KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Rural Indiana Struggles With Drug-Fueled HIV Epidemic

In response to an HIV outbreak of historic proportions, Indiana’s legislature passed a bill permitting drug users in areas with disease outbreaks to trade used needles for clean ones. Sarah Varney reports for KHN and PBS NewsHour from Austin, Indiana. (Sarah Varney, 5/4)

Political Cartoon: 'Great And Powerful?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Great And Powerful?'" by John Cole, The Scranton Times-Tribune.

Here's today's health policy haiku:


U.S. to set high
bar for managed Medicaid
vendors? About time.

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

Nearly Half Of State-Run Health Exchanges Face Financial Woes

Almost half of the 17 state-run health insurance marketplaces are confronting serious financial difficulties. Some may even be misusing health law grants to keep the exchanges operating. Under Obamacare, states are supposed to be able to cover the cost of operation starting this year.

The Washington Post: Almost Half Of Obamacare Exchanges Face Financial Struggles In The Future
Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act. Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange. (Sun and Chokshi, 5/1)

The Fiscal Times: Some States Are In Debt Over Obamacare Exchanges
Some states may be misusing Obamacare grants in order to keep their state insurance exchanges operating—potentially flouting a provision in the law requiring them to cover the costs of the exchanges themselves starting this year. That’s the concern of the Department of Health and Human Services Inspector General Daniel Levinson which sent a letter this week reminding health officials that they can't use ACA exchange "establishment" grants for overhead costs—like staffing—as some states like Washington have been doing. (Ehley, 5/1)

Politico Pro: State Exchanges Scramble For Funds
States running their own health insurance exchanges have largely managed to survive Obamacare’s initial rollout, but a much more mundane task now stands as the biggest threat to their survival: finding money to keep the lights on. ... Government auditors this week indicated their own concerns about the financial viability of the state exchanges. The HHS inspector general warned the Obama administration that states may be improperly using leftover federal grants to cover holes in their operating budgets. (Pradhan, 5/1)

News outlets also provide related updates from Washington state and Oregon -

The Seattle Times: State’s Health Benefit Exchange Struggling For Viability
Financial challenges are threatening the survival of Washington’s Healthplanfinder insurance exchange. First, the marketplace is facing a state budget proposal that would provide roughly two-thirds of the money that exchange officials say they need. Then this week, U.S. officials warned that exchange spending plans include what could be the illegal use of federal grant dollars. The Senate’s budget plan “threatens the viability” of the exchange, Ron Sims, chairman of the board overseeing the exchange, said in a recent statement. (Stiffler, 5/1)

The Oregonian: After A Year Of Losses, Many Oregon Health Insurers Seek Bigger 2016 Premiums
Moda Health wants to boost premiums an average 25 percent for more than 100,000 Oregonians next year, and other insurers are seeking even bigger hikes. Other insurers, however, are holding relatively steady or even reducing rates – notably Kaiser Foundation Health Plan with a nearly 2 percent cut. ... Though not final, the filings suggests a major rescrambling of the individual market, where more than 200,000 Oregonians who are not on Medicare or the Oregon Health Plan buy their own coverage. (Budnick, 5/1)

12 Million Gain Medicaid Coverage Under Health Law, Administration Says

The expansion of the health program for low-income residents has also helped the bottom line for a number of hospital companies, which are facing fewer uncompensated care charges. Other Medicaid news examines developments in Pennsylvania, Montana, Michigan and Arizona.

The Hill: Almost 12 Million Gained Medicaid Coverage Under ObamaCare
More than 11.7 million more people have health insurance through Medicaid or the Children’s Health Insurance through ObamaCare, new data show. The new report from the Obama administration shows that as of the end of February, there were over 11.7 million more people enrolled in the programs compared to the period before October 2013, when ObamaCare’s coverage expansion went into effect. The numbers come on top of another 11.7 million people who signed up for private insurance through the law’s marketplaces. (Sullivan, 5/1)

Forbes: As States Expand Medicaid, Unpaid Hospital Bills Disappear
With more states expanding Medicaid coverage under the Affordable Care Act, hospital operators are reporting fewer unpaid medical bills and falling charity and uncompensated care expenses. ... This, coupled by an improving economy, is boosting revenues for hospital companies like Community Health Systems, Tenet Healthcare, HCA Holdings and Universal Health that are all seeing major reductions in numbers of uninsured patients. (Japsen, 5/3)

The Philadelphia Inquirer: Pa. Unravels Corbett's Health-Plan Mess
Healthy Pennsylvania was supposed to be former Gov. Tom Corbett's signature effort, a private-market plan designed to qualify the state for millions in Medicaid expansion dollars while mollifying foes of the Affordable Care Act. But when Corbett lost his reelection bid in November to Democrat Tom Wolf, who had vowed to replace Healthy Pennsylvania with traditional Medicaid expansion, many people thought the Republican would shelve the complex hybrid program. Corbett didn't and the result was chaos. ... The mess should be coming to an end. Last week, the state Department of Human Services announced that it had transferred 121,234 people from Healthy Pennsylvania's private coverage option to HealthChoices, a traditional Medicaid expansion program. (Calandra, 5/3)

