KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Fourth Florida Insurer Agrees To Cap Cost Of HIV Drugs

A fourth insurer in Florida, Preferred Medical Plan, was hit with a federal civil rights complaint for discriminating against people with HIV. All have now agreed to lower drug costs. (Nicholas Nehamas, Miami Herald, 1/22)

Political Cartoon: ‘A Friend In Need?’

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: ‘A Friend In Need?’" by Roy Delgado.

Here's today's health policy haiku:


Senator Warren
has a new way to pay for
medical research.

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

Health Law Issues And Implementation

Ark. Gov. Calls For Keeping Medicaid Expansion For Two Years, Then Rethinking Approach

The program, often called the private option, did not expand Medicaid in the usual way, but instead used federal funds to buy private insurance for more than 200,000 poor people. Even with new Gov. Asa Hutchinson's support, it's not yet clear if the legislature will support an extension of the program.

The Washington Post's Wonkblog: Republicans Are Finally Learning They Can’t Undo Obamacare
If you care about the politics of Obamacare and the future of health care reform, Arkansas's new Republican Gov. Asa Hutchinson just gave one of the most important health-care speeches in recent memory. For the past two years, Arkansas has played a significant role in getting a number of conservative states to accept Obamacare's Medicaid expansion. The state's previous Democratic governor, Mike Beebe, in early 2013 struck a deal with Republican state lawmakers and the Obama administration to use federal Medicaid expansion dollars to purchase private coverage for low-income adults. (Millman, 1/22)

Arkansas News: Hutchinson Says He Wants To Continue Private Option Through 2016, Find Alternatives
Gov. Asa Hutchinson said Thursday he will ask the Legislature to continue the so-called private option for two more years and create a task force to explore alternative solutions the state could implement after that. In a much-awaited speech at the University of Arkansas for Medical Sciences in Little Rock, Hutchinson said hospitals should not have to face “a traumatic cliff” every time the Medicaid expansion program known as the private option is up for renewal. He said he will ask the Legislature to continue the program through Dec. 31, 2016. (Lyon, 1/22)

Politico: Arkansas Governor Eyes Changes To Medicaid Expansion
Arkansas Gov. Asa Hutchinson said Thursday he wants to end his state’s Obamacare Medicaid experiment, which has been a national model for conservative states. The Arkansas program uses federal funds to buy people private health plans on the Obamacare exchange. Dubbed “the private option,” it was an innovation designed to draw support of red-state lawmakers otherwise opposed to President Barack Obama’s health care law. (Wheaton, 1/22)

The New York Times: Arkansas: Governor Seeks To Continue An Alternative To Medicaid
Gov. Asa Hutchinson, a Republican, asked lawmakers Thursday to keep the state’s alternative to Medicaid expansion under the Affordable Care Act in place for two more years. In the meantime, he said, a task force will come up with recommendations for changing or replacing it. The program, known as the private option, has used federal funds to buy private insurance for more than 200,000 poor people through the marketplace instead of adding them to traditional Medicaid. (Goodnough, 1/22)

Modern Healthcare: New Arkansas Governor Wants To Renew, Then Rethink, Medicaid Expansion
Arkansas Republican Gov. Asa Hutchinson called on the Legislature to keep the state's private-option approach to Medicaid expansion backed by his Democratic predecessor through 2016 so that roughly 200,000 low-income residents won't lose access to insurance coverage. But Hutchinson, in a highly anticipated speech Thursday, also called for the creation of a legislative task force to study other options for providing insurance to those who can't afford it in the future. (Demko, 1/22)

Also in the news, Ohio Gov. John Kasich tours Western states and touts Medicaid expansion.

Great Falls (Mont.) Tribune: Ohio Gov Backs Medicaid Expansion, Budget Amendment
Ohio Gov. John Kasich told a small group of Montana legislative Republicans they should not oppose expansion of Medicaid on the basis of "strict ideology." "I gotta tell you, turning down your money back to Montana on an ideological basis, when people can lose their lives because they get no help, doesn't make a lot of sense to me," Kasich told Republican lawmakers. Kasich, a possible 2016 Republican presidential contender, is touring state legislatures across the West to drum up support for a constitutional convention to modify the U.S. Constitution to include a balanced budget amendment. (Adams, 1/21)

Salt Lake Tribune: Ohio Gov. Kasich Promotes Balanced Budget Amendment In Utah Visit
Ohio is one of the 28 states that has expanded Medicaid as envisioned in the Affordable Care Act. Montana and Utah are among the states that are still debating that action, which has been unpalatable to the state's conservatives. Kasich said he didn't see it as inconsistent to expand an entitlement program and at the same time calling on the federal government to balance its budget. He said if the constitutional amendment passes, many federal programs, including Medicaid, may need to be reconsidered, but that doesn't mean the destruction of the social-safety net. (Canham, 1/22)

The Associated Press: Kelly Says He Will Keep Open To Medicaid Expansion
A co-chair of the [Alaska] Senate Finance Committee said the state is not on a path to expanding Medicaid. But Sen. Pete Kelly, R-Fairbanks, said Thursday that he would keep an open mind to the possibility. Kelly made his comments as the committee discussed hiring former state health commissioner Bill Streur as a consultant. Streur served under former Gov. Sean Parnell, who resisted expanding Medicaid coverage, citing cost concerns. (Bohrer, 1/22)

Latino Enrollment Is Obamacare Priority

Officials are using a bevy of new methods to try to entice this traditionally hard-to-reach group to purchase health insurance. In the meantime, one Florida zip code leads the nation in enrollment.

