Kaiser Health News - Mental Health

Viewpoints: Mass. Experience May Not Be True Test For National Health Law; 'Dishonest' Campaign By Medical Device Makers

Wed, 22 May 2013 13:13:22 GMT

The New York Times: Economix: Massachusetts Employees Will Keep Their Health Plans
Massachusetts is often held up as a window into America's health insurance future, because it embarked on what came to be called the Romneycare reform six years ago. Like the Affordable Care Act provisions going into effect nationwide next year, Romneycare aimed to increase the fraction of the population with health insurance by imposing mandates on employers and employees and by subsidizing health insurance plans for middle-class families without employer plans. ... The details and dollar amounts in the Massachusetts health care law differ from the national Affordable Care Act, and for that reason alone I hesitate to infer too much from the Massachusetts experience (Casey B. Mulligan, 5/22).

The National Review: It's Not 'Universal Coverage'
This history of Obamacare's political origins makes it all the more ironic that Obamacare, from what we now know, should not be considered a "universal coverage" plan, even by the benchmark the administration was using in 2009. Estimates from the Congressional Budget Office (CBO) point to this conclusion. In its latest assessment of the law, released in conjunction with new budget projections, the CBO indicates that the number of uninsured residents in the United States will never fall below 31 million -- three million more uninsured people than was estimated for the non-mandate plan President Obama rejected -- and that the insured will never be as much as 90 percent of the population (James C. Capretta, 5/21).

The Hill: Treat Nonprofit Health Care Fairly
For decades, unions have negotiated high quality, affordable health insurance through nonprofit Taft-Hartley plans -- one of the few reliable private providers for lower income individuals. ... In addition to being a long-standing and successful provider, these plans have been models of efficiency, achieving better cost savings than for-profit insurance carriers with medical loss ratios often exceeding 90 percent. That means 90 cents out of every dollar go to patient care. ... But as currently interpreted, the ACA would block these plans from the law's benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law's penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers (Joseph T. Hansen, 5/20).

Los Angeles Times: Why The Medical Device Tax Needs To Stay
The chief drawback of a law as complex as the Affordable Care Act, the health insurance reform measure passed in 2010, is that it provides self-interested opponents a multitude of places to stick a wedge in and hammer away. But you'd be hard-pressed to find a campaign against the ACA as narrow-minded and dishonest as the one mounted by medical device manufacturers (Michael Hiltzik, 5/21).

Fox News: 5 Reasons The Government Is Not Prepared To Handle ObamaCare
The recent turn of events with the Obama Administration and a lack of transparency are a significant red flag to the impending catastrophe of how the proposed changes under the Affordable Care Act could be the next ensuing disaster. … The emerging IRS scandals, as they pertain to the multiple crises of the Obama Administration, are an ominous sign for how these very mistakes will impact the outcome of how the Affordable Care Act is implemented, and ultimately the lives of every American consumer (Dr. Sreedhar Potarazu, 5/21).

Fox News: Americans Beware – ObamaCare Expands How The IRS Can Hurt You
Most of us interact with the Internal Revenue Service once a year at tax time. But President Obama's Affordable Care Act health law puts us under the IRS's thumb all the time. The IRS has a history of using leaks and delays to punish people based on their politics. The latest is news that the IRS delayed processing requests for tax exempt status from the Obama administration's conservative critics, and even leaked information about them to the press (Betsy McCaughey, 5/20).

Des Moines Register: Possible Medicaid Compromise Is Encouraging
(Iowa Gov. Terry) Branstad indicated he would be willing to accept a form of Medicaid expansion if it came with assurances that if the federal government reduces funding for the program in the future, Iowans would not be left picking up the cost. On Tuesday, Sen. Jack Hatch, D-Des Moines, said legislative leaders and the governor's staff have been meeting frequently and may have a deal soon. The final, compromise plan should capture the maximum amount of federal money available, insure Iowans earning up to 138 percent of poverty level and be able to gain approval by the federal government. Whether elected officials are successful remains to be seen, but there is more hope now than there was a week ago (5/21).

Des Moines Register: Broader Medicaid Wouldn't Produce A Healthier Iowa
Bluntly, expanding Medicaid coverage would only make its recipients "feel better," but not actually be better. That makes Medicaid a very expensive feel-good program. Expanding Medicaid lives up to the name of the Affordable Care Act -- it gives "affordable care," nothing more. And the financial protection afforded Medicaid recipients is most effective in protecting against "catastrophic" health expenditures (Bob Williams, 5/21).

The Washington Post: Free Genes From Patent Restrictions
Jolie's news highlights an arcane but increasingly important question of patent law. As the sequencing of the human genome has expanded the ability to test for such genetic susceptibilities, is the discovery of the gene itself a patentable invention? (Ruth Marcus, 5/21).

The Seattle Times: Is Catholic Church Taking Over Health Care In Washington
Lord knows our schools have problems. But suppose we tried to solve them by doing something radical -- say, turning the schools over to the Catholic Church. … If put to a vote, this plan would crater. Most of us aren't Catholic, so I'm guessing we'd never go along with letting the creeds of that one faith run something as universal as education. So why are we allowing it with health care? (Danny Westneat, 5/21).

Miami Herald: Stopping Medicare Fraud
Miami has long had the sorry reputation for being the nation's leader in Medicare fraud, with seemingly just about anybody -- from convicted felons to, well, actors -- allegedly cashing in on what's supposed to be a medical safety net for the country's elderly and disabled. How can this happen? And keep on happening? ... But another part of Medicare, the administration arm that certifies that care givers who tap into Medicare reimbursements are actually qualified to do so and then verifies that they actually deliver the services they vouch for, must be much more diligent. Especially so in fraud capitals like Miami where it's so easy to find an abundance of seniors, some of whom are achingly vulnerable to crooks and cons (5/19).

JAMA: Value of Unique Device Identification in the Digital Health Infrastructure
In recent years, high-profile cases of medical device failure resulting in patient harm -- such as implantable cardioverter-defibrillator leads and metal-on-metal hip implants -- have received substantial attention both in the medical literature and popular press. These examples illustrate the need for a more effective system of monitoring device performance and protecting patient safety (Drs. Natalia A. Wilson and Joseph Drozda, 5/21).