The Hill: Pennsylvania Prepares Backup Plan For ObamaCare Case
Pennsylvania Gov. Tom Wolf (D) on Friday outlined a contingency plan for his state in case the Supreme Court guts ObamaCare. Wolf’s plan calls for Pennsylvania to set up its own insurance marketplace if the court rules against the Obama administration in the case King v. Burwell. The case could revoke subsidies that help 7.5 million people afford healthcare coverage, but only in the roughly three-dozen states relying on the federal marketplace. If Pennsylvania sets up its own marketplace, as 13 other states have, subsidies there would continue to flow. (Sullivan, 5/1)

The Associated Press: Obama Administration Raises Medicaid Expansion Concerns
The Obama administration has concerns about provisions in Montana's new law to expand Medicaid, but it is willing to work with the state to overcome them, a spokesman for HHS said on Friday. Agency spokesman Ben Wakana said in a statement that officials are encouraged by the bipartisan support of Medicaid expansion and look forward to working with the state on a few concerning issues. "As we consider the state's proposal, our priority will be to make sure that any waiver approval provides for coverage that is affordable and accessible for Montanans and does not impose significant cost-sharing or premiums on individuals with very low incomes," Wakana said. (Baumann, 5/3)

Politico Pro: Obama Administration Faces Key Medicaid Test In Michigan
About 600,000 low-income adults have signed up for expanded Medicaid in Michigan, but that new coverage could soon be threatened as the Republican-led state seeks major concessions from the Obama administration to allow conservative-favored reforms to the program. ... By September, Michigan must seek a federal waiver requiring low-income adult Medicaid enrollees earning above the poverty line — about $11,800 for an individual — to make a choice once they’ve been enrolled for four years: either sign up for a subsidized private health plan through, or pay potentially up to 7 percent of household income toward their health care costs to stay enrolled in Medicaid. The first option would essentially allow Michigan to accomplish what some other Republican-led states have been asking of the Obama administration for years — receive full Obamacare funding for a partial expansion of Medicaid just to the federal poverty line. (Pradhan, 5/1)

The Associated Press: Patients To Have Say In Suit Disputing Arizona Medicaid Plan
Patients who have received insurance coverage through Arizona's Medicaid expansion will have a say in a lawsuit challenging the legality of the plan, an advocacy group said Saturday. The Arizona Center for Law in the Public Interest, which represents low-income Arizona residents, applauded a judge's decision to grant their clients' request to help defend the expansion. (5/3)

Florida Legislative Session Ends In Disarray After Divisive Medicaid Battle

The lawmakers still need to pass a state budget but it's not clear when or how they will do that. News outlets look at the political and practical effects of the impasse.

Tampa Bay Times: Gauging The Political Fallout From Tallahassee Gridlock: Will It Matter?
A rundown of what happened: The House adjourned three days early, which was historically unprecedented, to protest a budget impasse and reject Senate demands to discuss Medicaid expansion under the federal Affordable Care Act. The Senate, united in rare bipartisan accord, stayed in town, passing bills to the empty chamber across the hall and accusing the House of violating the state Constitution with its early exit. Senate Democrats sued the House, asking the court Thursday to bring representatives back to finish their work. On Friday, the Florida Supreme Court ruled that the House had violated the state Constitution — but, with the midnight deadline of the regular session approaching, it was too late to call anyone back to Tallahassee. Will any of it matter? "I think there will be very little political fallout," said Steve Vancore, a Democratic political consultant and pollster. (Klas and Mazzei, 5/3)

Orlando Sentinel: How The Florida Legislature Crashed And Burned
The gridlock is a function of the high stakes at play — billions of dollars in taxpayer funds, access to health insurance for 800,000 to 1 million Floridians and potential deep cuts to health-care providers. But it's also a symptom of the stark philosophical differences between the more conservative House and more moderate Senate, despite overwhelming Republican control in both chambers. (Rohrer, 5/2)

The Associated Press: Court Order Brings Acrimonious Fla. Legislative Session To Close
A last-ditch effort to force the Florida Legislature back to work floundered on Friday after the state's highest court ruled that there would be no "beneficial result" to force the state House to reconvene. The Florida Supreme Court ruled unanimously against the lawsuit filed by state Senate Democrats that asked the court to order the House to return to the Capitol. The House had abruptly adjourned Tuesday amid a hardening stalemate with the Senate over a new state budget and whether to expand Medicaid coverage to 800,000 Floridians. (5/2)

PolitiFact/Tampa Bay Times: PolitiFact Florida: Running The Numbers On Medicaid Expansion
Even before the Florida House adjourned early, Speaker Steve Crisafulli laid blame for the session's budget impasse clearly on Medicaid expansion. ... the House believed the move would drag people into a costly system that didn't work. "Under federal law, other low-income Floridians have access to health care subsidies to buy private insurance for less than the average cost of a wireless phone bill," said Crisafulli, R-Merritt Island. "In fact, if we choose Obamacare expansion, 600,000 will lose eligibility for their subsidies, of which 257,000 would be forced into Medicaid. " ... Crisafulli's numbers are largely correct. Some people who get subsidies now would lose them and become eligible for Medicaid. But he ignores the benefits of Medicaid for the very poor, as well as other uninsured Floridians who would gain coverage. (Gillin, 5/3)

Obamacare Enrollment Deadline Passes For Most -- But Exceptions Do Exist

The New York Times details who might qualify to enroll for health coverage before the next open season begins. Meanwhile, news outlets take a look at a range of other implementation issues, including funding for the health law's risk corridor program and some marketplace reverberations.