USA Today: Efforts Intensify To Sign Up Hispanics For Health Care
With the enrollment deadline looming, the Obama administration and advocacy groups are ramping up efforts to sign up millions of Hispanics for health coverage through online exchanges set up under the Affordable Care Act. Activists in states with high Latino populations are using various strategies to recruit a traditionally hard-to-reach group that already faces barriers to health care. The activists have been especially aggressive in Texas and Florida, which declined to expand Medicaid under the 2010 health care law. (King, 1/22)

The Miami Herald: One Florida ZIP Code Leads The Nation In Obamacare Enrollment
In one Hialeah ZIP Code, where signs selling “Obamacare” are plastered across storefronts and cover freeway billboards, more people have selected a plan on the Affordable Care Act insurance exchange than in any spot in the country, according to the data release by the U.S. Department of Health and Human Services on Thursday. Despite the political rancor associated with the healthcare reform law, residents of Hialeah signed up in record numbers for coverage in 2015. (Herrera, Nehamas and Chang, 1/22)

Obama Administration Offers Supreme Court Robust Defense Of Health Law

Chief Justice John Roberts will be pivotal to deciding the fate of the law, The Washington Post reports. The administration says health law detractors have offered a challenge that "strains credulity."

The Washington Post's Plumline: For Chief Justice John Roberts, Anti-Obamacare Lawsuit Poses Major Dilemma
The government has now filed its brief responding to the challengers in the King v. Burwell lawsuit, which claims the Affordable Care Act doesn’t make subsidies available to people in states on the federal exchange. If the Supreme Court upholds the challenge, it could yank subsidies from millions and unleash untold disruptions that could cripple the law in many parts of the country. (Sargent, 1/22)

CQ Healthbeat: Health Law Challenge 'Strains Credulity,' Administration Says
President Barack Obama’s administration submitted a full-throated defense of the health care overhaul law to the Supreme Court on Thursday, arguing that challengers have a theory that at times is baseless, implausible, “strains credulity” and “does not respect the rule of law.” The brief, filed by Solicitor General Donald Verrilli Jr. and other administration lawyers, argues that the challenge “rests on an acontextual misreading of a single phrase in two subclauses” of the president’s signature law, and “an implausible account of the act’s design and history.” (Ruger, 1/22)

Judge Orders Calif. To Grant Temporary Coverage To Medi-Cal Applicants Caught in Limbo

The state of California will offer temporary benefits to applicants who have been waiting more than 45 days for officials to determine if they are eligible for the state's Medicaid program.

Kaiser Health News: Judge Orders California To Make Timely Decisions On Medicaid Coverage
Medi-Cal applicants who have been waiting for more than 45 days can receive temporary health benefits while officials determine eligibility for the public insurance program, a state Superior Court judge ruled this week. The decision came in a lawsuit filed in September alleging that a large backlog of applications to California’s Medicaid program left hundreds of thousands of people unable to access health care. (Gorman, 1/23)

CQ Healthbeat: California To Cover Medicaid Applicants Stuck In Limbo
The state of California is preparing to grant temporary health coverage to Medicaid applicants who did not get coverage decisions within a required 45-day period. Alameda County Superior Court Evelio Grillo ruled against the state Tuesday in a case brought by advocates who want to reduce the number of Medicaid applicants who are waiting, sometimes for months beyond the federal deadline, for decisions about whether they qualify for benefits. (Adams, 1/22)

Capitol Hill Watch

House Approves Bill To Permanently Prohibit Taxpayer Funding For Abortion

The vote, which coincided with the annual March for LIfe rally, came after some Republican women and moderate lawmakers helped scuttle another vote on a more controversial measure that would have banned abortions after 20 weeks.

