KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Planning Ahead?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Planning Ahead?'" by Clay Bennett, Chattanooga Times Free Press.

Here's today's health policy haiku:

SUNFLOWER AND SUNSHINE STATES JOIN FORCES

Kansas governor
Says he will join Florida
In Medicaid suit.

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Medicare

Health Law Pilot Program Saves Nearly $400M In Two Years

The Pioneer accountable care model rewards participating hospitals that deliver high-quality care at lower-than-expected costs — and punishes high spenders. Despite the program's savings, 13 of the original 32 participating hospital systems dropped out or switched to other models after failing to meet performance targets.

The Wall Street Journal: Pioneer Model Saved Medicare Nearly $400 Million In Two Years
A key pilot program in the federal health law saved Medicare nearly $400 million over two years and is the first alternative-payment model certified to cut costs while improving health-care quality, the Centers for Medicare and Medicaid Services said. That finding by independent actuaries makes the Pioneer Accountable Care Organization model eligible to be expanded to larger group of Medicare beneficiaries, CMS officials said. ... The Pioneer ACOs have met with mixed success by other measures. Thirteen of the original 32 participating hospital systems have dropped out or switched to other models after failing to meet performance targets. (Beck, 5/4)

Vox: This Small, Wonky Obamacare Program Saved $384 Million Over 2 Years
Obamacare took what an economist once described to me as the "spaghetti approach" to reducing health-care costs: throwing a bunch of different experiments at the wall and seeing what stuck. Today, the law arguably had its first success: Medicare's independent actuary has certified that an Obamacare program has saved money — $384 million over the past two years, to be exact. And the Obama administration is now eying how to make this program bigger — and, ideally, generate even more savings. (Kliff, 5/4)

Reuters: U.S. Medicare Test Program Saved Hundreds Of Millions Of Dollars
A U.S. government test program with doctors and hospitals slowed healthcare spending in Medicare coverage for the elderly and disabled by hundreds of millions of dollars in 2012 and 2013 but savings were less in the second year, a study released Monday said. The Journal of the American Medical Association study looked at beneficiaries in 32 Pioneer Accountable Care Organizations (ACOs), in which hospitals and doctors follow 33 quality and care standards for Medicare fee-for-service patients. In return they can receive a portion of any healthcare savings back from the government. (Humer, 5/4)

CNBC: Obamacare Program Generates 'Substantial' Medicare Savings
An Obamacare program designed to hold down Medicare costs and improve patient outcomes generated more than $384 million in savings in its first two years of operation, Health and Human Services Secretary Sylvia Burwell said Monday. The savings realized from participants in Pioneer Accountable Care Organizations—groups of medical providers that coordinate patient care in return for lump-sum Medicare payments—represents about $300 per Medicare beneficiary per year during 2012 and 2013, Burwell said, citing an independent evaluation report. (Mangan, 5/4)

The Hill: Obamacare Program Saves Medicare $400 Million
A pilot program created under ObamaCare to change Medicare's payment system saved almost $400 million and will be expanded, the administration announced Monday. An independent report released by the Department of Health and Human Services on Monday finds that the pilot program saved Medicare more than $384 million across 2012 and 2013. The pilot program, called Pioneer Accountable Care Organizations, is part of an effort to shift Medicare to paying for quality instead of quantity of care. Under the program, groups of doctors agree to accept lump payments under Medicare instead of individual payments for each service they provide, as in the traditional Medicare payment system. (Sullivan, 5/4)

Another analysis, however, finds that nearly 60 percent of Medicare payments are still based on the volume of care given rather than quality, and DaVita HealthCare Partners Inc. agrees to pay $450 million to settle a whistleblower lawsuit --

Modern Healthcare: Medicare Payments Still Lean Toward Volume, Not Value
Of the $360 billion in payments Medicare made to providers in 2013, 58% continued to flow through traditional fee-for-service models with no regard for quality or outcomes, according to a new analysis by the employer-backed Catalyst for Payment Reform. HHS recently announced ambitious targets to accelerate the government's move to value-based models, such as accountable care organizations and bundled payments. (Rice, 5/4)

Reuters: DaVita To Pay $450M In Medicare Fraud Lawsuit On Wasted Drugs
DaVita HealthCare Partners Inc, one of the largest U.S. kidney dialysis providers, said it agreed to pay $450 million to settle a whistleblower lawsuit accusing it of deliberately wasting medicines in order to receive higher Medicare payments. The lawsuit alleged that DaVita, whose largest shareholder is Warren Buffett's Berkshire Hathaway Inc, used larger-than-necessary medicine vials or unnecessarily spread medicine dosages across multiple treatments, knowing that Medicare would pay for what it considered "unavoidable" waste. (Stempel, 5/4)

Health Law Issues And Implementation

Kansas To Join Fla. Governor's Suit Over Hospital Financing And Medicaid Expansion

The governors of Florida, Kansas and Texas say the Obama administration is trying to coerce their states into expanding the health care program for low-income residents by threatening to cut other Medicaid funds that have helped hospitals treat many uninsured patients.