The New York Times: Health Insurance Deadline Passes For Most, But There Are Exceptions
The last chance to sign up for health insurance this year under the Affordable Care Act passed on Thursday, when an extended deadline for enrollment expired. While most people will have to wait until the next open enrollment period in the fall, there is an exception for those who have a change in circumstances — like losing your health coverage because of the loss of a job, or getting married or having a baby. (Carrns, 5/1)

The Minneapolis Star-Tribune: Doctors' Financial Interests, And Potential Conflicts, Have Become Public Information
The new Open Payments data from the Centers for Medicare and Medicaid Services (CMS) cover many types of financial relationships besides investments, such as consulting deals, free travel for conferences and straight gifts. The disclosure program was created as part of the Affordable Care Act to shed light on hidden financial relationships in medicine — a topic of national urgency as health care consumes a growing share of government, business and household budgets. (Carlson, 5/3)

King V. Burwell Challenge To Health Law's Subsidies Viewed As Test For Chief Justice

Meanwhile, Modern Healthcare reports that CEOs overwhelmingly expect the high court to rule in favor of the government and uphold the health law when it announces it's King V. Burwell decision this summer.

The Washington Post: Roberts At Center Stage As Supreme Court Approaches Historic Decisions
In one of the court’s two blockbuster cases, about the implementation and continued viability of President Obama’s Affordable Care Act, Roberts is likely to play the pivotal role. ... Smith said that the test for Roberts will be the fight over the Affordable Care Act, where challengers say the words of the statute do not allow subsidies for those who buy health insurance on a federal exchange, only those set up by states. If Roberts votes for a technical reading of the law instead of agreeing with the administration about the intent of Congress in passing the legislation, Smith said, “that will change how he is perceived for quite a while.” (Barnes, 5/3)

Modern Healthcare: Hospital CEOs Expect ACA Subsidies To Be Upheld
Healthcare chiefs overwhelmingly predict the U.S. Supreme Court will rule in favor of the government in the King v. Burwell case, which threatens health insurance subsidies in states that don't run their own exchanges, according to results of Modern Healthcare's inaugural CEO Power Panel survey. The survey indicated 75% of CEOs believe the court will side with the government, and that would be good for their organizations; 2% said subsidies would be upheld, but it would be bad for them. The Affordable Care Act has already provided significant benefits, said Dr. Gary Kaplan, CEO of the Virginia Mason Health System, Seattle. (Sandler, 5/2)

Despite Health Law Goal, Emergency Room Visits Still On The Rise

News outlets report on the findings of a survey of E.R. doctors conducted in March in which about three-quarters said they had witnessed a continued increase in emergency visits -- which is the opposite of what many expected would happen once Obamacare took effect.

The Wall Street Journal: U.S. Emergency-Room Visits Keep Climbing
Emergency-room visits continued to climb in the second year of the Affordable Care Act, contradicting the law’s supporters who had predicted a decline in traffic as more people gained access to doctors and other health-care providers. A survey of 2,098 emergency-room doctors conducted in March showed about three-quarters said visits had risen since January 2014. That was a significant uptick from a year earlier, when less than half of doctors surveyed reported an increase. The survey by the American College of Emergency Physicians is scheduled to be published Monday. (Armour, 5/4)

USA Today: Contrary To Goals, ER Visits Rise Under Obamacare
Three-quarters of emergency physicians say they've seen ER patient visits surge since Obamacare took effect — just the opposite of what many Americans expected would happen. A poll released today by the American College of Emergency Physicians shows that 28% of 2,099 doctors surveyed nationally saw large increases in volume, while 47% saw slight increases. By contrast, fewer than half of doctors reported any increases last year in the early days of the Affordable Care Act. (Ungar and O'Donnell, 5/4)

Campaign 2016

GOP Presidential Field Grows As Carson, Fiorina Launch Campaigns

Dr. Ben Carson, a retired neurosurgeon, has been a staunch critic of the health law, and Carly Fiorina is a former tech executive. News outlets also report on other potential candidates -- N.J. Gov. Chris Christie, Ohio Gov. John Kasich and La. Gov. Bobby Jindal.