The Wall Street Journal: House Passes Bill Prohibiting Federal Funds Being Used for Abortions
Some female Republican and centrist lawmakers helped scuttle a vote on a controversial measure to ban abortions after 20 weeks of pregnancy, prompting the House on Thursday to pass a separate, largely symbolic bill that would further restrict federal funding to pay for abortions. The last-minute scramble laid bare a rift within the Republican Party and highlighted its delicate relationship with an issue that ties the GOP to social conservatives. Republicans want to show their commitment to curbing abortions without turning off women voters who hold mixed views on the procedure. (Peterson and Radnofsky, 1/22)

Politico: House Votes To Block Federal Funding Of Abortion
President Barack Obama lashed out at House passage Thursday of a bill that would permanently prohibit taxpayer funding for abortion. The House easily passed it after GOP leaders had to cancel a vote on another bill that would have banned most abortions after 20 weeks of pregnancy, which got caught up in a fight about exemptions for rape victims. (Villacorta, 1/22)

The Washington Post: House Republicans Pass Watered-Down Antiabortion Bill
About two dozen Republicans, led mostly by a small group of female lawmakers, forced the House leadership to pull an antiabortion bill from consideration and replace it with a less restrictive measure Thursday. The episode exposed a growing concern within the GOP that emphasizing culture-war issues in the new Congress could distract from the party’s broader agenda and upend hopes of retaking the White House. (O'Keefe, 1/22)

Politico: Abortion Bill's Collapse Shows Moderates' Clout
John Boehner has a new balancing act: Handling the moderate backbencher resurgence. In years past, it was just the far right that dragged Boehner by the hair. But the political pendulum has swung closer to the center, and now, everyday members of the House Republican Conference are regaining their voice and willing to criticize their leadership for catering almost exclusively to conservatives. (Sherman and Bresnahan, 1/22)

Politico: Rape Controversies Return To Haunt GOP
With the GOP in control of both chambers of Congress, Republicans in the House were poised to pass a ban on abortions after 20 weeks of pregnancy to try to advance it in the Senate. The bill is an outright challenge to Roe v. Wade, decided exactly 42 years ago. Instead, House leaders had to cancel the vote after objections from some female Republicans who deemed a rape exemption unacceptably narrow and burdensome. (Wheaton, 1/22)

The Washington Post: Abortion Opponents Rally On Mall, Optimistic That Nation’s Views Are Aligning With Theirs
With legislative drama about abortion literally unfolding behind them at the U.S. Capitol, tens of thousands of abortion opponents held an upbeat rally Thursday to emphasize participants’ belief that U.S. culture is turning in their favor. As has become standard in recent years, the March for Life participants were overwhelmingly young and religious, with busloads of students who had come from across the country giving the Mall the feeling of a pop concert. (Boorstein, 1/22)

USA Today: Obama Praises Roe V. Wade., Criticizes House GOP
President Obama marked the 42nd anniversary of the Supreme Court's ruling in Roe v. Wade with a statement praising the pivotal abortion rights ruling. The 1973 decision "protects a woman's freedom to make her own choices about her body and her health, and reaffirms a fundamental American value: that government should not intrude in our most private and personal family matters," Obama said. (Jackson, 1/22)

NPR: States Continue Push To Ban Abortions After 20 Weeks
House Republicans decided Wednesday night to shelve a bill that would have banned abortion at 20 weeks post-conception. But 10 states already ban abortions at 20 weeks and two others are defending such laws in court. Activists are pushing for bans in at least three more states; a panel in the South Carolina Legislature passed one Thursday. (Ludden, 1/22)

New Congress Faces Old Medicare Pay Issues

Meanwhile, the new GOP Senate Budget Committee chairman said he wants to balance the budget within 10 years, and Wisconsin Sen. Tammy Baldwin calls for hearings on improper opioid prescribing at a VA medical center.

The Associated Press: Budget Chairman Promises GOP Plan To Balance In Decade
The new Republican chairman of the Senate Budget Committee said Thursday that he'll try to pass a fiscal blueprint this spring that will promise a balanced budget by the end of 10 years. "We'll try and balance the budget in a 10-year period," Sen. Mike Enzi, R-Wyo., said on a conference call with reporters. "And we hope to do it without gimmicks and bad accounting." But Enzi wouldn't say what he hopes to do with special budget legislation that can overcome a Democratic filibuster in the Senate. Many conservatives hope to use unique filibuster-proof legislation permitted under the budget process to repeal the new health care law. (1/22)

Elizabeth Warren Would Ding Law-Breaking Drug Makers And Use The Fines To Fund Research

The Massachusetts Democrat plans to introduce a bill next week that would require drug makers that break the law to send a percentage of their profits to the U.S. National Institutes of Health for five years.