Orlando Sentinel: Kansas, Texas Join Florida Medicaid Expansion Suit
Kansas and Texas will file amicus briefs supporting Florida in its lawsuit against the federal government over Medicaid expansion, Gov. Rick Scott announced Monday. Scott filed suit last week, alleging that the federal government is “coercing” the state into accepting Medicaid expansion by witholding the extension of a different Medicaid program. The Low Income Pool brings $1.3 billion in federal funds to the state to pay hospitals for care for the poor and uninsured and is set to expire June 30. (Rohrer, 5/4)

Tampa Bay Times: Gov. Rick Scott's Lawsuit Against Obama Finds Support From Texas, Kansas
The legal challenge alleges that federal health officials are trying to coerce Florida into expanding Medicaid by threatening to end the $2.2 billion Low Income Pool program, which reimburses hospitals for uncompensated care. ... Kansas and Texas are in a similar situation when it comes to healthcare funding. The Republican-led Legislatures in both states have rejected federal Medicaid expansion money. But each receives supplemental federal funding for hospitals that treat large numbers of uninsured and Medicaid patients. The program in Texas is scheduled to end in September 2016. The program in Kansas runs through 2017. (McGrory, 5/4)

Kansas City Star: Sam Brownback Supports Lawsuit Seeking To Protect Hospital Payments
The Obama administration has written Florida — and Kansas — threatening to cut off the payments [designed to help hospitals care for low-income patients], which provide Kansas with roughly $45 million annually. Federal officials say the payments aren’t needed because low-income patients now have access to Medicaid health insurance. But Kansas and Florida have refused to expand Medicaid. And on Monday Brownback said the federal government can’t force the states to widen the insurance program with threats to cut off the hospital funding. (Helling, 5/4)

Wichita Eagle: Governor: Kansas Will Join Legal Brief Backing Florida In Suit Over Medicaid Expansion
Kansas will join a brief in support of a lawsuit brought against the Obama administration by the state of Florida, Gov. Sam Brownback said in a statement Monday. ... “The Supreme Court ruled in 2012 that the federal government is prohibited from coercing the states to expand Medicaid,” Brownback said in a statement. “Kansas intends to join Texas through an amicus brief supporting Florida’s effort to stop the Obama administration from cutting off health care dollars for the Low Income Pool in an effort to force Obamacare upon the states,” Brownback continued. “In joining with Florida and Texas, Kansas is protecting the states’ right to make their own determinations about these issues.” (Lowry, 5/4)

The Kansas Health Institute News Service: Brownback Administration To File Brief In Support Of Florida Medicaid Expansion Lawsuit
Gov. Sam Brownback on Monday announced that Kansas would file a brief supporting Florida Gov. Rick Scott’s lawsuit against the federal government over Medicaid expansion. The Centers for Medicare and Medicaid Services recently warned Florida, Kansas and Texas that failing to expand Medicaid under the Affordable Care Act could jeopardize special funding to pay hospitals and doctors for treating the poor. (5/4)

Stateline: Federal Money For Charity Care At Risk In Several States
The federal government is quietly warning states that failure to expand Medicaid under the Affordable Care Act could imperil billions in federal subsidies for hospitals and doctors who care for the poor. In an April 14 letter to Florida Medicaid director Justin Senior, Vikki Wachino, acting director of the U.S. Centers for Medicare and Medicaid Services (CMS) wrote: “Uncompensated care pool funding should not pay for costs that would be covered in a Medicaid expansion.” (Vestal, 5/5)

And in Louisiana, lawmakers take a step toward Medicaid expansion.

(Baton Rouge) Advocate: Hospital Fee Measure Clears State House Of Representatives Panel
For the first time, state legislators opened a crack in the political door that could lead to Louisiana participating in Medicaid expansion — a key component of the Affordable Care Act — but only after a new governor takes office. A state House panel Monday advanced legislation that would allow Louisiana hospitals to assess fees on themselves to attract more federal dollars for patient care. But it would only take effect if the state agrees to change Medicaid income qualifications to sign up uninsured people who make too much to join the government coverage but too little to buy adequate insurance on the private market. (Shuler, 5/5)

The Associated Press: Financing Plan For Medicaid Expansion Wins Louisiana Committee Support
Lawmakers have repeatedly refused to expand Louisiana's Medicaid program, siding with Gov. Bobby Jindal in opposition. But on Monday, they started advancing a proposal that would help pay for an expansion if Louisiana's next governor has any interest. Without objection, the House Appropriations Committee approved legislation by House Speaker Chuck Kleckley that would let hospitals pool their dollars and use that money to help pay for the state's share of the cost for a Medicaid expansion. (DeSlatte, 5/4)

New Orleans Times-Picayune: Louisiana's Heath Care Funding Plan Stuck In Limbo Until Bobby Jindal Leaves Office
[State House Speaker Chuck] Kleckley indicated Jindal's unwavering opposition to Medicaid expansion -- a major component of President Barack Obama's health care overhaul -- likely makes the issue a nonstarter until he leaves in January. "There's not a whole lot I can do about that," Kleckley said. He noted, though, that most of the candidates running for governor have suggested they are at least open to Medicaid expansion. The resolution, sponsored by Kleckley, R-Lake Charles, and Walt Leger, D-New Orleans, sets up a framework that allows hospitals to pool their money to draw down matching federal dollars made available by expanding Medicaid. (Lane, 5/4)

Also, a Tennessee lawmaker finds himself facing a barrage of criticism.