The Associated Press: Ben Carson, Famed Neurosurgeon, Running For President
Carson earned national acclaim during 29 years leading the pediatric neurosurgery unit of Johns Hopkins Children's Center in Baltimore, where he still lives. He directed the first surgery to separate twins connected at the back of the head. His career was notable enough to inspire the 2009 movie, "Gifted Hands," with actor Cuba Gooding Jr. depicting Carson. ... He has compared the Affordable Care Act, Obama's signature legislative achievement, to slavery. Yet Carson also has blasted for-profit insurance companies; called for stricter regulations — including of prices — of health care services; and said government should offer a nationalized insurance program for catastrophic care. (Peoples and Barrow, 5/4)

USA Today: Report: Ben Carson To Run For President
At the 2013 Values Voter Summit, he said Obamacare was "the worst thing that has happened in this nation since slavery." His fiery rhetoric could appeal to the most conservative primary voters, some of whom may be wary of more establishment-aligned potential candidates, such as former Florida governor Jeb Bush and New Jersey Gov. Chris Christie. But garnering support from a wider swath of GOP voters as a novice to electoral politics could prove challenging. (Allen, 5/4)

The New York Times: Ben Carson On The Issues
Ben Carson, a retired pediatric neurosurgeon, announced Sunday that he is running for the Republican presidential nomination. A Fox News commentator, he is a fierce critic of President Obama’s health care law, calling it “the worst thing that has happened in this nation since slavery.” Here is where he stands on some of the biggest issues of the 2016 campaign. (Mullany, 5/3)

CNN: John Kasich: Likelihood Of Presidential Run 'Looks Pretty Good'
John Kasich has more high-level experience in politics than most candidates, starting with his role as the House's budget chairman during the late 1990s, when the United States enjoyed several years of budget surpluses. But he's also taken a number of positions that are problematic on the right: Kasich expanded Medicaid under President Barack Obama's health care law, and he has supported Common Core education standards and a path to citizenship for undocumented immigrants. (Bradner, 5/3)

USA Today: Jindal Finds Friendship On Road, Hostility At Home
Friday's speech was one of two appearances Jindal, a Republican mulling a presidential bid, made in Washington this week before supportive audiences that shared his views on school choice, repealing the Affordable Care Act, immigration reform and other issues. Back home, though, the crowds are a lot less friendly. In Louisiana, Jindal is widely disliked for refusing to expand Medicaid, proposing drastic cuts to higher education and other programs, and switching his stance on Common Core education standards. (Barfield Barry, 5/2)

The New York Times: Christie’s Camp Mobilizes To Salvage White House Hopes
Mr. Christie, the governor of New Jersey, consulted with advisers, adjusted his jet-black suit and gamely walked onto a stage before 300 guests eating yogurt parfait and almond croissants. He recited statistics about Social Security and Medicare costs and projected the air of a man thoroughly unbothered by the swirling legal drama back in New Jersey, which he left unmentioned. But behind the scenes, his aides, his allies and even his wife were mobilizing, working the phones and blasting out memos to supporters, trying to hold on to whatever chance Mr. Christie had to make a run at the presidency, according to interviews. (Barbaro and Haberman, 5/2)

Meanwhile, the Associated Press examines what could become the political and policy legacy of the current president -

The Associated Press: Obama Presidential Legacy Begins To Take Shape
Obama would also count the 2010 health care law as a legacy item, provided that it is upheld when the Supreme Court rules by the end of June on another challenge to one of its key components. The law has survived multiple attempts by congressional Republicans to overturn all or just parts of it. Obama's legacy also will be shaped by failures and setbacks in domestic and foreign policy and the rancorous political partisanship he promised to heal but did not. (5/4)

Capitol Hill Watch

Bipartisan Coalition Pushes For Increased NIH Funding

The effort to boost funds for the National Institutes of Health is part of the 21st Century Cures bill, introduced last week. Also included in that measure is a provision designed to undo a federal law that requires drug and device manufacturers to disclose payments to doctors. Meanwhile, a separate measure sought by hospital advocates that was introduced in the House would end the system in which some Medicare auditors keep a share of disputed payments.

The Hill: Push To Boost Medical Research Gains Traction
An unusual coalition of Democrats and conservative Republicans is calling for increased funding for the National Institutes of Health, but the lawmakers must contend with spending caps known as the sequester. Bipartisan legislation introduced this week, called 21st Century Cures, would provide billions of dollars in new funding for medical research at NIH. The caps provide a major obstacle. But coming on the heels of a major deal to reform Medicare payments, the passage of the bill would be another bipartisan accomplishment on healthcare. (Sullivan and Ferris, 5/2)

The Wall Street Journal's Pharmalot: House Draft Bill Drops CME Payment Disclosures To Sunshine Database
Tucked into a Congressional draft bill for jump starting medical innovation is a passage that would undo a portion of a federal law requiring drug and device makers to disclose payments to doctors. Specifically, the 21st Century Cures bill would no longer require these companies to report payments made to doctors for continuing medical education sessions, medical journal reprints or textbooks. (Silverman, 5/1)

CQ HealthBeat: Hospitals Seek End To Contingency Fees For Auditors
The American Hospital Association is pushing to end a system in which some auditors for Medicare keep a share of disputed payments through contingency fees. The influential trade group is lobbying for a House bill (HR 2156), offered by Reps. Sam Graves, R-Mo., and Adam Schiff, D-Calif., that would alter the operations of the recovery audit program. Among its aims is to shift this program away from a system in which the recovery audit contractors, or RACs, are paid by keeping about 9 percent to 12.5 percent of every claim they deny, the group said. They would instead get flat fees, as other Medicare contractors do. (Young, 5/1)


Volume Of Narcotics, Generics Prescribed To Seniors Detailed In Massive Data Release

News outlets mine the most specific breakdown of Medicare prescription drug claims ever to be made public by the Centers for Medicare & Medicaid Services.