The Wall Street Journal's Pharmalot: Senator Wants Big Drug Makers That Break The Law To Fund NIH
Seeking to replenish funding for new scientific research, U.S. Sen. Elizabeth Warren (D-Ma.) plans to introduce a bill next week that would require drug makers that break the law to send some of their profits to the U.S. National Institutes of Health. Drug makers that reach settlements with the federal government for paying kickbacks to doctors, defrauding Medicare or Medicaid or illegally marketing medicines would have to pay 1% of their annual profits for each blockbuster medicine that can be traced to public sector research. Such a penalty would run for five years, which Warren notes is the same amount of time covered under most settlements. (Silverman, 1/22)

The Hill: Elizabeth Warren: How About A 'Swear Jar' For Drug Companies?
Sen. Elizabeth Warren (D-Mass.) turned her fire from Wall Street to large pharmaceutical companies on Thursday, unveiling a bill to make big drug companies pay into a fund for medical research when they reach a settlement for law-breaking. Warren's bill, the Medical Innovation Act, would require large drug companies that reach a settlement with the government for breaking the law to pay a "small portion" of their profits over five years into a fund for research at the National Institutes of Health, and the Food and Drug Administration. (Sullivan, 1/22)

Politico: Warren Takes On Drug Companies At Health Care Conference
Sen. Elizabeth Warren took the populist ire she usually reserves for Wall Street banks and directed it Thursday at drug companies that are making billion-dollar profits. Addressing a leading health reform advocacy group, the Massachusetts Democrat lambasted pharmaceutical firms that are “making money by skirting the law” even while relying on taxpayer-supported research to develop blockbuster medications. (Pradhan, 1/22)

Administration News

Obama's Push To Change Sick-Leave Laws Raises Small Business Concerns

News outlets analyze some of the health policy issues included in President Barack Obama's state-of-the-union address.

NPR: Obama's Big Bid To Change Sick-Leave Laws May Hinge On Small Business
In his State of the Union speech earlier this week, President Obama pitched a plan to boost what he called "middle-class economics." He asked Congress to help him make community college free, cut taxes for the middle class — and also do this: "Send me a bill that gives every worker in America the opportunity to earn seven days of paid sick leave," Obama said. "It's the right thing to do." Many in the business lobby aren't likely to agree with that. Lisa Horn, a lobbyist with the Society for Human Resource Management, says that businesses would prefer flexibility for workers to choose how to spend their leave — whether that means sick time or vacation. Horn asserts that the effect of a federal paid sick leave rule would be that businesses will cut back on other benefits. (Noguchi, 1/22)

PBS Newshour: In U.S., Support For Paid Family Leave But No One To Pay
The United States and Papua New Guinea are the only countries in the world that do not provide any paid time off for new mothers. Why haven’t maternity leave laws kept pace with the increase of working parents? Economics correspondent Paul Solman explores the debate on whether time off for new parents is also good for business. (1/22)

CQ Healthbeat: Personalized Cures Could Put New Pressure On FDA
President Barack Obama's push for more personalized medicines, articulated in his State of the Union address, comes at a time when the Food and Drug Administration is reviewing more narrowly targeted therapies and policymakers are questioning whether the agency is capable of evaluating the safety and efficacy of next-generation medicines. (Gustin, 1/22)


How Georgia And Missouri Hospitals Stack Up

George Health News and The St. Louis Post-Dispatch take a look at how their hospitals rate on new quality metrics put in place by the Affordable Care Act and whether those metrics are meaningful. Meanwhile, Modern Healthcare explores how payment spats between providers and insurers continue despite the move away from fee-for-service systems.

Georgia Health News: Hospitals Get Financial Rewards ... Or Do They?
A majority of Georgia hospitals will get performance bonuses from Medicare for their quality of care, federal data show. The 59 percent of Georgia hospitals getting the financial reward exceeds the national average of 55 percent, according to a Kaiser Health News article. The bonuses come from measurements that include patient satisfaction, lower death rates and how much patients cost Medicare. (Miller, 1/22)

Modern Healthcare: Value-Based Care Not Likely To End Payer/Provider Financial Spats
A large payer and health system in California are embroiled in a bitter feud over expired contract terms, the type of fight all too common in the fee-for-service world. With healthcare switching to value-based care, some had hoped these types of financial squabbles would disappear as the interests of providers and payers became more closely aligned on reducing costs. (Herman, 1/22)

Other media look at how doctors and patients may be able to harness big data to make better care decisions -

The Philadelphia Inquirer: 'Big Data' Coming Soon To Cancer Care In Philly
An association of cancer specialists is racing ahead with an ambitious project aimed at improving the quality and efficiency of cancer care by mining patients' electronic health records. The 30,000-member American Society of Clinical Oncology announced a partnership Wednesday with SAP, the global software giant whose U.S. base is in Newtown Square. They are developing CancerLinQ, a computer network intended to help cancer doctors make treatment decisions for their patients based on the results of comparable patients. (McCullough, 1/22)

The Associated Press: Medicare Adds Star Ratings For Dialysis Center Comparison
Medicare is adding a visual tool to help kidney patients compare the quality of dialysis centers: Star ratings. Medicare's online Dialysis Facility Compare already included quality information such as whether patient death and hospitalization rates were higher than expected. But it says that information wasn't always easy for patients to understand. (1/22)

Public Health And Education

Disneyland Measles Outbreak Triggers Discussion, Criticism Of Anti-Vaccination Movement

The measles outbreak originated in California at Disneyland and has since been tracked to include 70 infected people in six states.

