he said, are health care costs, consolidation, concentrated market power and hospital closures. (Levin Becker, 5/1)

Texas Tribune: Study: Texas' Rate Of Uninsured Falls
The rate of Texans without health insurance has fallen 8 percentage points since enrollment in the federal Affordable Care Act began, according to a new study. ... But Texas remains the state with the highest percentage of uninsured people, the study found, and for the first time, the state has the largest raw number of uninsured residents in the country. (Walters, 4/30)

Pioneer Press: House GOP, DFL Split Over Expected Savings From Fraud In Health Bill
It's the $285 million question: how much waste, fraud and abuse is there in Minnesota's public health programs? In a health and human services budget passed 72-60 early Wednesday morning, House Republicans bank on $300 million in savings from a concerted crackdown on waste in Medicaid and other programs -- and believe the actual savings could be even higher. But an analysis prepared by the Department of Human Services and trumpeted by DFL lawmakers has a much lower savings estimate: $16.5 million in the next biennium. (Montgomery, 4/29)

Forum News Service: Rochester OKs 'Destination Medical Center' Projects
The board members of the Destination Medical Center group approved Thursday two new projects: construction of a Hilton hotel with special amenities tailored for medical clientele and the purchase of Chateau Theatre in downtown Rochester, [Minn.]. The four-star hotel will stand 23 stories tall on the corner of Broadway and Center Street. Developers said construction will start within weeks, and will have unique features like places for in-building blood draws for patients of nearby Mayo Clinic. (Jeffries, 4/30)

The Associated Press: Rural Hospitals Struggle To Stay Open, Adapt To Changes
After 45 years of providing health care in rural western Missouri, Sac-Osage Hospital is being sold piece by piece. ... Sac-Osage is one of a growing number of rural U.S. hospitals closing their doors, citing a complex combination of changing demographics, medical practices, management decisions and federal policies that have put more financial pressure on facilities that sometimes average only a few in-patients a day. (Lieb, 5/1)

The Associated Press: Q&A: Why Have Rural Hospitals Been Closing?
There are more than 4,700 hospitals in the U.S, spread about evenly between urban and rural areas. But that number has been dwindling. More than 100 hospitals have closed since 2010, and the pace has quickened in the past couple of years. Hospitals are closing at about the same rate in urban and rural areas, but health care analysts say the effect often is more pronounced in small towns, where residents typically must travel farther to get to the next nearest hospital. (Lieb, 5/1)

Texas Tribune: Teladoc Files Antitrust Suit Against Medical Board
In just over a month, a new state rule is set to kick in that could undercut the business model of Dallas-based Teladoc, a rapidly growing telemedicine company that connects patients and doctors over the telephone and internet. With the clock ticking, the company is brandishing every weapon in its arsenal, deploying teams of lobbyists and lawyers to fight a Texas Medical Board rule change that it says is more about stifling competition than protecting patient health. The board's rule, set to start June 3, would prevent doctors from treating people over the phone — making a diagnosis or prescribing medicine — unless another medical professional was physically present to examine the patient. (Walters, 4/30)

The Des Moines Register: Stalled Medical Marijuana Bill Causes Acrimony At Iowa Capitol
A debate over medical marijuana legislation is getting acrimonious at the Iowa Capitol, and is even spilling over into a fight over anti-abortion legislation. ... The bill would allow Iowans with a range of health problems to obtain medical marijuana. Those conditions could include cancer, multiple sclerosis, Crohn's disease, post-traumatic stress disorder, and other chronic and debilitating ailments. (Petroski, 4/30)

Providence Journal: Raimondo's Medicaid Group Unveils Proposed Cuts
After being brought together just nine weeks ago, Governor Raimondo's Reinventing Medicaid working group released a report on Thursday that, at the governor's request, offers recommendations on cutting $91 million in state spending on the health care program for people of low incomes. The two biggest cuts in the report, which the governor has already included in her 2016 budget proposal, would hit hospitals and nursing homes. These include cutting Medicaid payments to hospitals by 5 percent, saving the state $15.7 million, and 3 percent to nursing homes, for $13.3 million in savings. (Salit, 4/30)