USA Today: Government Releases Huge Data Set On Drugs Prescribed To Seniors
An unprecedented public release of federal Medicare drug data this week allows Americans to learn more about which drugs are being prescribed most to senior citizens and how much they cost the health care system. The data, released by the U.S.Centers for Medicare & Medicaid Services, shows which drugs were prescribed, by whom, to Medicare Part D beneficiaries, allowing researchers to look at issues such as generics versus brand names and the volume of narcotic painkillers being prescribed. (Ungar, 5/1)

The Wall Street Journal: Generic Vicodin Was A Top Medicare Drug In 2013, Data Shows
Generic Vicodin’s ranking as the drug most widely prescribed to Medicare beneficiaries in 2013 illustrates how comfortable doctors have become reaching for this powerful painkiller for primary care, despite its potential for abuse. An analysis of data released last week on Medicare’s prescription-drug program found that more than half of the prescriptions for the drug, known generically as hydrocodone acetaminophen, came from family-practice or internal-medicine physicians. Those two specialties represented just under a quarter of the more than one million providers in the data. (Wilde Mathews and Beck, 5/3)

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, 5/1)

Kaiser Health News: Medicare Itemizes Its $103 Billion Drug Bill
The federal government popped the cap off drug spending on Thursday, detailing doctor-by-doctor and drug-by-drug how Medicare and its beneficiaries spent $103 billion on pharmaceuticals in 2013. The data show that 14 drugs cost the federal government and Medicare beneficiaries more than $1 billion each, accounting for nearly a quarter of Medicare prescription drug spending in 2013. Most of those drugs are used to treat chronic conditions that plague the elderly, including diabetes, depression, high cholesterol and blood pressure, dementia and asthma. (Rau, 5/30)


LifePoint Hospitals Profits Beat Expectations Due To Higher Admissions And Health Law

In other industry news, Myriad Genetics is fighting to sustain its business model nearly two years after the Supreme Court struck down gene patents. And Modern Healthcare's first quarterly poll of top health care leaders shows most support the trend toward value-based reimbursements.

The Wall Street Journal: LifePoint Hospitals Profit Rises On Higher Admissions
LifePoint Hospitals Inc. said on Friday that its profit rose 5% in the first quarter, as health-care reform continued to help drive higher admissions volumes. The rural hospital operator’s top and bottom lines surpassed analysts’ expectations, but the company’s shares fell about 6% in midday trading as investors focused on a deceleration in same-hospital admissions and took profits after shares rose more than 30% over the past 12 months. (Beilfuss, 5/1)

The Wall Street Journal: Myriad Genetics Fights Off Threats From Rivals
Myriad Genetics Inc. used a patent-protected monopoly to become one of the most successful and controversial DNA testing companies in the world. Now, nearly two years after the Supreme Court struck down its gene patents, Myriad is fighting to sustain its business model amid growing threats from rivals. (Walker, 5/3)

Modern Healthcare: CEO Power Panel Poll Finds Broad Support For Value-Based Pay
More than three-quarters of a representative sample of the nation's top healthcare leadership back the ongoing shift toward value-based payment systems, which reward providers for what they achieve rather than what they do. Yet only 20% are willing to do away completely with the industry's still dominant fee-for-service reimbursement model, according to the first quarterly poll of Modern Healthcare's CEO Power Panel. (Conn and Sandler, 5/2)

Veterans' Health Care

Vets Waiting For Care In Ohio Can Be Treated At Air Force Medical Center Under VA Deal

The five-year deal between Wright-Patterson Air Force Medical Center and the Department of Veterans Affairs could be a model for other regions plagued by long wait times for patients. And a VA system in Maryland is pairing mental health treatment with job services to aid struggling veterans.

The Associated Press: Ohio Vets' Medical Care To Expand Under Air Force, VA Pact
An agreement intended to help decrease wait times for veterans seeking medical care has been forged between Air Force and Veterans Affairs officials in Ohio. The five-year agreement signed by Wright-Patterson Air Force Medical Center and U.S. Department of Veterans Affairs officials allows VA medical facilities in Ohio to send veterans to Wright-Patterson's medical center for inpatient or outpatient services. (5/3)

The Baltimore Sun: Veterans Program Pairs Job Services With Mental Health Treatment
[Wallace] Clayton was one of 675 military veterans referred last year to a Veterans Affairs program in Maryland with a dual focus: helping veterans diagnosed with mental health disorders continue treatment while getting them trained for and placed in jobs. The Compensated Work Therapy program, run by the VA Maryland Health Care System, identifies veterans who have trouble getting and keeping jobs due in part to mental health disorders and illnesses such as depression, anxiety disorders and PTSD. (Mirabella, 5/2)

State Watch

State Highlights: In Calif., Immigrants Would Qualify For Medi-Cal Under Pending Bill; N.Y. Medicaid Revamp Emphasizes Outpatient Care

News outlets cover health care issues in California, New York, Pennsylvania, Ohio, Indiana, Texas, South Dakota, Washington, Florida and Iowa.