The Washington Post: The Disneyland Measles Outbreak And The Disgraced Doctor Who Whipped Up Vaccination Fear
Just before 7 p.m. last Thursday, as the Disneyland measles outbreak was emerging, the Los Angeles Times published an outraged editorial. It didn’t blame Disneyland, where the outbreak originated before going on to infect 70 people across six states. Nor did it blame any public agency. Instead, it took aim at a buoyant movement that won’t “get over its ignorant and self-absorbed rejection of science.” The faction was the anti-vaccine movement — its holy text a retracted medical study, its high priest a disgraced British doctor named Andrew Wakefield. “The prospect of a new measles epidemic is disturbing,” the editorial said. “So is the knowledge that many ill-informed people accept a thoroughly discredited and retracted study in the journal Lancet that purported to associate vaccination with autism. (McCoy, 1/23)

Los Angeles Times: Fewer California Parents Refuse To Vaccinate Children
The number of California parents who cite personal beliefs in refusing to vaccinate their kindergartners dropped in 2014 for the first time in a dozen years, according to a Times data analysis. The shift came amid rising alarm over the number of children being exempted from immunization, which prompted new campaigns to reverse the trend. A state law that went into effect last year made it more difficult for parents to excuse kindergartners from vaccines. Instead of signing a form, parents now must get a signature from a healthcare provider saying that they have been counseled on the risks of rejecting vaccinations. Alternatively, they can declare they are followers of a religion that prohibits them from seeking medical advice from healthcare practitioners. (Xia, Lin and Poindexter, 1/22)

Opioid Use By Young Women Spurs Birth Defect Concerns

Federal health officials say nearly one-third of women who might get pregnant are getting opioid painkiller prescriptions such as Vicodin and Oxycontin, even though such prescriptions carry birth defect big risks.

The Washington Post: On Painkillers And Thinking About Getting Pregnant? Better Talk To Your Doctor.
More than one-fourth of women who might become pregnant are getting prescriptions for opioid painkillers, such as Vicodin and Oxycontin, that can cause birth defects and other serious problems early in pregnancy, according to a report released Thursday by the Centers for Disease Control and Prevention. These common opioid medications are typically prescribed to treat moderate to severe pain, and they can also be found in some prescription cough medicines. But taking them early in pregnancy is dangerous. (Sun, 1/22)

State Watch

State Highlights: Md. Gov. Proposes Cuts In Medicaid Reimbursements; Idaho Officials Mull Health Care Overhaul

A selection of health policy stories from Maryland, Idaho, Wisconsin, Colorado, Rhode Island and New York.

The Associated Press: Hogan Says Budget Has Limits, But Provides Record K-12 Funds
Del. Maggie McIntosh, the chair of the House Appropriations Committee, said she has a lot of questions about how the overall budget plan would affect state employees, health care and K-12 education in all counties. Hogan’s plan would reduce rates paid to Medicaid healthcare providers to fiscal year 2014 levels, which would save about $160 million. The plan also calls for state employee compensation adjustments to save $156 million. (1/22)

The Baltimore Sun: LGBT Groups Criticize Hogan For Pulling Back Medicaid Regulation Banning Discrmination
Gov. Larry Hogan may have sent a message of “tolerance and mutual respect” during his inauguration on Wednesday, but advocates for the state's lesbian, gay, bisexual and transgender community say his early actions in office have signaled something different. In one of his first acts, Hogan held up a regulation that would have banned Medicaid providers in the state from discriminating on the basis of sexual orientation and gender identity, according to state officials. The provision was proposed in recent months under the administration of Hogan's predecessor, Martin O'Malley, at the urging of LGBT groups. (Rector, 1/22)

The Associated Press: Wisconsin Governor Touts Drug Testing For Aid Recipients
Medicaid recipients in Wisconsin would be required to undergo drug testing and could be limited in how long they can receive benefits under measures proposed Thursday by Gov. Scott Walker, who is positioning himself as a reformer as he eyes a 2016 presidential run. The idea, which Walker first proposed during his re-election campaign, will be included in his state budget released to the Republican-controlled Legislature on Feb. 3. Walker announced for the first time Thursday that the plan would apply to childless adults on Medicaid, as well as those applying for or receiving aid from other state benefit programs. (Bauer, 1/22)

The Associated Press: Idaho Health Care Officials Call For Overhaul
Idaho's health care system for the poor has been stretched to its limits and needs an overhaul, the program's director said Thursday. The Catastrophic Health Care Cost Program handled fewer cases last year than it had previously, but it continued to be burdened by issues such as mental health care, Roger Christensen told state budget writers. (Krusei, 1/22)