JAMA Pediatrics: Stunting The Growth Of Child Health Research
A recent comprehensive assessment concluded that "lack of research, poor research, and poorly reported research" greatly limit child health research. Children participate in medical research at rates less than one-half those of adults, perhaps attributable to inadequate opportunities, ineffective recruitment strategies, and parents' greater concerns about their children's safety than their own in research settings. Meanwhile, health care spending on children declines every year as a share of national expenditures, causing concern that investment in child health research will decline as well (Dr. Matthew M. Davis, 5/20).

JAMA Internal Medicine: Evaluating Health System Processes With Randomized Controlled Trials
Health system processes shape and define health care and the medical experience of patients, health care practitioners, and society at large. These processes range from targeted mandates, such as gown and glove precautions for patient contact or automated computer alerts, to wider choices, such as deciding how to respond to medical emergencies, how to use (or not use) performance metrics or patient satisfaction surveys, what new health care facilities to build, or even how to finance health care costs and medical insurance. Given their unquestionable importance, we contend that health system processes should be routinely evaluated with randomized controlled trials (Drs. John P. A. Ioannidis and Vinay Prasad, 5/20).

The Medicare NewsGroup: Does Medicare Overpay Private Plans? The Debate Heats Up
The debate on whether Medicare Advantage (MA) is reducing health care costs is intensifying. A recently released analysis of government data by America's Health Insurance Plans (AHIP), the main health insurance lobby, found that seniors enrolled in MA plans in California and Nevada had better health outcomes than patients enrolled in Traditional Medicare. … Given the growing toxic environment in Washington and the fact that MA has become a political football, it's unlikely that the CMS or Congress will act before the 2014 elections, delaying a closer look (John Wasik, 5/21).

Health Policy Solutions (a Colo. news service): The Year Of Mental Health At The Colorado Legislature
In addition to other health care reforms (Medicaid expansion, improved parity for behavioral health coverage) two historic pieces of behavioral health legislation moved forward this year. One deals with Colorado's civil commitment laws -- statutes long overdue for a 21st century update. The other is a bill that includes over $20 million in funding to create a statewide behavioral health crisis response system. The governor signed both bills into law at the Jefferson Center for Mental Health on May 16 (Michael Lott-Manier, 5/21).

WBUR: Cognoscenti: Your Patient Is Your Partner: Collaboration Creates The Best Medical Outcomes
In a recent interview, physician and noted social activist Dr. Paul Farmer gave this advice to graduating medical professionals: their real impact will come when they work in teams. As the co-founder of Partners in Health and a champion of improving health in underserved communities, Farmer's work is built on building partnerships and applying successes and lessons learned to new frameworks (Laurie Edwards, 5/22).

State Roudup: Loophole Could Mean Calif. Docs Eat Some Costs

Wed, 22 May 2013 13:13:00 GMT

A selection of health policy stories from California, Kentucky, Texas, Florida, North Carolina, Oklahoma and Missouri.

Sacramento Bee: Loophole In Health Care Law Could Stick Doctors With Tab
A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills. A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims. Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation -- but insurers are responsible only for the first month (Sanders, 5/21).

Los Angeles Times: Strike At UC Medical Centers Continues; More Picketing Wednesday
As the afternoon wore on, the number of union members on the picket lines at the University of California medical centers started to thin. But hundreds of workers concerned about staffing levels and pension reforms planned to continue striking throughout the evening. Union spokesman Todd Stenhouse said that the decision to strike was a difficult one for many (Gorman and LaGanga, 5/21).

Sacramento Bee: Thousands Strike At University Of California
As non-emergency surgeries were postponed and fill-in medical technicians were brought in from out of state, thousands of employees walked off the job Tuesday at the UC Davis Medical Center and four other University of California hospitals. The two-day strike, due to end at 4 a.m. Thursday, was billed by the union for nearly 13,000 nursing assistants, pharmacists, operating room scrubs and other workers as a walkout over medical staffing levels and patient safety (Hecht and Lindelof, 5/21).

The Associated Press: N. Ky. Health Department Stops Well-Child Exams
The health department in northern Kentucky says it plans to stop offering well-child visits because Medicaid no longer offers reimbursement for them. Health department spokeswoman Emily Gresham Wherle told The Kentucky Enquirer that the agency will not schedule any new appointments at their locations in Boone, Campbell, Kenton and Grant counties (5/21).

The Texas Tribune: Bill Lets Police Take Guns From Those In Mental Crisis
Police would have new authority to take firearms away from Texans who are in a mental crisis under a bill the House approved on Tuesday that is now headed to Gov. Rick Perry's desk. Senate Bill 1189, by state Sen. Joan Huffman, R-Southside Place, would allow police to confiscate guns from people who are experiencing a mental health crisis if they determine the person is a danger to themselves or others (Grissom, 5/21).

Health News Florida: Leapfrog Group Ranks FL 10th In Safety
Thirty-seven percent of Florida hospitals have received an "A" grade from the Leapfrog Group, a nonprofit organization that grades participating hospitals on their efforts to prevent medical errors, putting the Sunshine State in 10th place. The scoring system is based on 26 safety measures including hand-washing and care of patients with catheters or ventilators, according to the Leapfrog web site. Hospitals are given letter grades based on these scores (Burton and Gentry, 5/21).

North Carolina Health News: On the Road: Wos Takes Medicaid Message To The People
The head of the state's Department of Health and Human Services has received less than a wholehearted reception as she's traveled the state explaining the governor's proposed Medicaid overhaul (Sisk, 5/22).

North Carolina Health News: Senate Gives More Detail On Budget Plan
More details about the Senate's plans for Medicaid and the state's health care budget emerged Monday as senate leaders explained more of their thinking around their budget plans. In meetings with the media and during presentations in appropriations meetings Monday afternoon, senators reiterated several times that Medicaid has become a drag on state spending (Hoban, 5/21).

Tulsa World: House Speaker Won't Save Insure Oklahoma
Oklahoma Speaker of the House T.W. Shannon has pulled the plug on Gov. Mary Fallin's plans to save the Insure Oklahoma program, which provides health care to working poor Oklahomans. As a result, 9,000 people currently getting state and federally subsidized private insurance through the program will be left without coverage (Greene, 5/20).