The San Jose Mercury News: Health Care: Illegal Immigrants Would Get Medi-Cal Under California Bill
On Monday, state legislation that would extend free or low-cost health care coverage to immigrants who are in the country illegally heads to the Senate Appropriations Committee for a key vote. If Senate Bill 4 can make it over that hurdle, through the Assembly and ultimately garner Gov. Jerry Brown's signature, more than a million low-paid undocumented farm and construction workers, hotel maids and service workers would qualify for Medi-Cal, the state's health program for the poor. (Seipel, 5/3)

The Associated Press: N.Y. Medicaid Overhaul Envisions Combined Outpatient Care
Using an estimated $8 billion as incentives, New York is overhauling Medicaid, pushing providers to establish more outpatient clinics, reduce hospital beds, use electronic records and enable low-income patients to see doctors and psychologists in the same visit. Medicaid now covers almost one-third of all 19 million New Yorkers. Half this year's $62 billion budget is paid by the federal government. (5/3)

The Philadelphia Inquirer: Suit Aims To End Ban On Elder-Care Work After Felony
Anyone with a felony conviction, no matter what it was for or how long ago it occurred, is precluded under Pennsylvania's Older Adult Protective Services Act from working in nursing homes, home health care, or residential facilities for the mentally ill or mentally retarded. That's why late last month the woman - who asked not to be identified for fear of losing her job - joined a lawsuit in Commonwealth Court against the state and three of its departments, seeking to have the law declared unconstitutional. (Von Bergen, 5/2)

The Sacramento Bee: Injuries, Illness Fuel California Vaccine Bill Partisans
A bill requiring full vaccinations for almost every California school child has charged Sacramento, mobilizing constituents who arrive from around the state for impassioned, marathon hearings. Much work at the Capitol can seem obscure and remote from most citizens, but Senate Bill 277 has connected with people on an emotional level. (White, 5/1)

The Associated Press: Ohio Clinics Close, Abortions Decline Amid Restrictions
The number of abortion providers in Ohio has shrunk by half amid a flurry of restrictive new laws over the past four years, and the number of the procedures also is declining, according to a review of records by The Associated Press. Both sides agree the added limits and hurdles placed on Ohio abortions have played a role in facility closures reaching to every corner of the nation’s 7th most populous state. What is less clear is whether the downward trajectory in procedures is a cause or an effect of some of the most significantly reduced abortion access in the nation. (Carr Smyth, 5/3)

The Associated Press: Texas The Front Line On High School ECG Debate
Spurred by the deaths of teenagers ... who are struck down each year by sudden cardiac arrest, Texas lawmakers are pushing to make their state the first to require public high school athletes to undergo electrocardiogram testing. Those pushing for the change ... say testing is relatively cheap and simple, and that it could save lives. ... But opponents of mandatory screening, including the American College of Cardiology and American Heart Association, question its effectiveness, saying it would lead to thousands of false-positives each year, which would lead to further, more expensive testing that isn't necessary. (Vertuno, 5/3)

The New York Times: Pine Ridge Indian Reservation Struggles With Suicides Among Its Young
Since December, the Pine Ridge reservation, a vast, windswept land of stunning grasslands and dusty plateaus, has been the scene of an unfolding crisis: nine people between the ages of 12 and 24 have committed suicide here. ... Many more youths on the reservation have tried, but failed, to kill themselves in the past several months: at least 103 attempts by people ages 12 to 24 occurred from December to March, according to the federal Indian Health Service. ... Tribe officials, clergy members and social workers say they cannot remember such a high rate of suicides and attempts in such a short period of time on the reservation, which is already overwhelmed with high rates of unemployment, poverty, domestic abuse and alcohol addiction. (Bosman, 5/1)

Kaiser Health News: Rural Indiana Struggles With Drug-Fueled HIV Epidemic
In a first for Indiana, the state’s legislature last week passed a bill permitting drug users in areas with disease outbreaks to trade used needles for clean ones. It’s in response to an HIV outbreak of historic proportions. Kaiser Health News correspondent Sarah Varney and PBS NewsHour producer Jason Kane travelled to Austin, Indiana, near the Kentucky border, to file this story that aired on the NewsHour on May 1, 2015. Here's the transcript. (5/4)

The Seattle Times: Banking On Faith: Cost-Sharing Ministries Offer Obamacare Alternative
The Miras — including daughter Jael, 4, and baby Sienna Rain, now a healthy 9-month-old — are among the growing numbers of people looking to “health care-sharing ministries” across the U.S. At last count, there were more than 10,000 members in Washington state and nearly 400,000 nationwide, individuals and families whose medical costs are taken care of entirely through the organized goodwill — and monthly payments or “shares” — of like-minded religious followers. (Aleccia, 5/2)