The Denver Post: Colorado Lawmakers Advance Bill To Spread Telehealth Across State
A bill that would boost telemedicine in Colorado by preventing health insurance plans from requiring in-person care to patients when it can be appropriately provided remotely progressed to the House floor on a unanimous committee vote Thursday. The House Health, Insurance and Environment Committee approved a bill that would expand a current law supporting telemedicine — care delivered via a computer, smartphone or other device — only for patients residing in counties with 150,000 or fewer residents. (Draper, 1/22)

The Associated Press: Bill Would Let Terminally Ill Use Experimental Drugs In RI
While a handful of states have passed or are considering right-to-die laws, a Rhode Island lawmaker wants the state to give terminally ill patients the "right to try." Democratic Rep. Joseph McNamara says his bill is the opposite of laws that allow terminally ill patients to legally take their live. It would let them obtain experimental drugs that have not been federally approved. (McDermott, 1/22)

The Associated Press: NY Asks Feds To Probe 2013 Rikers Island Mentally Ill Inmate Death
Federal prosecutors should launch a civil rights probe into the 2013 death of a mentally ill Rikers Island inmate who was locked in his cell for six days without care or medication, a state oversight panel concluded in a review that called the treatment "so incompetent and inadequate as to shock the conscience." Bradley Ballard, a 39-year-old paranoid schizophrenic with diabetes, died shortly after a doctor finally went into his cell and found him naked, covered in feces and badly infected from a piece of cloth he tied tightly around his genitals. (Pearson, 1/23)

Health Policy Research

Research Roundup: Reforming Medical Training; The Effects Of A Ruling On The Health Law

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

The New England Journal of Medicine: Institute Of Medicine Report On GME — A Call For Reform
The 21-member IOM Committee on the Governance and Financing of Graduate Medical Education, two thirds of whose members are or previously were academic medical and nursing leaders, asserted that GME programs that are supported by Medicare do not train adequate numbers of physicians who are prepared to work in needed specialties or underserved geographic areas. The report recommends the creation of a new GME financing system “with greater transparency, accountability, strategic direction, and capacity to innovate.” ... This article will cover the key recommendations of the IOM committee, strong objections to them voiced by recipients of Medicare GME payments, and disagreements over whether there is a shortage of physicians. (John K. Iglehart, 1/22)

JAMA: Diagnostic Performance By Medical Students Working Individually Or In Teams
Diagnostic errors contribute substantially to preventable medical error. ... Our aim was to investigate the effect of working in pairs as opposed to alone on diagnostic performance. ... Volunteer fourth-year medical students recruited via mailing lists at Charité Medical School, Berlin, Germany, participated in the study during June 2013 and gave written informed consent. Their main task was to evaluate 6 simulated cases of respiratory distress on a computer .... Working collaboratively reduced diagnostic errors among medical students. As in previous research, neither differences in knowledge nor in amount and relevance of acquired information explained the superior accuracy of the pairs .... Similar to other studies, collaboration may have helped correct errors, fill knowledge gaps, and counteract reasoning flaws. (Hautz et al., 1/20)

The Kaiser Family Foundation: Tapping Nurse Practitioners To Meet Rising Demand For Primary Care
Over 58 million Americans reside in geographic areas or belong to population groups that are considered primary care shortage areas. ... This brief focuses on the untapped potential of one type of advanced-practice nurses – nurse practitioners – to increase access to primary care. In 2012, about 127,000 NPs were providing patient care in the U.S., roughly half of whom – around 60,400 – were practicing in primary care settings. ... optimizing our existing primary care capacity by removing barriers to NPs’ full deployment is a step that states, public and private health insurance programs, and managed care plans are in a position to take in the immediate term. Fuller participation of NPs in primary care might help, in particular, to increase access in underserved rural and urban areas. (Van Vleet and Paradise, 1/20)

The Urban Institute/Robert Wood Johnson Foundation: Characteristics Of Those Affected By A Supreme Court Finding For The Plaintiff In King V. Burwell
In a recent brief, we examined the broad coverage and premium implications of a ruling that would end federal tax credits for marketplace-based private health insurance coverage in states in which the federal government operates the marketplaces. Here, we provide the characteristics of those affected by such a ruling. Of the 9.3 million people estimated to lose tax credits under a finding for King, two-thirds would become uninsured. Most of these are adults with incomes between 138 and 400 percent of the federal poverty level (FPL). Over 60 percent of those who would become uninsured are white, non-Hispanic and over 60 percent would reside in the South. More than half of adults have a high school education or less, and 80 percent are working. (Blumberg, Buettgens and Holahan, 1/22)