St. Louis Post-Dispatch: Nixon's Changes At Medicaid Agency Puzzle Health Care Advocates
Questions continued to swirl in the state capital Tuesday about the sudden departure last week of Missouri's Medicaid director, a widely respected physician who had navigated choppy political waters for six years. Health care advocates and legislators said that former Medicaid chief Ian McCaslin was forced out by Gov. Jay Nixon's office. But none could pinpoint why (Young, 5/22).

State Programs, Agreements With Feds Aim At Better Mental Health Care Delivery

Tue, 21 May 2013 13:16:00 GMT

States seek to improve how they deliver mental health care: In Georgia, a revamp shows success stories; Connecticut seeks an agreement to better care for children with mental health problems; and in Texas, lawmakers back a diversion program to keep the mentally ill from jail.

Georgia Health News: DOJ Pact Shows Results, But Challenges Remain
A man who lived for years in a crude shelter in the woods is now housed in an apartment. A young woman who was institutionalized for a dozen years now lives in her own home, and is using the bathroom by herself for the first time in her life. The two individuals’ transitions are among the success stories of Georgia's 2010 agreement with the U.S. Justice Department to revamp the state's system to care for people with mental illness and developmental disabilities (Miller, 5/20).

CT Mirror: Proposal Seeks To Lay Groundwork For Better Children's Mental Health
In an effort that grew out of personal experience, advice from experts and the stories parents told in the wake of the massacre at Sandy Hook Elementary School, the head of the legislature’s Committee on Children Monday unveiled a proposal aimed at making it easier for families to access mental health services for children. The bill is a first step, a framework for the mental health system, Sen. Dante Bartolomeo, a freshman Democrat from Meriden, said as she outlined the measure, flanked by mental health experts and parents of those killed at the Newtown school (Becker, 5/20).

The Texas Tribune: House Backs Mental Health Jail Diversion Program
The House tentatively approved a bill Monday that would allow Harris County Jail to start a pilot program that officials hope would become a model for reducing mental illness in local lockups across Texas. Senate Bill 1185, by Sen. Joan Huffman, R-Southside Place, would create a program that connects mentally ill inmates with social, clinical, housing and welfare services during the first weeks after the person's release from jail (Grissom, 5/20).

New Psychiatric Diagnostic Manual Released

Mon, 20 May 2013 13:33:45 GMT

Long-awaited update of "the psychiatrist's bible" has stirred controversy.

Marketplace: How Much Is The DSM-5 Worth?
Controversy has dogged the new DSM-5, what people like to call "the psychiatrist's bible," and it won't even be officially released until this weekend. Really, the book is a manual clinicians use to diagnose and classify people with mental illness. While it sounds pretty dry, there's a whole lotta drama around this book. The federal government has questioned its value. ... some practitioners are boycotting it and there are charges that it's not ready for prime time. Before I say anything more about the DSM-5, here are a couple of facts about the DSM IV. It's 19 years old and it still brings in about $4-5 million a year (Gorestein, 5/17).

Medpage Today: APA Leaders Defend New Diagnostic Guide
The fifth edition of the "psychiatrist's bible" was officially released here in all its 947-page glory, with its developers offering a spirited rebuttal to their critics. Known as DSM-5, the new version of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders was launched at a press briefing to kick off the organization's annual meeting. Most of the changes from the previous edition had already been made public, at least in general outline (Gever, 5/18).

McClatchy: Child Mental Health Disorder Rising, Cost Society $247 Billion Annually
Up to one in five American youngsters – some 7 million to 12 million by one estimate – experience a mental health disorder each year, according to a new report billed as the first comprehensive look at the mental health status of American children. And the rate is increasing, said the U.S. Centers for Disease Control and Prevention, which produced the study, released Thursday (Pugh, 5/16).

State Roundup: Okla. Gov. Pushes Funding Fix To Cover 9,000 On Medicaid

Mon, 20 May 2013 04:00:00 GMT

A selection of health policy stories from Oklahoma, Texas, California and Massachusetts.

The Associated Press: Fallin Urges Last-Minute Health Care Fix
Gov. Mary Fallin proposed a last-minute legislative change Friday to the state's Insure Oklahoma program that would direct $50 million in state tobacco taxes to pay for more than 9,000 people who are expected to lose their health insurance under the program. Insure Oklahoma currently uses federal Medicaid funding, state tobacco tax revenue and payments from workers and employers to provide health insurance to about 30,000 low-income Oklahomans, but the federal government notified Oklahoma last week that the program must change in order to qualify for federal funding (Murphy, 5/18).

The Associated Press: Legislators Devote New Funding To Mental Health
For the first time since (Texas) state lawmakers made historic budget cuts a decade ago, legislators are dedicating hundreds of millions more dollars to mental health care. (Haven for Hope in Bexar County) serves as a model of the services and success they aim to accomplish. ... As Republicans and Democrats in the Texas House and Senate hash out the details of the state’s 2014-15 budget — there are fights over water, roads and education — one issue they are not arguing about is support for mental health. "One thing we could all agree on was mental health was, to a large extent, a driver of crime," said state Rep. John Zerwas, R-Simonton (Grissom and Rocha, 5/19).

The Texas Tribune: House OKs Bill To Expand Mental Health In Managed Care
Managed care plans would be required to offer more mental health services to Medicaid recipients under a bill tentatively approved by the House on Friday. … The majority of mental health services -- such as medication management and counseling -- are already provided to Medicaid recipients through managed care (Aaronson, 5/17).

Los Angeles Times: City Of San Francisco, Worker Unions Protest Kaiser Premium Hike
It's a trend many public employees can relate to: Health insurance premiums climb year after year, while at the bargaining table workers have agreed to kick in more for pensions, take salary cuts and sign on to furlough days. But when Kaiser Permanente -- which insures 45,000 public workers here -- proposed another hike for 2014, San Francisco's Health Service System teamed up with labor unions to say "no more" (Romney, 5/19).