Des Moines Register: Innovation Helps Address Nurse Shortage
Shortages in the numbers of skilled professionals loom. A scarcity of educators produces constant strain. Burnout threatens the very newest nurses. But innovative educational and practice options could help Iowa and its health care system meet the increasing demands on this essential caregiving profession. ... The U.S. Bureau of Labor Statistics lists "registered nurse" as among the top job occupations for growth through 2022 — an increase of 19 percent. "If you look across the country, there are places that already experiencing some shortages, although Iowa is not among them," says Rita Frantz, dean of the University of Iowa College of Nursing. What Iowa is short on are the people qualified and willing to teach nursing. It is at nursing schools that the pressures of the changing profession and the state's aging demographics are felt most acutely, say experts (Roberson, 5/3)

Modern Healthcare: UnitedHealthcare Pilot To Curb Lab Costs Draws Protest
A UnitedHealthcare pilot to control rising clinical laboratory costs in Florida has sparked an uprising among physicians and lab companies who say the program is burdensome and unfairly limits competition. After a delay caused by physician complaints, in mid-April UnitedHealthcare started requiring doctors in its Florida provider network to give prior notice when ordering one of 79 lab tests, and to use a limited group of pre-approved labs for those tests. (Royse, 5/2)

The Wall Street Journal's Pharmalot: Should Companies Have To Pay For Disposal Of Unwanted Drugs?
Should drug makers be required to pay for take-back programs in which consumers can drop off unwanted medicines? A growing number of local officials believe they should. Earlier this week, San Mateo County in California became the fourth local government in the country to adopt an ordinance that mandates the pharmaceutical industry underwrite the costs of a take-back program. (Silverman, 5/1)

Editorials And Opinions

Viewpoints: Medical Bills' Gibberish; Meeting Patients' Needs; Cutting Back On Antibiotics

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

The New York Times: The Medical Bill Mystery
I have spent the last two and a half years reporting and writing about medical costs, and during that time I have pored over hundreds of patients’ bills. And while I’ve become pretty adept at medical bill exegesis, I continue to be baffled by how we’ve come to tolerate the Kafkaesque stream of nonexplanations that follow health encounters. Bills variously use CPT, HCPCS or ICD-9 codes (more about those later). Some have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently received a $45,000 hospital bill with the explanation “miscellaneous.” (Elisabeth Rosenthal, 5/2)

The Washington Post: We Need To Take Better Care Of Our Elderly
Sometimes it seemed as if the only “personalized medicine” my mother received over the two months before she came home, frail and battle-worn, was when my brother or I brought a spoon with ice chips to her lips after she requested it. Such is the state of medical care for many of our elderly in our best hospitals. Aside from spending untold dollars mapping the genomes of Americans, we must — once again — learn to provide true “personalized care” to every one of the soon-to-be 72 million geriatric patients in our midst. While not scientifically “precise,” nurturing in caregivers the skillful application of compassion and empathy it takes to do this work will — in the end — benefit us all. (Jerald Winakur, 5/1)

The New York Times' The Upshot: With Sickest Patients, Cost-Sharing Comes At A Price
The growth in health care spending is slowing down, and one reason might be that cost sharing is rising. The proportion of insured workers with at least a $1,000 deductible was 41 percent in 2014, quadruple that in 2006. Hidden in the numbers is the fact that increasing cost sharing for patients with chronic illnesses can backfire, causing their health care spending to go up, not down. (Austin Frakt, 5/4)

The Washington Post: An Order Of Chicken, Hold The Drugs
Every once in a while, glaciers crack on long-stalled public policy issues. That is the welcome case now after decades of inaction on antibiotic resistance — the emergence of bacteria that can defeat the lifesaving drugs used in human medicine since the 1940s. The problem leads to 23,000 deaths and 2 million illnesses a year in the United States from infections that are difficult or impossible to treat. Now, at last, the longstanding refusal of food producers to recognize and address the problem appears to be waning. (5/1)

The Wall Street Journal: How Big Data Will Customize Our Health Care
Data is the future of health. Advances in wearables, like the Apple Watch, and other monitoring tools will bring new meaning to the term, “self aware.” For many, devices will track where we go, what we eat and how we sleep. The result will be a torrent of data documenting our bodily functions in real time. In essence, medical technology will create a synthetic nervous system run in parallel with our natural one. The opportunities for tweaking various systems will be tremendous. The challenge will be how to process all of this new data. (Drew Harris, 5/1)

Los Angeles Times: State By State, Abortion Laws Control Women In The Guise Of Protecting Them
It’s become a tiresome, fill-in-the-blank news story: “The conservative-dominated state legislature in _________ voted to restrict women’s access to abortion by doing ___________, insisting it’s for women’s safety and health.” ... If legislators were sincere about safeguarding women’s health, the bills getting passed would be about better sex education, more and cheaper health clinics and counseling and contraceptives, so abortion could become what President Clinton once characterized as “safe, legal and rare.” Instead, it’s about preventing women from getting abortions, and controlling them by controlling their fertility, a trick as old as men and women. (Patt Morrison, 5/1)