The (Chattangooga) Times Free Press: Americans For Prosperity Spend Big Trying To Sway Tennessee Lawmakers
Republican Rep. Kevin Brooks of Cleveland says all he did in January was ask fellow GOP lawmakers to keep an open mind on Republican Gov. Bill Haslam's Insure Tennessee proposal. But the House assistant majority leader quickly found himself under attack in his own back yard from a barrage of radio ads, courtesy of the Tennessee chapter of a powerful national group, Americans for Prosperity. (Sher, 5/5)

GOP Senators Slam Oversight Of State Exchange Spending

Meanwhile, Politico reports that the health law's SHOP exchanges for small businesses are struggling to attract participants despite offering lower premiums, while addiction treatment programs have not fulfilled the health law's promise due to infrastructure problems.

The Hill: Senators Demand Better Oversight Of State ObamaCare Spending
Two Republican committee chairmen are pressing the Obama administration to improve its oversight of how state-run ObamaCare marketplaces use federal dollars, citing an inspector general report on potential violations of law. Sens. Orrin Hatch (R-Utah) and Chuck Grassley (R-Iowa) wrote to the head of the Centers for Medicare and Medicaid Services (CMS) on Monday asking for the agency to issue clarifying guidance on how the federal dollars can be spent. (Sullivan, 5/4)

And an online survey of ER doctors finds that emergency room visits have increased under the health law despite its intention to reduce their use -

The Hill: ER Visits Climb Under ObamaCare, Poll Finds
Emergency room visits have increased under ObamaCare despite the law’s intention to reduce their use for standard medical care, a new survey finds. The survey of ER doctors finds that three-quarters say their number of patients has increased since ObamaCare’s insurance mandate took effect at the beginning of 2014. (Sullivan, 5/4)

The Washington Examiner: Emergency Room Visits Up, Despite Obamacare
Too many Americans get care in emergency rooms instead of doctors offices — and expanded health coverage is making the problem worse rather than fixing it. Three in four emergency room doctors said patient visits have increased since the Affordable Care Act's requirement to have health insurance went into effect, in an email survey released Monday by the American College of Emergency Physicians. (Winfield Cunningham, 5/4)

MNsure Chief Leaving For Think Tank Job

The departure of Scott Leitz was described as a "normal, healthy transition" by the chairman of the state exchange board. Meanwhile, nearly 5,000 Maryland consumers signed up for Obamacare plans during the special enrollment period extended to those who discovered they owed tax penalties as a result of being uninsured.

Minnesota Public Radio: MNsure Chief Leitz Stepping Down
MNsure's chief executive is quitting the health insurance exchange. Scott Leitz announced his resignation Monday to MNsure's board of directors. Allison O'Toole, the agency's deputy director of external affairs, will take over as MNsure's interim head starting May 22. (Zdechlik, 5/4)

The Baltimore Sun: 4,700 Get Insurance During Special Enrollment In Maryland
More than 4,700 Marylanders signed up for health insurance during a special six-week enrollment period that helped them to avoid a federal tax penalty in 2015. Many of these were people who were surprised to find they had been charged a penalty in 2014 for not signing up for insurance, according to officials who run the online marketplace where people enroll. By the time they found out about the penalty open enrollment had closed. The special enrollment allowed them extra time to get insurance and not face a penalty in 2015. (McDaniels, 5/4)

Marketplace

Paramedics Face Roadblocks In Efforts To Play Larger Health Care Role

In a small number of communities, paramedics are providing in-home care, coordinating patient services and saving millions. Despite these successes, Medicare, Medicaid and most private insurers won’t reimburse for such work and states must address the regulatory hurdles in place. Meanwhile, a new app applies the Uber-model to facilitate doctor housecalls.

Politico: Reimbursement Issues Block Paramedics From Expanded Role
Paramedics are primed to play a larger role in the health care system, which they’re sure will help lower costs and benefit patients. Yet they’re running into regulatory roadblocks that they say state and federal officials have to move. Despite the track record of initiatives in places like Nevada and Texas, where paramedics are providing in-home care, coordinating patient services and saving millions in the process, Medicare, Medicaid and most private insurance plans still won’t reimburse for such work. (Mershon, 5/4)

The New York Times: An Uber For Doctor Housecalls
New smartphone apps can deliver doctors to your doorstep. Heal is a smartphone app similar to the on-demand car service Uber, but instead of a car, a doctor shows up at your door. Users download the app and then type in a few details such as address and the reason for the visit. After adding a credit card and a request for a family doctor or a pediatrician, the physician arrives in 20 to 60 minutes for a flat fee of $99. Heal began in Los Angeles in February, recently expanded to San Francisco and is set to roll out in another 15 major cities this year. Heal doctors are on call from 8 a.m. to 8 p.m., seven days a week, said Dr. Renee Dua, a founder and the chief medical officer of Heal. (Jolly, 5/5)

Worldwide Spending For Cancer Drugs Reaches $100 Billion: Study

IMS Health reports that U.S. patients accounted for more than 42 percent of that total. Also, the Connecticut Mirror examines efforts by the governor and other top elected officials to protect state pharmaceutical companies from competitors through a trade pact.