Health Policy Research

Research Roundup: Testing Before Eye Surgery; Health Law Coverage Gains; End-Of-Life Talks

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

The New England Journal of Medicine: Preoperative Medical Testing In Medicare Patients Undergoing Cataract Surgery
Cataract surgery is the most common elective surgery among Medicare beneficiaries, with 1.7 million procedures performed annually. It is also very safe, with less than a 1% risk of major adverse cardiac events or death. ... since 2002, guidelines from multiple specialty societies have deemed routine preoperative testing unnecessary. ... In this national assessment of variation in routine preoperative testing before cataract surgery, we found that more than half of Medicare beneficiaries undergoing cataract surgery underwent at least one preoperative test, despite strong evidence about the lack of benefit of preoperative testing. This represents a substantial increase in testing over levels during the baseline period and is most likely an unnecessary Medicare expense. (Chen et al., 4/16)

Health Affairs: Millions Of Americans May Be Eligible For Marketplace Coverage Outside Open Enrollment As A Result Of Qualifying Life Events
Federal regulations establish special enrollment periods—times outside of open enrollment periods—during which people may enroll in or change their health insurance plans .... To be eligible, a person must experience a shift in income or another “qualifying life event,” such as a change in marital status or the number of dependents .... We produced an upper-bound estimate that 3.7 million nonelderly adults with coverage through a federal or state Marketplace could have ... become eligible for a special enrollment period because of income shifts. In addition, more than 8.4 million nonelderly adults who did not have Marketplace coverage—three-quarters of whom had no insurance—became eligible for a special enrollment period as a result of other qualifying life events. Many ... may be unaware of their eligibility. (Hartman et al., 4/29)

The Kaiser Family Foundation: Data Note: How Has The Individual Insurance Market Grown Under The Affordable Care Act?
6.7 million people were insured through marketplace plans as of October 15, 2014. However, it has been unclear precisely how many of these Marketplace enrollees were previously uninsured or how many would have purchased individual coverage directly from an insurer in the absence of the ACA. Kaiser Family Foundation analysis of recently-submitted 2014 filings by insurers to state insurance departments (using data compiled by Mark Farrah Associates) shows that 15.5 million people had major medical coverage in the individual insurance market – both inside and outside of the Marketplaces – as of December 31, 2014. Enrollment was up 4.8 million over the end of 2013, a 46% increase. (Levitt, Cox and Claxton, 4/29)

The Urban Institute: Taking Stock: Gains In Health Insurance Coverage Under The ACA As Of March 2015
We examine changes in insurance coverage for nonelderly adults (ages 18 to 64) overall and by state Medicaid expansion status going back to the first quarter of 2013. ... Fifteen million nonelderly adults gained coverage between September 2013 and March 2015 as the uninsurance rate fell from 17.6 percent to 10.1 percent. ... There have been large coverage gains for low- and middle-income adults targeted by key ACA provisions. ... There were gains in coverage for adults in each age, gender, and racial and ethnic group examined, but adults who are young, nonwhite, or Hispanic saw especially large percentage-point gains. (Long et al., 4/16)

The Commonwealth Fund: Latinos Have Made Coverage Gains But Millions Are Still Uninsured
Since the Affordable Care Act’s health insurance marketplaces opened and states began to expand Medicaid eligibility, uninsured rates among Latinos have begun to decline for the first time in decades. ... the Commonwealth Fund Biennial Health Insurance Survey finds Latinos continue to have the highest uninsured rates among major U.S. racial or ethnic groups. ... While about one-quarter of Latino adults who live in states that expanded their Medicaid programs were uninsured by the end of 2014, nearly half remain uninsured in states that, so far, have not expanded their Medicaid program. ... Texas and Florida, neither of which have expanded eligibility for their Medicaid programs, are home to the largest proportion of Latinos who are uninsured. (Doty et al., 4/27)