Los Angeles Times: St. John's Picks Providence Health & Services In Bidding War
After months of controversy, the owner of St. John's Health Center said it plans to sell the landmark Santa Monica hospital to Catholic chain Providence Health & Services. The hospital has been at the center of an intense competition that featured bids from UCLA Health System, other Catholic hospital chains and Los Angeles billionaire Patrick Soon-Shiong (Terhune, 5/17).

The Texas Tribune: Texas On Track To Restore Cancer Research Funding
The Legislature is on track to restore financing for the Cancer Prevention and Research Institute of Texas. In an effort to restore public trust in the beleaguered agency, budget negotiators made the agency's financing for 2014-15 biennium -- $595 million -- contingent upon the passage of Senate Bill 149, which the House tentatively approved on Friday (Aaronson, 5/17).

Medpage Today: No Hike In Mass. Hospital Use Post Health Reform
Health care reform in Massachusetts did not increase overall use of inpatient resources, but other states may not be so lucky, researchers found. Before and after a reform, the average number of quarterly admissions per hospital was 1,502 and 1,557, respectively -- translating into a nonsignificant net change of 0.3 percent when compared with controls, according to Amresh D. Hanchate, PhD, an economist at the Veterans Affairs Boston Healthcare System, and colleagues (Kaiser, 5/17).

California Healthline: Assembly Approves Race, Ethnicity In Quality Reporting
The Assembly yesterday passed a bill that requires state officials to include race and ethnicity when compiling health care quality data. AB 411 by Assembly member Richard Pan (D-Sacramento) would not create any kind of difficulty for state officials, since that data already exists, according to Pan. The point is to make state officials use it, Pan said. … The information is already being collected by the state Department of Health Care Services so it's not really much more work to mine that data for health disparities by race or ethnicity, Pan said (Gorn, 5/17).

Updated Diagnostic Guidebook For Mental Disorders To Be Unveiled This Weekend

Fri, 17 May 2013 13:33:34 GMT

In advance of its release, the new edition of the Diagnostic and Statistical Manual of Mental Disorders has triggered debate and controversy surrounding the many changes included in this 947-page book.

The Washington Post: Psychiatry's Revamped DSM Guidebook Fuels Debate
For ADHD, the definition is being broadened, meaning the disorder could be diagnosed in more children. In the case of autism, the opposite is true. The new criteria are among the changes that will be released with the publication this weekend of the long-awaited guidebook that psychiatrists and other mental health clinicians use to diagnose mental disorders. It's the first major update in nearly 20 years. The 947-page tome by the American Psychiatric Association adds some new disorders, broadens criteria for existing ones and tightens them for other illnesses (5/17).

Reuters: Psychiatrists Unveil Their Long-Awaited Diagnostic 'Bible'
The long-awaited, controversial new edition of the bible of psychiatry can be characterized by many numbers: its 947 pages, its $199 price tag, its more than 300 maladies (from "dependent personality disorder" and "voyeuristic disorder" to "delayed ejaculation," "kleptomania" and "intermittent explosive disorder"), each limning the potential woes of being human. But to the psychiatrist who shepherded the tortuous creation of the "Diagnostic and Statistical Manual of Mental Disorders," perhaps the single most important number is the "5" in its title: This is the DSM-5, not the DSM-V (Begley, 5/17).

State Highlights: State Medicaid Investigators Get More Money To Investigate Fraud

Fri, 17 May 2013 13:32:00 GMT

A selection of health policy stories from Texas, Kansas, Georgia, Wisconsin and California.

CQ HealthBeat: OIG Final Rule Allows Medicaid Investigators To Use Data Mining
State Medicaid fraud investigators will be able to get federal matching funds to electronically search for potential fraud, under a final rule to be published on Friday. The rule, which will be published by the Health and Human Services Office of Inspector General, is expected to save the federal government about $34.3 million from fiscal 2014 through fiscal 2023 in fraudulent claims that would have been paid (Adams, 5/16).

The Texas Tribune: End-Of-Life Bill Sparks Anger, Accusations
Political powerhouse Texas Right to Life is working overtime to try to defeat a compromise measure aimed at improving state laws governing "end of life" medical decisions. But with time running out to get Senate Bill 303 passed, the fight over the legislation has shifted from political to personal. Sen. Bob Deuell, R-Greenville, a family physician who has worked for years to craft legislation acceptable to faith-based groups, the disability community and medical professionals, said Texas Right to Life is acting like "the woman that went to Solomon and wanted the baby to be cut in two" (Aaronson, 5/17).

The Texas Tribune: House Backs Bill To Protect Medicaid Providers’ Rights
Medicaid providers would have clearer due process rights during fraud investigations under a measure the House gave tentative approval to on Wednesday. The bill would also codify the state's rules for withholding payments to providers during such investigations (Smith and Aaronson, 5/16).

Kansas Health Institute: Governor's Mental Health Initiative Panned At Manhattan Meeting
Karen McCulloh spent much of Wednesday afternoon listening to state officials explain how Gov. Sam Brownback's mental health initiative might work. She said she didn't hear much that she hadn't heard before. … Brownback has said his initiative, much of which remains undefined, is meant to "strengthen" the state's mental health system and better serve those most at-risk of hospitalization or incarceration (Ranney, 5/16).

Georgia Health News: Albany Hospital Merger Slowed By Latest Ruling
U.S. District Court Judge Louis Sands has issued a temporary restraining order against further moves by Phoebe Putney Health System to consolidate with the former Palmyra Medical Center in Albany. The ruling had been sought by the Federal Trade Commission. Phoebe Putney officials said in a statement that the judge's action won't alter day-to-day operations at the former Palmyra, which was purchased from HCA and has been renamed Phoebe North (Miller, 5/16).

Milwaukee Journal Sentinel: Uninsured, Low-Income Visits To Hospital
More than 1 million visits to Wisconsin's hospitals were by patients who were uninsured and low-income in 2011 -- an increase of more than 30 percent since 2006, according to the Wisconsin Hospital Association Information Center's annual Guide to Wisconsin Hospitals. The Wisconsin Hospital Association Information Center also reported that 70 percent of surgeries and procedures now done at the state's 148 hospitals don't require an overnight hospital stay and are done in outpatient departments. The figure shows that the traditional measure of inpatient stays no longer is a valid way to gauge a hospital's patient volume and size (Boulton, 5/16).