The Commonwealth Fund: What's Behind Health Insurance Rate Increases? An Examination Of What Insurers Reported To The Federal Government In 2013–2014
The Affordable Care Act requires health insurers to justify rate increases that are 10 percent or more for nongrandfathered plans in the individual and small-group markets. Analyzing these filings for renewals taking effect from mid-2013 through mid-2014, this brief finds that the average rate increase submitted for review was 13 percent. Insurers attributed the great bulk of these larger rate increases to routine factors such as trends in medical costs. Most insurers did not attribute any portion of these medical cost trends to factors related to the Affordable Care Act. The ACA-related factors mentioned most often were nonmedical: the new federal taxes on insurers, and the fee for the transitional reinsurance program. On average, insurers that quantified any ACA impact attributed about a third to these new ACA assessments. (McCue and Hall, 1/20)

The Kaiser Family Foundation: Abortion Coverage In Marketplace Plans, 2015
In the years following the passage of the ACA, ... the availability of abortion coverage varies considerably. In states that have not banned abortion coverage, plans sold on the Marketplace electing to include abortion coverage must segregate funds consumers pay for abortion coverage from those paid for all other care. By 2017, at least one Multi-State plan that excludes abortion coverage must be available in each Marketplace, so that consumers have an option to enroll in a plan that does not cover abortion. ... As the debate on abortion continues, both sides remain dissatisfied with how the law is being implemented with regard to abortion coverage. Given the polarized nature of the abortion debate in this country, the issue of access to abortion coverage will continue to be a focus of policy at both the state and national level. (Salganicoff and Sobel, 1/21)

Georgetown University Center for Children and Families/The Kaiser Family Foundation: Modern Era Medicaid: Findings From A 50-State Survey Of Eligibility, Enrollment, Renewal, And Cost-Sharing Policies In Medicaid And CHIP As Of January 2015
As of January 1, 2015, 28 states set their Medicaid income eligibility levels for parents and other adults to at least 138 percent of the federal poverty level (FPL), reflecting their implementation of the ACA Medicaid expansion. ... There is no deadline for states to expand Medicaid, and debate over the adult expansion will continue in some states in 2015. Medicaid and CHIP coverage for children and pregnant women remains strong across states, but without Congressional action there will not be continued funding for CHIP beyond September 2015. If CHIP funding expires, some children may lose coverage and some may face higher premiums and cost-sharing .... On the operational and systems side, many states have achieved significant progress toward realizing the ACA’s vision of a modernized, streamlined enrollment system, but work continues in many areas. (Brooks, Artiga et al., 1/20)

AARP Public Policy Insitute/The Urban Institute: Transitioning From Medicaid Expansion Programs To Medicare: Making Sure Low-Income Medicare Beneficiaries Get Financial Help
[The Affordable Care Act] does not let people continue Medicaid expansion coverage once they are eligible for Medicare. As a result, many individuals will transition from the Medicaid-expansion program, where they face very low out of-pocket costs, to Medicare, where their basic costs will start at $1,495.80 per year in 2014 and 2015. This amount does not include the thousands of dollars in potential additional cost sharing associated with service use, including inpatient hospital services and prescription drugs. These costs place a tremendous burden on low-income people ... However, there are programs that can help low-income people with these new costs as they move from the Medicaid expansion to Medicare. (Flowers, Buettgens and Dev, 1/21)

The Urban Institute/Medicare Payment Advisory Commission: The Need To Reform Medicare's Payments To Skilled Nursing Facilities Is As Strong As Ever
Well-documented shortcomings in Medicare's payment system for skilled nursing facilities (SNFs) have prompted many revisions to the system. This study finds that Medicare's payments to SNFs for therapy and non-therapy ancillary (NTA) services are the least accurate they have been since 2006. Payments are less reflective of cost differences across both stays and facilities and payments are less proportional to costs. An alternative design that would base payments on patient characteristics and establish separate payments for NTA services would increase payment accuracy and dampen the incentives to furnish excessive therapy and avoid patients with complex medical needs for financial gain. (Carter, Garrett and Wissoker, 1/15)

The Heritage Foundation: Replacing Medicare’s SGR: Four Bipartisan Options To Finance A Permanent Fix
Replacing the current SGR with a more rational Medicare physician payment system will increase Medicare spending. The Congressional Budget Office (CBO) estimates that the cost of the policy embodied in the compromise bill would be $144 billion over 10 years. If Congress were to base payment updates on medical inflation, it would cost $204 billion over the initial decade of implementation. ... There are at least four major structural changes that have attracted bipartisan support and would improve the functioning of the program and guarantee permanent savings in the future. These reforms are: benefit modernization, means-testing expansion, increasing eligibility age, and new competitive bidding in Medicare Advantage. (Moffit and Senger, 1/21)

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

MinnPost: Medical Information On Many Hospital Websites Is Unbalanced, Study Finds
About three-quarters of Americans search the Internet for medical information within any 12-month period, and almost half of them do so to find out information about a specific medical treatment or procedure. What many consumers do not understand, however, is that much of that “educational” information is really a form of advertising — even on the websites of many large, reputable, nonprofit teaching hospitals. (Perry, 1/6)