Institute of Medicine: Healthy, Resilient, and Sustainable Communities After Disasters: Strategies, Opportunities, and Planning for Recovery
Disasters often impact fundamental elements of a community -- physical infrastructure, health and social services, social connections -- that affect the health of its residents. Accordingly, the recovery period ... presents an important opportunity to redesign physical and social environments in a manner that will improve a community's long-term health status .... In response to concerns that health considerations are not adequately incorporated into disaster recovery decision making, the Institute of Medicine assembled an ad hoc committee to develop recommendations and guidance on strategies for mitigating disaster-related health impacts and optimizing the use of recovery resources to pursue more deliberately and thoughtfully the goal of healthier, more resilient and sustainable communities. (Tuckson et al., 4/15)

The Urban Institute/Inquiry: The Journal of Health Care Organization, Provision, and Financing: The Expanding Role Of Managed Care In The Medicaid Program
This research studies county-level Medicaid managed care (MMC) penetration and health care outcomes among nonelderly disabled and nondisabled enrollees. Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and health care outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals. (Caswell and Long, 4/16)

PLOS ONE: No Easy Talk: A Mixed Methods Study Of Doctor Reported Barriers To Conducting Effective End-Of-Life Conversations With Diverse Patients
Though most patients wish to discuss end-of-life (EOL) issues, doctors are reluctant to conduct end-of-life conversations. Little is known about the barriers doctors face in conducting effective EOL conversations .... [In this study] 99.99% doctors reported barriers with 85.7% finding it very challenging to conduct EOL conversations with all patients and especially so with patients whose ethnicity was different than their own. ... The biggest doctor-reported barriers to effective EOL conversations are (i) language and medical interpretation issues, (ii) patient/family religio-spiritual beliefs about death and dying, (iii) doctors’ ignorance of patients’ cultural beliefs, values and practices, (iv) patient/family's cultural differences in truth handling and decision making, (v) patients’ limited health literacy and (vi) patients’ mistrust of doctors and the health care system. (Periyakoil, Neri and Kraemer, 4/22)

The UCLA Center for Health Policy Research: Health And Health Behaviors Of Japanese Americans In California: A Sign Of Things To Come For Aging Americans?
The Japanese American population is leading the nation in aging. According to the 2010 U.S. Census, the number of adults 65 and older among Japanese Americans (23.6%) was nearly twice the number of adults in that age group in the general population (12.9%). The same trend has also been observed in California. ... Using data from the California Health Interview Survey (2003, 2005, 2007, 2009, and 2011- 2012), this report contributes to the understanding of the health status and health-related characteristics of Japanese Americans. ... This study shows that for a majority of the indicators (9 out of 15), the Japanese American adult population experiences lower risk. As such, their health and health behaviors may be a source of future study for examining healthy aging, not only in California but also in the United States in general. (Meng et al., 4/29)

Institute of Medicine: Vital Signs: Core Metrics For Health And Health Care Progress
Thousands of measures are in use today to assess health and health care in the United States. Although many of these measures provide useful information, their sheer number, as well as their lack of focus, consistency, and organization, limits their overall effectiveness in improving performance of the health system. To achieve better health at a lower cost, all stakeholders -- including health professionals, payers, policy makers, and members of the public -- must be alert to what matters most. ... Vital Signs identifies the need for a standard set of core measures as a tool for improving health in the United States. This book explains the current use of metrics in health and health care and then proposes a streamlined set of 15 standardized measures, with recommendations for their application at every level and across sectors. (Blumenthal et al., 4/28)

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

Reuters: U.S. Data Show That Mammograms Still Often Begin At 40
Despite 2009 recommendations to stop giving women under 50 screening mammograms, the rate of first mammograms occurring at age 40 is on the increase, according to a new study. ... [Dr. Soudabeh Fazeli Dehkordy of the University of Michigan Health System in Ann Arbor and a team of researchers] used data from surveys in the years before and after the ... recommendation – 2007, 2008, 2010 and 2012 -- to look at patterns in women’s use of mammograms by age. Screening rates were lower overall in 2010 and 2012 than in previous years, the authors report in the American Journal of Preventive Medicine, but the proportion of women who began getting screened at age 40 increased, and was highest after the ... recommendations were issued in 2009. (Doyle, 4/24)