Reuters: Global Cancer Drug Spending Hits $100 Billion In 2014: IMS Health
Worldwide spending on cancer medicines reached $100 billion in 2014, an increase of 10.3 percent from 2013 and up from $75 billion five years earlier, according to IMS Health's Global Oncology Trend Report released on Tuesday. The $100 billion, which represents 10.8 percent of all drug spending globally and includes supportive care drugs to address things like nausea and anemia, was driven by expensive newer treatments in developed markets, IMS found. ... The United States accounted for 42.2 percent of total spending, followed by the top-five European markets, comprised of Germany, France, Britain, Spain and Italy. (Berkrot, 5/5)

Marketing Wars Intensify Over Personalized Medicine

Hospitals seek to increase their visibility in this growing field. Meanwhile, an Ohio health system loses its final appeal in an antitrust case and several hospital and insurance companies report their latest earnings.

Modern Healthcare: Imprecise Marketing Of Precision Medicine: Advertising May Be Running Ahead Of Science
Public radio listeners across the country recently heard the following commercial: “Destroying cancers based on each tumor's genetic fingerprint. The promise of discovery. More information at VanderbiltHealth.com.” ... Why was Vanderbilt in Tennessee beaming its message to National Public Radio listeners in Boston and other markets across the country? Jill Austin, Vanderbilt's chief marketing officer, said it was to educate the public about what personalized medicine has to offer and to raise the academic medical center's profile, which could help recruit faculty and staff. ... Other health systems also have taken to the airwaves, print and the Internet to market their prowess in precision medicine. ... The personalized medicine marketing wars are on. (Wolinsky, 5/2)

Kaiser Health News: Patients Not Hurt When Their Hospitals Close, Study Finds
A hospital closure can send tremors through a city or town, leaving residents fearful about how they will be cared for in emergencies and serious illnesses. A study released Monday offers some comfort, finding that when hospitals shut down, death rates and other markers of quality generally do not worsen. (Rau, 5/4)

Modern Healthcare: Rejected At Supreme Court, ProMedica Plans To Divest Contested Hospital
The U.S. Supreme Court denied ProMedica's request Monday to review a ruling that the Ohio health system's 2010 hospital deal violated antitrust laws. The defeat ends a nearly five-year battle with the Federal Trade Commission. ProMedica said in a statement Monday that the system and the hospital it acquired, St. Luke's in Maumee, Ohio, will work together over the next six months to develop a detailed divestiture plan to submit to the FTC. (Schencker, 5/4)

Reuters: Tenet Posts Profit As Newly Insured Visit Its Hospitals
Hospital operator Tenet Healthcare Corp on Monday posted a net profit in the first quarter, compared with a year-ago loss, as more people with health insurance used its facilities. The third-largest U.S. for-profit hospital chain said the number of uninsured and charity patients it treated continued to decline, while its paying admissions jumped 6.2 percent, reflecting growth in newly insured patients. (Kelly, 5/4)

The Wall Street Journal: Tenet Healthcare Swings To Profit
Tenet Healthcare Corp. swung to a first-quarter profit as the hospital operator’s revenue benefited from increased admissions and more insured patients. Tenet in March reached a deal that will give it control of United Surgical Partners International Inc. amid a wave of consolidation in the sector. The deal will create a joint venture with Welsh Carson Anderson & Stowe, combining Tenet’s short-stay, or ambulatory, surgery centers and imaging facilities with USPI, which the private-equity firm owns. ... The Affordable Care Act and other government health-care-payment changes have sparked a wave of hospital industry consolidation in recent years. (Stynes, 5/4)

Modern Healthcare: DaVita Reports $111M Net Loss In First Quarter
DaVita HealthCare Partners' first-quarter performance swung to a net loss of $111 million from a year ago, when the kidney care and medical group operator posted net income of $183.3 million. The first quarter results include a tentative $495 million settlement in a civil suit brought in 2009 alleging DaVita wasted medication and then billed Medicare for it. The case was unsealed in 2011. DaVita, based in Denver, said settlement negotiations were ongoing. (Evans, 5/4)

Minnesota Public Radio: Iron Range Hospital Finds New Life With Essentia In Charge
Critics questioned if Essentia would deliver what it promised. Three years later, though, even some skeptics say that while concerns remain, Essentia has made things better. The health care system says it's spent $7 million upgrading the facility, per the lease agreement and has paid down nearly $6 million in hospital debt. The city still owns the hospital but Essentia can buy it outright once the bonds are satisfied. (Zdechlik, 5/4)