California Healthline: Increasing Medical Residencies Could Help Inland Empire
As the Inland Empire grapples with a shortage of primary care physicians, experts say the solution hinges on creating more medical residencies. New state legislation could help. AB 1176 proposes to increase the number of primary care medical residencies in underserved regions, such as the Inland Empire. The new slots would be funded by levying a fee on insurers (McSherry, 5/16).

State Roundup: N.D. Abortion Clinic Sues To Stop New Law

Thu, 16 May 2013 13:42:00 GMT

A selection of health policy stories from North Dakota, Connecticut, California, Massachusetts, Texas, Oregon, Oklahoma and North Carolina.

The New York Times: North Dakota's Sole Abortion Clinic Sues To Block New Law
The running battle over the regulation of abortions entered a North Dakota courtroom on Wednesday, as the state’s sole abortion clinic sued to block a new law that it says could force it to shut down. The law, requiring doctors performing abortions to have admitting privileges at a nearby hospital, was promoted by anti-abortion legislators, who argued that it would mean better care for women who suffer medical emergencies (Eckholm, 5/15).

CT Mirror: Big Health Care Savings Help Counter Shrinking State Budget Revenues
State officials trying to close a last-minute hole in the next budget got some good news Wednesday in the form of major savings in health care costs for retired state employees. The Legislature’s nonpartisan Office of Fiscal Analysis issued a memo indicating it has reduced its projected cost of providing health care to retired state workers in the fiscal year that begins July 1 by $140.6 million, and in 2014-15 by $166.5 million. The nonpartisan office is boosting the projected health care costs for current employees by $46.7 million in the next budget and by $36.4 million in 2014-15, but the net savings over the next two years still totals $224 million (Phaneuf, 5/15).

HealthyCal: Counties Still Not Prepared To Offer Expanded Mental Health Care
More than one million people in California suffer from mental illness -- the largest number of any state. When the final phase of the new federal health care law starts in January of next year, more California residents than ever before will be able to seek help for problems ranging from depression, anxiety, and addiction to schizophrenia and bipolar disorder. But mental health providers in the state’s Central Valley are unprepared for an influx of thousands of patients (5/16).

Boston Globe: State Health Insurers Post Mixed Financial Results
The state’s biggest health insurers reported mixed first-quarter financial results Wednesday, with two notching income gains, one registering lower earnings, and one posting a loss. While all of the health insurance companies said they were working to hold down premiums as they rolled out new products and shifted doctors and hospitals to risk-sharing payments, each cited unique factors influencing financial performance in the three months ending March 31 (Weisman, 5/15).

Los Angeles Times: 13 Health Care Workers Arrested In Protest At UC Regents Meeting
Thirteen people were arrested Wednesday at the UC regents meeting during a sit-down protest by health care workers threatening to strike at the system's medical centers. The University of California regents left during the protest while UC police cleared the room, handcuffing the protesters and leading them out of the hall at the Sacramento Convention Center (Gordon, 5/15).

The Texas Tribune: Senate Backs Bill On Psychotropic Drugs For Foster Kids
Lawmakers in both chambers have now endorsed legislation that would require guardians of foster children to take greater caution before giving psychotropic drugs to the children. The Senate on Wednesday approved a version of the "informed consent" measure that is slightly different than the one approved by the House in April (Aaronson, 5/15).

Lund Report: Oregon House Passes Assessments For Hospitals And Nursing Facilities
The House passed assessment taxes on hospitals and long-term care facilities by a wide 54-5 margin Tuesday, ensuring Oregon’s health and human service budgets will raise over a billion dollars from providers in coming years and leverage $1.4 billion from the federal government next biennium for Medicaid. Hospitals are compensated for their assessments with higher reimbursements for the Oregon Health Plan while nursing homes are paid for the use of their beds by Medicaid patients. … House Bill 2216 extends an expanded hospital assessment of 5.32 percent for two years. A previous bill, House Bill 2056, was attached to that version, which extends the long-term care facility assessment for six years, while expanding it to include all nursing homes except the Oregon Veterans Home (Gray, 5/15).

Lund Report: Single-Payer Activists Keep Dream Of Universal Health Care Alive In Oregon
Wes Brain was uninsured last winter when a tonsillectomy showed signs of throat cancer. He qualified for the high-risk Oregon Medical Insurance Pool, which the state has administered through Regence BlueCross BlueShield. But gaining access to that insurance soon proved a big obstacle for the Ashland resident, when Regence erroneously told him he hadn't submitted his driver's license. … Eventually, his policy was approved. He paid $2400 -- three month’s premium. His doctor ordered a PET scan for March 1. But then Regence came back and told him no, he’d have to wait until March 1 to even begin authorization (Gray, 5/15).

Stateline: Oklahoma's "Life-Preserving" Law Raises Questions For Doctors
University of Tulsa law professor Marguerite Chapman has been studying end-of-life issues in Oklahoma for three decades and has come to a conclusion: "It's getting almost to the point that you need a government permit in order to die in this state." Certainly, dying has gotten a lot more complicated here, the result of a unique measure passed by the Oklahoma legislature and signed into law last month by Republican Gov. Mary Fallin. Modeled after legislation written by the National Right to Life Committee, the law says that patients who are disabled, elderly or terminally ill cannot be denied life-preserving treatments if they or their health proxies want it (Ollove, 5/16).

North Carolina Health News: Bill To Compel Insurers To Cover Autism Treatment Advances
For kids with autism in North Carolina, it’s possible to get insurance coverage for the process of diagnosing the developmental disorder. But for the bulk of those kids, getting an insurance company to cover treatment is another matter (Hoban, 5/15).

Oregonian: Mental Health Staff In Oregon Prison System Push For Big Raises
A group of unionized mental health workers in the Oregon state prison system wants a pay raise that even they acknowledge is big enough to cause a public relations problem. About 50 mental health specialists who handle inmates with addictions and other mental health problems want to be reclassified because their job descriptions have changed, including a requirement of a master's degree. Under their current proposal, they're seeking raises between 25 percent and 26 percent, which would result in a maximum salary of more than $80,000, according to a memo obtained by The Oregonian (Esteve, 5/15).