NPR: Maybe You Should Rethink That Daily Aspirin
We've all heard that an aspirin a day can keep heart disease at bay. But lots of Americans seem to be taking it as a preventive measure, when many probably shouldn't. In a recent national survey, more than half the adults who were middle age or older reported taking an aspirin regularly to prevent a heart attack or stroke. The Food and Drug Administration only recommends the drug for people who've already experienced such an event, or who are at extremely high risk. (Singh, 4/27)

HealthDay/The Philadelphia Inquirer: ER Practices Key To Helping Those Addicted To Painkillers
A comparison of three treatments for narcotic painkiller addiction found that patients given the medication buprenorphine in the emergency department do better than those given only referrals. Addiction to prescription narcotic painkillers such as Oxycontin or Vicodin is "a huge public health problem," study first author Dr. Gail D'Onofrio, chair of emergency medicine at Yale School of Medicine in New Haven, Conn., said in a university news release. Drug overdoses account for more deaths each day in the United States than car crashes, she and her colleagues noted. (Dallas, 4/28)

Reuters: Young Women Say They Are Happy With IUDs
College women who choose an intrauterine device (IUD) for long-term contraception say it hurts to have the device inserted at first, but they are otherwise very happy with it more than a year later, according to a new U.S. survey. The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have both endorsed IUDs as first-line contraception for young women who have never had children, but many providers, especially in the U.S., still are not comfortable giving IUDs to these women, said lead author Dr. Alexandra M. Hall of the University of Wisconsin in Menomonie. (Doyle, 4/23)

Medscape: Precertification Requirement Delays Discharge After Stroke
Requiring precertification from private insurance companies delays hospital discharge of stroke patients to a nursing facility or rehabilitation, a new study shows. Researchers found that patients who required insurance precertification had an average delay in discharge of 1.5 days compared with 0.8 day for those not requiring such precertification, a statistically significant difference of 0.7 day. (Anderson, 4/28)

HealthDay: Antibiotics Shortages Could Put Patients At Risk From Superbugs
Shortages of antibiotics, including those used to treat drug-resistant infections, may be putting patients at risk for sickness and death, according to a new report. Between 2001 and 2013, there were shortages of 148 antibiotics. And the shortages started getting worse in 2007, researchers found. (Reinberg, 4/23)

Reuters: Patients Hospitalized On Weekends Risk More Falls And Infections
Patients admitted to the hospital on weekends are more likely to get a preventable illness or injury during their stay than people admitted during the week, a large U.S. study finds. Even after adjusting for patient characteristics, including the severity of the condition that brought them to the hospital, weekend admission was still linked with more than a 20 percent increased likelihood of hospital-acquired conditions when compared to weekday admissions, lead author Dr. Frank Attenello, a researcher at the University of Southern California, said by email. (Rapaport, 4/21)

The Chicago Sun-Times: Great Recession Linked To Rise In Depression
The Great Recession saw the number of adults in the United States suffering from major depression rise significantly and remain higher, according to a new Loyola University Stritch School of Medicine study touted as the first to examine the recession’s impact on mental health. Writing in the Journal of Clinical Psychiatry, the researchers said it’s not a stretch to think that the impact of the recession, which officially began in December 2007 and lasted 18 months, on economic security contributed to that. (4/25)

Reuters: Finding LGBT-Competent Doctors May Be Difficult
Finding doctors at U.S. teaching hospitals who consider themselves competent to care for lesbian, gay, bisexual and transgender (LGBT) patients may be difficult, suggests a new study. Few such hospitals reported having ways to identify doctors knowledgeable about LGBT health, and only a few hospitals offered comprehensive LGBT-competency training to their staffs, researchers report in the American Journal of Public Health. (Seaman, 4/21)

Editorials And Opinions

Viewpoints: Faster Drug Approvals; Medical Privacy; Fla. Official's Opposition To Medicaid Expansion