Modern Healthcare: Health Net Boosted By Medicaid Expansion, ACA Exchanges
First-quarter profit at Health Net edged slightly upward, but the effects of the Affordable Care Act on the health insurer's swelling membership and top line was perhaps more notable. Health Net's Medicaid enrollment increased 31% in the first quarter of 2015 compared with the same period last year, totaling more than 1.7 million low-income Americans. That's more than half of the company's 3.2 million members. Health Net sells Medicaid managed-care plans in Arizona and California, both of which expanded Medicaid under the healthcare reform law to people making up to 138% of the poverty line. (Herman, 5/4)

Public Health And Education

Virginia AG Says Abortion Clinics Aren't Bound By Stricter Building Standards

Mark Herring's opinion reverses that of the state's previous Republican attorney general and will likely put the abortion debate back on the front burner in Virginia. Meanwhile, the case of an Indiana woman convicted of feticide after self-aborting is raising questions about women's reproductive rights and abortion.

The Associated Press: Herring: Abortion Clinics Can Be Exempted From New Standards
New, strict building standards should not be applied retroactively to existing abortion clinics, Virginia Attorney General Mark Herring said Monday in an opinion contradicting advice given by his Republican predecessor. The new standards would treat abortion clinics like hospitals and cover issues such as hallway widths, closet sizes and covered entrances. Staff for former Republican Attorney General Ken Cuccinelli told state health officials during his tenure that abortion clinics must abide by the new rules. Herring now says that was bad advice and would essentially shut down abortion services in the state. (Suderman and O'Dell, 5/4)

The Washington Post: Va. Attorney General Gives Abortion Rights Advocates A Boost
Virginia Attorney General Mark R. Herring (D) ­sided Monday with abortion rights advocates seeking to free clinics from strict, hospital-style building standards, issuing a legal opinion that whipped up those on both sides of the polarizing issue. Herring’s action reverses an opinion from his Republican predecessor, Ken Cuccinelli II, and put an issue that has long divided lawmakers back on the front burner. The advisory opinion has no immediate effect on clinics currently operating, but it could influence the state Board of Health when members consider an overhaul of rules. (Portnoy and Vozzella, 5/4)

Indianapolis Star/USA Today: Ind. Woman's Sentence For Self-Abortion Draws Scrutiny
On Feb. 3, [Purvi] Patel became the first Indiana woman to be convicted of feticide in connection with her own miscarriage. Legal experts say her 20-year sentence for feticide and neglect of a dependent is one of the most severe penalties an American woman has faced for aborting her own pregnancy. Anti-abortion activists have shown little interest in the case. But Patel's feticide conviction under a state statute adopted in 1979 to fight illegal abortion clinics is raising questions among legal scholars, medical examiners and women's rights advocates about how much control women should have during their pregnancies, and whether they can be held criminally responsible when something goes wrong. (Disis, 5/3)

And troubling long-term data on complications related to an implanted contraceptive device is published after an unusual eight-year delay -

The New York Times: Long-Term Data On Complications Adds To Criticism Of Contraceptive Implant
When a new contraceptive implant came on the market over a decade ago, it was considered a breakthrough for women who did not want to have more children, a sterilization procedure that could be done in a doctor’s office in just 10 minutes. Now, 13 years later, thousands of women who claim they were seriously injured by the implant are urging the Food and Drug Administration to take the device off the market and to warn the public about its complications. (Rabin, 5/3)

Panera Bread To Stop Using Ingredients On Its New 'No-No List'

The food company joins a growing list of chains to announce moves to decrease or eliminate artificial sweeteners, preservatives and flavor enhancers from their menus. Yet, while eating salt has long been a dietary target, scientists are examining some of sodium's benefits.

The New York Times: Panera Bread Plans To Drop A Long List Of Ingredients
Acesulfame K. Ethoxyquin. Artificial smoke flavor. The first, an artificial sweetener; the second, a preservative; and the third, a flavor enhancer, are just a few of the ingredients that Panera Bread wants to banish from its kitchens by the end of 2016. In doing so, Panera would join the growing ranks of food companies and restaurants that have announced plans to eliminate a variety of artificial preservatives, flavors and colors, as well as different kinds of sweeteners and meat from animals raised with antibiotics, in response to consumer demands for transparency and simplicity in the foods they eat. (Strom, 5/4)

The Washington Post: Pass The Salt, Please. It’s Good For You.
In the past, people thought that salt boosted health — so much so that the Latin word for “health” — “salus” — was derived from “sal” (salt). In medieval times, salt was prescribed to treat a multitude of conditions, including toothaches, stomachaches and “heaviness of mind.” While governments have long pushed people to reduce their intakes of sodium chloride (table salt) to prevent high blood pressure, stroke and coronary heart disease, there are good reasons why cutting down on salt is not an easy thing to do. Scientists suggest that sodium intake may have physiological benefits that make salt particularly tempting — and ditching the salt shaker difficult. ( Zaraska, 5/4)

State Watch

Bill To Extend Health Coverage To People In Calif. Illegally Could Cost The State $740 Million

A fiscal analysis is the first price estimate for the proposal introduced in the California legislature last December.