MinnPost: Sedentary Early-Death Risk Higher Than From Being Obese, Study Finds
Being physically inactive is associated with twice the risk of dying prematurely than being obese, according to a study published last week in the American Journal of Clinical Nutrition by a multinational team of researchers. Furthermore, even a small increase in physical activity among individuals who are currently sedentary — the equivalent of, say, a 20-minute brisk walk daily — may help lower their risk of premature death, whether they are obese or not, the study suggests. (Perry, 1/19)

Medscape: Prescription Opioid Abuse Waning
Prescription opioid abuse in the United States has plateaued, with early indicators suggesting it may finally be declining, new research suggests. A study examining opioid abuse trends between 2002 and 2013 showed that prescriptions for opioid analgesics, rates of opioid diversion and abuse, and opioid-related deaths increased significantly from 2002 through 2010. However, all three measures flattened or decreased from 2011 through 2013. (Brauser, 1/22)

Reuters: More Older Adults Are Reporting Falls
Since the late 1990s, almost 30 percent more adults age 65 and older are likely to say they have had a recent fall, according to a new study. The rise – from 28 percent of seniors reporting a fall in 1998, to 36 percent in 2010 – may be due in part to increased awareness of fall risks, but it is not just a result of the population aging, study authors say. (Lehman, 1/21)

Editorials And Opinions

Viewpoints: GOP's Difficulties With Abortion; Physician-Assisted Suicide; Problems At WHO

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

The Washington Post: What Is The GOP Thinking?
There they go again. Given control of Congress and the chance to frame an economic agenda for the middle class, the first thing Republicans do is tie themselves in knots over . . . abortion and rape. (Eugene Robinson, 1/22)

The New York Times: Abortion Bill Bait-And-Switch
House Republican had planned to mark Thursday’s 42nd anniversary of the Supreme Court’s 1973 Roe v. Wade decision by pushing through a brazenly unconstitutional measure to prohibit almost all abortions 20 weeks after fertilization. That plan was abruptly abandoned when some female representatives objected to the bill’s callously narrow and politically tone-deaf rape and incest exceptions. (Dorothy J. Samuels, 1/22)

USA Today: The Ultrasound Generation
Thursday, hundreds of thousands took to the mall to march in protest of abortion, which stills thousands of tiny beating hearts in America daily. The crowd has become an overwhelmingly young one. So young that the site of the 2010 March for Life prompted the then-departing head of NARAL, Nancy Keenan, to remark, "I just thought, my gosh, they are so young. There are so many of them, and they are so young." (Ashley McGuire, 1/22)

The Wall Street Journal: Dr. Death Makes A Comeback
"I guess Jack’s won,” a pal of mine said, alluding to Jack Kevorkian , whose views on physician-assisted suicide are lately back in vogue. With backing from liberal financier George Soros —a longtime supporter of “right to die” legislation—proponents are intent on expanding beyond Oregon, Vermont and Washington the roster of states where the practice is legal. Legislation to allow assisted suicide is moving through New Jersey’s statehouse, last month a New York legislator vowed to introduce a similar bill, and in California state Sens. Bill Monning and Lois Wolk are working to legalize the practice. (Paul McHugh, 1/22)

The Washington Post: Mr. Hogan Proposes A Sensible Approach To Spending Cuts
Mr. Hogan’s proposals include cutting the state’s reimbursements to doctors who treat poor patients under Medicaid. That’s painful and may prompt some doctors to opt out, forcing more patients into emergency rooms. Still, the proposal also appears to piggyback on a similar Medicaid cut Mr. O’Malley made just days before he left office as he sought to close a deficit in the current year’s budget. (1/22)

The Wall Street Journal: All Is Not Well At The World Health Organization
It killed nearly 300,000 people, but the influenza pandemic of 2009 was a lucky escape. The H1N1 strain of the virus turned out to be milder than initially feared, limiting deaths and severe illness. That was just as well, said an independent review at the time. The report concluded that the World Health Organization was ill-prepared to deal with any global public-health emergency. Among its recommended reforms: an international reserve of responders who could mobilize swiftly against a dangerous epidemic, clear command structures so the WHO could lead this response, and a contingency fund to pay for it. (Jeremy Farrar, 1/22)

JAMA: Optimizing High-Risk Care Management
The most costly 1% of patients account for one-fifth of national health expenditures—accruing average annual expenses of nearly $90 000 per person. These individuals typically have several complex, co-occurring conditions for which they often receive poorly coordinated care, driving unnecessary utilization and poor outcomes. Given these characteristics, high-risk care management programs have potential to improve care and reduce costs for this population. ... Drawing on our experience implementing these programs across a large, integrated health system, we propose 3 overarching principles to guide the design and implementation of high-risk care management services. (Brian W. Powers, Sreekanth K. Chaguturu and Timothy G. Ferris, 1/22)