Weekend Reading: Volunteers In The Battle With Heart Disease

Thu, 16 May 2013 13:39:00 GMT

Every week reporter Ankita Rao selects interesting reading from around the Web.

The Atlantic: Lost In Medication
Psychiatrists who take time with their patients are not the norm. It's not because others don't care. Rather the system rewards efficiency, not empathy ... I treated a patient who had suffered from schizophrenia for years. He had finally achieved some stability on a cocktail of antipsychotic medications as he was passed along through the clinic, year after year ... One day, though, he showed up for his appointment looking completely different. His complaints had nearly disappeared; he was cheerful, optimistic. ... Inquiring about what had changed, I found out that with the assistance of the hospital work program, he had gotten a job for the first time in nearly 30 years. … In many places psychiatry has become a biological enterprise, with some psychiatrists even introducing themselves as "psychopharmacologists." In no other specialty does a physician define themselves by the medication that they use (Sarah Mourra, 5/10).

The New Republic: My Five Obamacare Anxieties
Conservatives are talking about the implementation of Obamacare in the same thoughtful way they talked about its enactment—that is, as an impending apocalypse. It won't be, as I've noted previously. Most Americans get insurance through employers, Medicare, and Medicaid, and that will still be the case on January 1, when Obamacare's big provisions take effect. But the minority who buy insurance on their own or have no insurance will see tremendous changes. And you don't have to be Rush Limbaugh to have real concerns about how those changes will play out (Jonathan Cohn, 5/13).

The Fiscal Times: Why The IRS Scandal Could Bring Down Obamacare
The Internal Revenue Service's scandalous targeting of Tea Party-themed and other conservative groups could severely damage President Obama – but it's not necessarily because anyone close to the White House sanctioned the allegedly independent actions by the tax collection agency. ... The real fallout could be that it will impede Obamacare, ... The IRS will largely administer this attempt at providing near-universal health insurance. It is responsible for overseeing the tax credits and tax increases in the law, and—most critically—ensuring that businesses and individuals comply with the individual mandate and other major provisions. Prominent Republicans are already connecting the unpopular insurance program to the questions swirling around the IRS (Josh Boak and Eric Pianin, 5/14).

The Weekly Standard: Eggs For Sale?
If you want to know what's going to go wrong in the culture, read the professional journals. A case in point: An article in the April 10 New England Journal of Medicine called for the creation of a commodities market for "made-to-order" human embryos. The authors, I. Glenn Cohen and Eli Y. Adashi—university professors, of course—treat embryos as the equivalent of a prize cattle herd. They note that sperm and eggs are already bought and sold for in vitro fertilization (IVF) and, further, that New York legalized buying eggs for use in biotechnological research a few years ago. Hence, "it is not clear" (an oft-used phrase in bioethical advocacy that frees the author from actually having to prove a point) why we should not also allow companies to make "made-to-order embryos" for profit, since that activity would be "more similar to the sale of gametes than the sale of children" (Wesley J. Smith, 5/14).

The New York Times: Seeking Clues To Heart Disease In DNA Of An Unlucky Family
Researchers have long known that a family history of early death from heart disease doubles a person's risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age 55 or a mother or sister before age 65. Scientists are studying the genetic makeup of each member of the Del Sontro family, searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA. Until very recently, such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and time-consuming that it was impractical to take on for an entire family (Gina Kolata, 5/12).

The New Yorker: Can We Patent Life?
On April 12, 1955, Jonas Salk, who had recently invented the polio vaccine, appeared on the television news show "See It Now" to discuss its impact on American society. Before the vaccine became available, dread of polio was almost as widespread as the disease itself. Hundreds of thousands fell ill, most of them children, many of whom died or were permanently disabled. The vaccine changed all that, and Edward R. Murrow, the show's host, asked Salk what seemed to be a reasonable question about such a valuable commodity: "Who owns the patent on this vaccine?" Salk was taken aback. "Well, the people," he said. "There is no patent. Could you patent the sun?" ... It took thousands of scientists and technicians more than a decade to complete the Human Genome Project, and cost well over a billion dollars. The same work can now be carried out in a day or two, in a single laboratory, for a thousand dollars—and the costs continue to plummet. As they do, we edge closer to one of modern science's central goals: an era of personalized medicine, in which an individual’s treatment for scores of illnesses could be tailored to his specific genetic composition. That, of course, assumes that we own our own genes (Michael Specter, 4/2).

The National Journal: How Much Big Insurance Paid A Small-Business Group To Fight A Premium Tax
The nation's leading health insurance industry group gave $850,000 to a top small-business trade association as part of a campaign to repeal a key provision of President Obama’s health care law, National Journal Daily has learned (Frates, 5/14).

Viewpoints: Angelina Jolie On Her Decision To Have a Double Mastectomy; Justice Ginsburg's 'Blind Spot' On Abortion

Tue, 14 May 2013 13:36:46 GMT

The New York Times: My Medical Choice
My doctors estimated that I had an 87 percent risk of breast cancer and a 50 percent risk of ovarian cancer, although the risk is different in the case of each woman. Only a fraction of breast cancers result from an inherited gene mutation. Those with a defect in BRCA1 have a 65 percent risk of getting it, on average. Once I knew that this was my reality, I decided to be proactive and to minimize the risk as much I could. I made a decision to have a preventive double mastectomy. I started with the breasts, as my risk of breast cancer is higher than my risk of ovarian cancer, and the surgery is more complex (Angelina Jolie, 5/14).

Forbes: If You Want to Stop Hospital Harm, Don't Call a Capitalist
The Leapfrog Group has just released its latest report grading the safety of hundreds of individual hospitals, but the real news isn't the "incremental progress." It's how a group started by some of the most powerful corporations in America has quietly devolved into just one more organization hoping press releases produce change. Amid the current enthusiasm for "value-based purchasing" by employers and possible privatization of Medicare, it is worth examining why Leapfrog's initial notion that corporations would spearhead a crackdown on crummy care failed and what we can learn from that publicly unacknowledged failure (Michael Millenson, 5/12).