Los Angeles Times: Healthcare For Those In U.S. Illegally Could Cost California $740 Million A Year
Extending state-subsidized healthcare coverage to people in the country illegally could cost California as much as $740 million annually, according to a Senate fiscal analysis released Monday. The report affixes a price tag to the proposal for the first time since Sen. Ricardo Lara (D-Bell Gardens) introduced his bill last December. Researchers at UC Berkeley and UCLA estimate that, in California, about 1.8 million people who are in the country illegally lack healthcare coverage. Around 1.5 million of them would qualify for Medi-Cal. (Mason, 5/4)

State Highlights: Mass. Nursing Home Chain's Problems; Highmark Seeks More Money To Fight UPMC In Pittsburgh

News outlets examine health care issues in Colorado, Connecticut, the District of Columbia, Indiana, Iowa, Kansas, Maryland, Massachusetts, Montana, New Jersey and Pennsylvania.

The Boston Globe: Woes Follow Nursing Home Chain’s Arrival
At Braemoor Health Center in Brockton, [Mass.], which had a blemish-free state review before Synergy took over, health inspectors have been summoned three times in the past year. They found lax infection control, among other concerns, and the nursing home was ordered to make improvements. Synergy’s expansion in Massachusetts has been rapid — the chain has purchased 10 nursing homes since December 2012 — and with the expansion have come complaints. State inspection reports of Synergy’s nursing homes routinely show striking increases in problems since the company arrived. In one home, a patient’s pressure sores were neglected for weeks. In another, racks of dishes and utensils floated in dirty water just before they were used to serve food. And in a third, there were not enough nurses. (Lazar, 5/5)

The Associated Press: Highmark Urges Pennsylvania To OK $175M For Hospital Network
Highmark executives and allies dominated a hearing before the state's top insurance regulator Monday, seeking a green light for the insurer to transfer $175 million into its western Pennsylvania hospital network to help it compete against rival University of Pittsburgh Medical Center. At the four-hour session, state lawmakers, local elected leaders and a health care workers' union were among those urging acting Insurance Commissioner Teresa Miller to approve the plan to tap Highmark's $5.5 billion insurance reserve and use the money for grants to the eight-hospital Allegheny Health Network. (Jackson, 5/4)

The Washington Post: Poor D.C. Babies Are More Than 10 Times As Likely To Die As Rich Ones
Infants are more than 10 times as likely to die in the District’s poorest ward than they are in its richest, the international advocacy group Save the Children said Monday. The findings, released Monday night as part of the group’s annual State of the World’s Mothers report, underscore how vast income inequality in the capital of the world’s richest country continues to yield startling disparities in health and survival at the neighborhood level. (Hauslohner, 5/4)

NJ Spotlight: State Seeks To Speed Up Ride, Shorten Waiting Time For Medicaid Transportation
The state government is planning to improve transportation for Medicaid recipients, which a number of providers and advocates have identified as obstacles preventing some patients receiving the care they need. State officials plan to require that every van have a geographic tracker that will enable dispatchers to tell patients how far away their ride is when waiting for transport to a healthcare appointment. This requirement will be included in a request for proposals (RFP) expected in the next 10 days for a company to serve as a transportation broker, hiring and dispatching local van providers. (Kitchenman, 5/4)

The Washington Times: D.C. Council Plans To Clarify Reproductive Health Care Law
A D.C. law banning businesses from discriminating against workers based on their opinions or use of birth control or abortion took effect over the weekend, despite attempts by congressional Republicans to block the measure. Even with the law’s enactment, the D.C. Council plans to move forward with a clarification to emphasize that the law does not require employers to provide insurance coverage for reproductive health care options for which they have moral or religious objections. (Noble, 5/4)

The Kansas Health Institute News Service: KanCare Anecdotes Abound, But Clear Data Harder To Find
More than two years into the implementation of KanCare — the state’s transfer of Medicaid administration to three private insurance companies — anecdotes about quality of care abound. Some consumer advocates say going beyond the individual stories to get a more comprehensive look at the program has been a challenge, and it’s hard to determine whether KanCare is making consumers healthier. (Marso, 5/4)

Connecticut Mirror: CT Officials See Targeting Trauma As Key To Improving Health
Studies suggest that the risks of health problems are particularly pronounced among those with four or more different types of adverse childhood experiences — known as ACEs. In recent years, scientists have been uncovering ways that significant stress early in life can lead to disease. And policymakers in Connecticut are now trying to target that stress more directly, hoping that preventing exposure to trauma or identifying and treating it early can lead to better health, education and social outcomes. (Levin Becker, 5/4)