The Wall Street Journal: A House Budget Response To High Court Ruling On Health Subsidies?
While the Supreme Court weighs King v. Burwell–the lawsuit questioning the federal government’s authority to provide financial assistance to people who buy insurance in the 37 states using federally operated insurance exchanges–many have focused on potential responses to the outcome. Language in the budget resolution unveiled this week appears to lay the groundwork for the House of Representatives to address this ruling through budget reconciliation procedures. (Chris Jacobs, 5/1)

Los Angeles Times: Two Bills Protecting Patients In Healthcare Networks Deserve Passage
The heathcare reforms in the 2010 Patient Protection and Affordable Care Act remain a work in progress, with some of the law's mandates causing new problems or exacerbating older flaws. One is inaccurate lists of the healthcare providers in insurers' networks; another is surprise bills by out-of-network providers. California lawmakers have offered proposals to solve these problems, and the Legislature should pass them. (5/3)

Toledo Blade: Gov. Kasich Must Stand Up To State Lawmakers Who Would Undermine Ohio’s Medicaid Program
The House version of Ohio’s next budget includes one redeeming measure: It continues Gov. John Kasich’s highly successful Medicaid expansion, despite grumbling from Tea Party extremists who care more about rigid anti-government ideology than they do about results. Even so, the House budget includes onerous changes to the state’s Medicaid program: caps on care, higher costs for the poorest families, bureaucratic hurdles that would lead to dangerous delays and gaps in health care, and a murky plan to force recipients, regardless of income, to contribute to health savings accounts. (5/3)

(Baton Rouge, La.) Advocate: Medicaid And Politics At The Louisiana State Capitol
Political arguments at the State Capitol continue to overwhelm the policy arguments over expanding Medicaid insurance coverage for the working poor. It’s as if the legislators set fire to piles of federal funding on the lawn in front of Huey P. Long’s statue, even as the state budget crumbles in the halls inside. Committees of the House and Senate voted almost along party lines, with most Republicans opposed and most Democrats in favor, to kill the expansion of health insurance that would be funded by the Affordable Care Act. That law’s nickname, “Obamacare,” continues to frighten Republicans, even at the state level — and even as the arithmetic argues for Louisiana joining other states in expanding insurance. (5/3)

Tulsa World: State Takes New Approach To Medicaid
The Oklahoma Legislature has approved a basic change in the way some of the state’s most expensive Medicaid patients are managed. ... It would potentially shift the management of some of the state’s most expensive Medicaid patients — the aged, blind and disabled — from the Oklahoma Health Care Authority to private contractors. A 2013 study found that such a move could save the state up to $1 billion over five years. The state’s previous experiment with managed care for Medicaid patients was unsuccessful. ... The health care authority maintains one of the nation’s lowest administrative cost ratios. But backers of the new program make an important point: The state budget cannot sustain the fast-growing cost of Medicaid. (5/4)

Quad City Times: Iowa Set For Medicaid Shift
Proponents say shifting management of Iowa’s Medicaid program to private organizations will lead to better patient outcomes and reduced state costs. But many are concerned the change will upset patient care. ... Managed Medicaid is not new to the country. Roughly 70 percent of Medicaid enrollees nationwide are served through managed care delivery systems, according to the federal government. ... But managed Medicaid is new to most Iowans on the program. “Most of the Medicaid population’s care isn’t coordinated right now,” [Iowa Department of Human Services spokeswoman Amy] McCoy said. “But moving it to private (organizations), doing it that way — many other states do it that way — we believe everybody has a chance to benefit from this, Medicaid recipients and the taxpayers of Iowa.” (Erin Murphy, 5/3)

Fayetteville, N.C., Observer: How's A Patient To Choose The Best Hospital?
There is a bewildering blizzard of ratings out there from commercial, government, nonprofit and media groups. Some health care experts say it's a rare hospital that can't find its way onto a top-10-percent list for something. ... So what's a patient to do? Most of us will just go to the nearest available hospital and hope for the best. In the case of acute illness or injury, the decision is especially a function of where you live. But if you're having a serious elective procedure and have insurance that allows you to make a choice, it's best to consult as many substantive measures as you can find, and then make an informed decision. (5/4)

The Washington Post: Making Polio History
Pakistan now stands as the main barrier to the global elimination of wild poliovirus. In two other countries where it is endemic, things are going well: There hasn’t been a case in Nigeria in nine months, and there has been only one in Afghanistan so far this year. Outbreaks last year in Syria, Iraq and other parts of Africa have been contained. Consider the progress: In 1988, there were more than 125 countries where polio was endemic. But now, all eyes are on Pakistan as the high season approaches for transmission of the virus. Plans are in place for the fight, methods are known, good intentions declared. Now a nation often weakened by its own internal chaos must deliver. (5/3)