The New York Times' Taking Note: Ginsburg's Roe V. Wade Blind Spot
Instead, Justice Ginsburg contended, the court prevented the states from working out on their own how best to regulate abortion, short-circuiting the democratic process and provoking an angry "backlash" among conservatives and resistance to Roe that continues to this day. But as the Times editorial page summarized last month, "The real story, as explained by Linda Greenhouse, a former New York Times reporter who now teaches at Yale Law School, and Reva Siegel, a professor there, is that political conflict over abortion was escalating before the Roe decision, and that state progress on decriminalization had reached a standstill in the face of opposition from the Roman Catholic Church" (Lincoln Caplan, 5/13).

National Review: The Medicaid Deniers
For years, progressives have claimed that they are the party of science. ... But there is at least one area of public policy where the Left has abandoned its rhetorical allegiance to science: health care. For years, studies have shown that patients on Medicaid — America’s government-run insurance program for the poor — do no better, and sometimes do worse, than those with no insurance at all (Avik Roy, 5/14).

Health Policy Solutions (a Colo. news service): New Evidence Against Colorado Medicaid Expansion
The problem is that the latest research suggests that much of the additional Medicaid spending will be wasted. Results from the Oregon Health Study Group … show that enrolling the able-bodied poor in Medicaid increases annual health spending by $1,172 per person per year without improving blood pressure, cholesterol levels or blood sugar levels. Rates of outpatient surgery, emergency department visits and hospital admissions are also unaffected. … While it is clear that Medicaid benefits the sick and helpless for whom it was originally designed, in the current environment there is little evidence of benefit from expanding Medicaid to cover able-bodied adults. In fact, the opposite may be true (Linda Gorman, 5/13).

Bloomberg/Businessweek: Want to Improve Health Care? Spend Less on It
It’s shocking that, in one of the richest countries in the world, millions are still denied access to health care—and especially preventative services—because they can't afford coverage. And the pain and disruption associated with paying medical bills is immense. The U.S.'s move toward universal health coverage is a step in the right direction. But the U.S. also needs to get more serious about keeping people out of doctors' offices and hospitals in the first place. That's the most effective – and by far the cheapest — path to longer, healthier lives (Charles Kenny, 5/13).

JAMA: Patients' Responsibility To Participate In Decision Making And Research
It is time to reduce the artificial barriers between research on one side and patient care and practice on the other. The path to effective, sustainable patient-centered health care and decision making requires that patients let clinicians know their priorities, understand which strategies are most likely to achieve their priorities, and participate in the research that generates this evidence (Drs. Mary E. Tinetti and Ethan Basch, 5/13).

Boston Globe: Looking Past A Patient's Crimes A Difficult Challenge
It was the first day of a new rotation. I was getting to know my patients, trying to match faces and diagnoses with names on my list. A frail man with end-stage heart failure, Mr. T was too weak to walk and spent most of his time in a reclining chair. He had been in the hospital for weeks with pneumonia, kidney failure, and several other complications. I introduced myself and proceeded to examine him. … No one came to visit him. A few days into the rotation, I found myself reading through his medical record, trying to figure out what his life outside the hospital had been like, and whether there might be a friend or relative able to help care for him after discharge. I was not prepared for what I discovered (Kiran Gupta, 5/13).

WBUR: Cognoscenti: Mental Illness: The View From Within
Amid the search and subsequent capture of Boston Marathon bombing suspect Dzhokhar Tsarnaev, and in the weeks since, I was riddled with fear, dread, and curiosity. I think that range of emotions was fairly common. Perhaps slightly less common was the other emotion I felt: a vague sense of shame. As someone who struggles with mental illness, I was waiting for everyone to start speculating about depression, bipolar disorder or schizophrenia as a possible explanation (Susan Senator, 5/14).

Viewpoints: Obama Took Risk On Budget Offer And Was Slammed By Rep. Ryan; Health Law Could 'Quash' Progress On Spending

Mon, 13 May 2013 13:33:28 GMT

Bloomberg: Obama's Budget Put The Onus On Ryan
Obama took a risk and proposed a budget containing cuts to entitlements cherished by his party. House Budget Committee Chairman Paul Ryan, a Wisconsin Republican, and his cohorts were unmoved; they wouldn't give an inch on new revenue. Simpson and Bowles gave Obama a pat on the back and largely refrained from criticizing Ryan or House Speaker John Boehner, while corporate leaders ducked. Moreover, Simpson and Bowles have revised their plan and moved to the right, proposing proportionately more spending cuts and less in new revenue. Obama is playing ball, Ryan isn't, and the two deficit hawks, and their CEO supporters, are rewarding the guy who is stiffing them (Albert R. Hunt, 5/12).

Los Angeles Times: Mother Knows Best
There are two things you can do for your mother on Mother's Day. One is to say "thank you." (Over lunch, with flowers.) The other is to ask her for advice -- even if she's not convinced you really want it. ... [Lois Doyle McManus has] got some advice for Congress as it ponders taxes and spending: Go ahead and bite the bullet. Elderly voters aren't as naive, or as greedy, as you seem to take them for. "They're going to have to fix Social Security and Medicare. Those of us who are using it are aware of it. There's something terribly wrong with a medical system that spends as much money as this. We're willing to do our part" (Doyle McManus, 5/12).

The Wall Street Journal: The Health Spending Decline
To the surprise of both political parties and planners of all types, American health-care spending appears to be slowing down. The health growth rate has flattened out at about 3.9 percent over the last three years -- a record low since the 1960s and down from the old normal of 6.2 percent to 9.7 percent in the 2000s. This is rare good economic news, given that health cost growth sends federal entitlement spending soaring and erodes middle-class wage increases. Can this trend last? Maybe, though not with the Affordable Care Act looming to quash any progress (5/12).

USA Today: The ObamaCare Train Wreck
When the Affordable Care Act was passed, opponents (mostly Republicans) warned that it would be a disaster. Few of us on Capitol Hill could have anticipated that we would later be joined by a raft of former Democratic proponents so eager to distance themselves from ObamaCare that they're using even harsher terms. Let's call these politicians the Train Wreck Club (Rep. Mike Pompeo, R-Kan., 5/10).