The Des Moines Register: HIV Infections Dropped 19% In Iowa Last Year
The number of Iowans becoming infected with the AIDS virus dropped 19 percent last year, and experts are hoping the progress continues. Ninety-nine Iowans last year received new diagnoses of being infected with HIV, the virus that causes AIDS. That was down from 122 in 2013, and it was the lowest number since 2003. (Leys, 4/4)

The Kansas Health Institute News Service: Advocates Make Last Push For Tobacco Tax
Advocates of raising the state’s tobacco tax made one last push Monday during a rally at the Statehouse, with a prominent physician saying cancer will overwhelm the state’s health care system if the tax isn’t raised. Legislators will look this week at options for raising $400 million to $500 million to close a budget gap and end the 2015 session. (Marso, 5/4)

CQ Healthbeat: DOJ Asked For Stance On Colorado Marijuana Law
The Supreme Court on Monday asked the Justice Department to weigh in on a lawsuit challenging Colorado’s marijuana legalization, even as the administration struggles to find a balance between strict federal laws and growing public acceptance of the drug. Right now, the justices are considering only whether Oklahoma and Nebraska should be allowed to file a lawsuit at the high court challenging the constitutionality of Colorado’s law, which has allowed sales of recreational marijuana since January 2014. (Ruger, 5/4)

The Baltimore Sun: Veterans Program Pairs Job Services With Mental Health Treatment
After Wallace Clayton served in the Army Special Forces in the mid-1970s, he says, he bounced from job to job for more than a decade. He worked in electronics assembly and repair, landscaping and home renovation — and never understood why he was having so much difficulty getting his life together. 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. (Mirabella, 5/4)

The Associated Press: Cleanup Of Superfund Town Would Leave Some Asbestos Behind
A long-delayed cleanup proposal for a Montana community where thousands have been sickened by asbestos exposure would leave the dangerous material inside some houses rather than remove it, as government officials seek to wind down an effort that has lasted more than 15 years and cost $540 million. Details on the final cleanup plan for Libby, Montana, and the neighboring town of Troy were to be released Tuesday by the Environmental Protection Agency. Asbestos would be left behind knowingly only where it does not pose a risk of exposure to people, such as underground or sealed behind the walls of a house, EPA project manager Rebecca Thomas said. Yet some residents worry the material eventually could escape and re-contaminate their community. (Brown, 5/5)

Editorials And Opinions

Viewpoints: Soaring Cost Of Drugs; Baltimore's Health Legacy; 'Quackery' Act; Issues For ACOs

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

The New York Times: Runaway Drug Prices
A drug to treat abnormal heart rhythms can cost about $200 on one day and more than $1,300 the next. A diagnosis of multiple sclerosis can lead to a drug bill of at least $50,000 a year. How companies set prices of specialty drugs for these and other complex diseases, like cancer and AIDS, has been a mystery to the patients who need them. Now the Obama administration and some states are tackling that lack of transparency and the rising costs. Mr. Obama has asked Congress to let Medicare officials negotiate prices with drug manufacturers .... And several states are considering bills that would require drug companies to justify their prices to public agencies. (5/5)

The New York Times: Race, Class And Neglect
Many people have pointed out that there are a number of black neighborhoods in Baltimore where life expectancy compares unfavorably with impoverished Third World nations. But what’s really striking on a national basis is the way class disparities in death rates have been soaring even among whites. Most notably, mortality among white women has increased sharply since the 1990s, with the rise surely concentrated among the poor and poorly educated; life expectancy among less educated whites has been falling at rates reminiscent of the collapse of life expectancy in post-Communist Russia. (Paul Krugman, 5/4)

NPR: Triage And Treatment: Untold Health Stories From Baltimore's Unrest
Over the last week, Baltimore's unrest has captured the nation's attention. Images of burning cars, the sounds of angry protesters and then peace rallies have dominated the airwaves and headlines. As the city's health commissioner, I heard other stories. I spoke with a 62-year-old woman who had a heart attack a year ago and who had stopped taking her blood pressure and blood-thinning medications. Her pharmacy was one of the dozen that burned down, and neither she nor the other people in her senior housing building could figure out where to get their prescriptions filled. ... In the wake of fires and violence, the initial priority for health officials was to make sure that our acute care hospitals were protected and that staff and patients could get to them safely. In the immediate aftermath, our focus was on ensuring that injured patients got triaged and treated. (Leana Wen, 5/4)

The Wall Street Journal: Americans’ Health Priorities Diverge From Washington’s Focus On Obamacare
Given the never-ending debate about the Affordable Care Act, you might think that when Americans are asked to name their top health priorities for the president and Congress, they would pick something related to Obamacare, whether it involves expanding the law, scaling it back, or repealing it. But it turns out the American people don’t live in the ACA bubble. Their top priority overwhelmingly, and on a bipartisan basis, was “making sure high cost drugs for chronic conditions were affordable for people who need them.” (Drew Altman, 5/4)