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

The Wall Street Journal: They’re Your Vital Signs, Not Your Medical Records
Experts estimate that in five years we will generate 50 times more health information than today. Diagnoses, treatments, DNA, medical images and vital signs already are being analyzed and stored. Health apps, thermometers and scales, and even devices implanted in our bodies, are connected and streaming data. In the not-too-distant future, our lives will depend upon how our health information is accessed and used. (David J. Brailer, 4/30)

Miami Herald: Why I Oppose The Expansion Of Medicaid
We oppose expanding Medicaid because it is a broken system with poor health outcomes, high inflation, unseverable federal strings and no incentive for personal responsibility for those who are able to provide for themselves. Under current law, Florida provides for our most vulnerable: low-income children, pregnant women, the elderly and disabled people. Under federal law, other low-income Floridians have access to healthcare subsidies to buy private insurance for less than the average cost of a wireless phone bill. In fact, if we choose Obamacare expansion, 600,000 will lose eligibility for their subsidies, of which 257,000 would be forced into Medicaid. (Florida House Speaker Steve Crisafulli, 4/29)

The Washington Post's Plum Line: Morning Plum: A Crack In Red State Resistance To Obamacare? Maybe Sort Of.
Politico reports this morning that there is a real shift underway among red state governors towards Obamacare: A number of them are newly open to accepting the Medicaid expansion — as long as they can couple it with some kind of work requirement. ... I’m going to suggest that this is, on balance, a good development — in the sense that more GOP governors appear open to finding terms upon which they are willing to take the money to cover their constituents. (Greg Sargent, 4/30)

Philadelphia Inquirer: Can We Really Trust Congress To Pay For The Obamacare Medicaid Expansion?
The notable success of Obamacare has been the growth in Medicaid enrollees --10 million concentrated in states that accepted the federal government’s incentives for expansion. But will the promise of continued federal funding for the expansion be kept? A report published April 9, 2015 by the Foundation for Governmental Accountability, the FGA, warns in its title: “Promises made, promises broken: State’s cannot trust Washington’s promise to fund Obamacare Medicaid expansion.” The FGA has few liberal friends, and the content of the report is unlikely to appear in the popular press. So, you get an opportunity to learn about it here. (Howard Peterson, 5/1)

Philadelphia Inquirer: Healthier Schools Means Increased Immunizations
The recent measles outbreak that infected children vacationing at California's Disneyland focused our attention on a potential public health crisis in our own backyard: Too few children are receiving potentially life-saving immunizations. Despite a high-quality health-care system and wide availability of immunization programs, the commonwealth has among the lowest vaccination rates in the country. In Pennsylvania, it is reported that only 86 percent of children entering kindergarten have the necessary vaccinations, compared with roughly 95 percent in the rest of the country. (Karen Murphy, 5/1)

Los Angeles Times: Going Undercover At Crisis Pregnancy Centers
You've seen the billboards up and down the state: "Pregnant and scared?" Well, Dania Flores wasn't pregnant but she was a little bit scared the first time she visited a crisis pregnancy center. A recent high school graduate, she was working undercover, posing as a pregnant teen to gather intel on these operations, which have but one goal: to prevent abortion. ... Flores said she was never informed that abortion was a safe, legal alternative to childbirth. She was never told that California's Medi-Cal program covered the cost of reproductive services, including abortion. Nor that time was of the essence. Instead, she says, she was misled and shamed by anti-abortion activists masquerading as concerned healthcare providers. (Robin Abcarian, 5/1)

JAMA: The Precision Medicine Initiative
The recent announcement by President Obama of a precision medicine initiative created excitement in the medical community. ... In one sense, medicine has always been personalized (if not always as precise as physicians and patients would like). Clinicians integrate signs and symptoms, evidence, their experience, and patient preference to facilitate decision making. What is new is that biomedical technology now allows a deeper understanding of many diseases. Drug development costs have increased sharply, leading pharmaceutical companies to focus on rarer diseases. In parallel, the significant decrease in the cost of genome sequencing has facilitated the discovery of many new, rare genetic diseases. Together, these advances have provided the necessary and sufficient conditions for the new model of precision medicine. (Euan A. Ashley, 4/30)