Modern Healthcare: Beware A 21st Century Quackery Act
Proposed legislation “modernizing” the Food and Drug Administration's approach to approving breakthrough drugs and devices would undermine the agency's ability to protect the American public from unproven and possibly unsafe new products. The so-called 21st Century Cures Act also contains sections that would hamstring healthcare providers and insurers in their efforts to lower the cost of care. Unless the legislation is sharply revised, it should be rejected by Congress or, if need be, vetoed by the president. (Merrill Goozner, 5/2)

The Washington Post's Wonkblog: A Horrifying Reminder Of What Life Without Vaccines Was Really Like
“The patient is placed on the sliding bed, shoved into the cabinet and the shield tightly locked. A rubber collar, which fits so snugly that almost no air can pass, is adjusted about the patient's neck. A switch is turned, and the cabinet begins its work.” This is how a 1930 article in “Popular Mechanics” described an “an artificial lung on wheels.” Better known as a tank respirator or iron lung, the machine ... was once a cutting-edge and living saving treatment for victims of polio. And it is a chilling reminder of what life without vaccines looks like -- and why we should worry about efforts to prevent kids from getting the shots they protect them, and other children, from diseases like measles. (Ana Swanson, 5/4)

The Washington Post: Bad News For Older Folks: Millennials Are Having Fewer Babies
A report released last week by the Urban Institute found that millennial women are reproducing at the slowest pace of any generation in U.S. history. Childbearing fell steeply in the years immediately following the “Great Recession,” with birthrates among women in their 20s declining more than 15 percent between 2007 and 2012. This shouldn’t be surprising. Previous periods of financial turmoil have encouraged women to, at the very least, delay childbearing. (Catherine Rampell, 5/4)

MinnPost: Why Alternative Therapies Are Not Harm-Free
I recently had a conversation with friends about the role of the placebo effect in alternative medical "therapies" such as acupuncture, Reiki and homeopathy. My friends readily acknowledged that such therapies have no basis in science, but they did believe they had a role to play in modern medicine — precisely because of the placebo effect. After all, said my friends, if you feel better after, say, undergoing acupuncture or a Reiki session or after taking a homeopathy cold “remedy,” who cares if it’s only the placebo effect at work? (Susan Perry, 5/4)

The Philadelphia Inquirer: Why I Told My Family My End-Of-Life Treatment Wishes At 28
Two months ago, I filled out a living will. I also signed a health care power of attorney, which appointed a health care agent. One month ago, I emailed the documents to my family and my doctors. Today, I’m still a healthy 28-year old but with an advance health care directive posted on my refrigerator. My advance directive specifies health care instructions if illness or incapacity prevents me from communicating. Composed of two parts, my living will provides guidelines for treatment based on my wishes, while my health care power of attorney authorizes my chosen health care agent to make sure they are followed. Yet, despite the availability of these legal mechanisms to protect your ability to control end-of-life care, I’m joined by only about one-third of Americans in having them. (Krystyna Dereszowska, 5/4)

JAMA: Pioneer Accountable Care Organizations: Traversing Rough Country
In theory, ACOs should be attractive to physicians. They provide an opportunity to proactively improve care for patients. They are an alternative to other methods of controlling costs, such as cuts in payment rates and extensive use of prior authorization. But for ACOs to be broadly successful, they will need stronger incentives, closer ongoing connections with patients, better logistical support from Medicare, and regulatory relief. For ACO programs to grow and be sustainable, physicians and hospitals must believe that they will be at least as well off financially if they become a high-functioning ACO as they would be if they continued with business as usual. ... Funds to reward successful systems will come from lower rates of payment increases over time for physicians and hospitals not in ACOs and from lower payments to low-performing ACOs. (Lawrence P. Casalino, 5/4)

JAMA: Accountable Care Organizations And Evidence-Based Payment Reform
Almost all health insurers have begun to implement ACOs and other accountable care reforms. In principle, this means that the clinicians in the ACOs may be more directly aligned with the goals of better quality and lower cost. However, in most ACOs today, including the Medicare ACOs, the clinicians’ payment is still largely based on FFS [fee for service]. A more “advanced” ACO might shift more of its payments from FFS toward accountable care through caps or reductions in some FFS rates and payments instead coming in the form of a per-member per-month amount that is tied to quality measures for the patient population. This provides more net revenues to the health care organization if costs are lower and quality is maintained, and gives its clinicians more flexibility to change how they deliver care. However, it also places the ACO at greater financial risk. (Mark McClellan, 5/4)

JAMA Internal Medicine: The Veiled Economics Of Employee Cost Sharing
Cost sharing has certainly increased, from copayments for physician office visits and prescription drugs to deductibles; the fraction of workers in a plan with at least a $1,000 deductible for coverage of a single person increased from 10% in 2006 to 41% in 2014. Higher cost sharing feels like a decrease both in the generosity of coverage and in compensation. It seems particularly unfair to lower-wage workers who face the same deductibles and copayments as their higher-paid counterparts and who may be discouraged from seeking needed care. But increase in cost sharing are not necessarily regressive nor necessarily associated with lower compensation. (Katherine Baicker and Amitabh Chandra, 5/4)