Scripps Howard News Service: Today’s Hospital Pricing Shows A Sickening Disparity
Don’t feel bad if you don't understand the wide, sometimes huge, discrepancies in fees hospitals charge for the same procedure. Or if you don't understand the arithmetical magic the hospitals use to arrive at those fees. Neither does the federal government. Their officials are mystified, too (5/13).

WBUR: Cognoscenti: Complex, Flawed -- And Necessary: Here Comes ObamaCare
Just when you thought it was safe to go back into the news, the dorsal fin of Obamacare has sliced the water's surface. Diehard opponents vow to make next year's midterm elections a referendum on a law they've disparaged as socialist claptrap. Meanwhile, conservative pundit David Brooks spies logistical icebergs ahead as the hellishly complex reforms are implemented. Brooks's concern, based on interviews with experts pro and con, is legitimate but manageable. As for the socialism charge, remember this if nothing else: Mandatory national health insurance was the brainchild of an anti-socialist reactionary (Rich Barlow, 5/13).

Houston Chronicle: Texas Should Restore Women's Health Care Funding
I would love to report that on this Mother's Day, women's health care is exactly where it should be in Texas: Regardless of her station in life, your mother, wife, daughter, sister or friend has access to the care she needs. But women's health care in Texas is in crisis. The safety net that's supposed to ensure women have access to preventive care and contraceptive services is in tatters, and it has been ever since the Legislature made deep and disproportionate cuts to the state's family planning program last session -- cuts that may soon be reversed (Janet Realini, 5/11).

Sacramento Bee: Steinberg Plan For Mental Health Has Real Merit
Important legislation is emerging that would significantly improve care for the most severely mentally ill people in California. Proposed by Senate President Pro Tem Darrell Steinberg, the package of bills warrants serious consideration by Gov. Jerry Brown, even though the measures would add to state costs, at least in the short run. Among his proposals, Steinberg is calling for construction or leasing of facilities that would provide 2,000 beds controlled by counties for individuals who are in the midst of crisis (5/11).

State Roundup: Texas Lawmakers Push To Modernize Medical Practices

Mon, 13 May 2013 04:00:00 GMT

A selection of health policy stories from New York, Tennessee, Oregon, North Carolina, Texas and California.

The New York Times: City Plans New Approach To Disciplining Mentally Ill Inmates
New York City will soon change the way mentally ill inmates are disciplined after breaking rules while in jail, creating alternatives to the more traditional approach of solitary confinement used for most inmates (Yee, 5/12).

North Carolina Health News: Cancer Drug Parity Bill Passes House
A bill aimed at reducing the cost burden for people with cancer who take oral medications made it through a vote on the floor of the state House of Representatives Thursday afternoon, getting it one step closer to law. Patients receiving cancer chemotherapy traditionally get their treatments via intravenous infusions or injections in their doctors' offices. But with new medications that are administered orally, patients don’t need to go to a doctor's office (Hoban, 5/10).

The Texas Tribune: Medical Association Backs Bills To Cut Red Tape
Health care providers in Texas could soon collect or verify patient information by swiping a driver’s license. The measure allowing such data collection is one of a handful that the Texas Medical Association is pushing this legislative session to help modernize medical practices (Aaronson, 5/13).

The Associated Press/Washington Post: Tenn. Hospital On Front Lines Of U.S. Pill Epidemic, Treating Babies Born Dependent On Drugs
He’s less than two weeks old, but he shows the telltale signs of a baby agitated and in pain: an open sore on his chin where he’s rubbed the skin raw, along with a scratch on his left check. He suffers from so many tremors that he’s been placed in a special area so nurses can watch him around the clock in case he starts seizing —or worse, stops breathing (Burke, 5/12).

Kaiser Health News: Capsules: Competition Spurs Ore. Insurers To Lower Proposed Rates
Also on the blog, Phil Galewitz reports on competition between insurers in Oregon: "Maybe competition among health insurance plans can lead to lower rates. As soon as Oregon this week became the fourth state to publicly list health insurers' proposed 2014 rates for individual and small group coverage, two plans moved to cut their suggested prices, the Oregonian reported Friday. Providence Health Plan and Family Care Health Plans sought to lower their rates when they noticed they were out of whack compared to competitors — five months before the health law's new online marketplaces even open for enrollment" (Galewitz, 5/10).

Stateline: Cities, State Face Off On Mandatory Paid Sick Leave
Soon there will be fewer sick New Yorkers riding the subway, serving food in restaurants, or infecting their classmates, after the New York City Council decided last week to require local businesses to give workers time off if they are ill or have to care for a sick child. But mandatory sick leave, hailed as a progressive public health measure by its supporters, is sparking fierce opposition in several state legislatures (Maynard, 5/13).

Oregonian: Republicans Draw Oregon Hospital Tax Into Debate Over PERS
A tax on big city hospitals became the latest hostage in the fight over public pensions Friday, raising the stakes of ongoing budget negotiations between Democrats and Republicans in the Oregon Legislature. The hospital tax is a key component of the state's health care budget, bringing in as much as $1.3 billion in federal funds, but Senate Republicans said they wouldn't support the tax until an agreement on additional cuts to the Public Employees Retirement System can be reached (Gaston, 5/10).

California Healthline: 'So Many Moving Parts' To Fit Together
The Department of Health Care Services announced this week that the Cal MediConnect duals demonstration project will not start until at least January, 2014, a delay from its previous expected launch date in October, 2013. Advocates for seniors' health care yesterday praised the decision, saying the extra three months will go a long way toward pulling all of the disparate pieces of Cal MediConnect into place. … The Cal MediConnect duals demonstration program affects about 456,000 Californians who are dually eligible for Medicare and Medi-Cal coverage in eight demonstration counties (Gorn, 5/10).

First Edition: May 13, 2013

Mon, 13 May 2013 11:26:53 GMT

Today's headlines include reports that Health and Human Services Secretary Kathleen Sebelius has been seeking out funds from private sources to support efforts to publicize the health law.

Kaiser Health News: Under-26 Coverage: Does It Matter If My Child Just Got Out Of Jail? (Video)
Kaiser Health News consumer columnist Michelle Andrews answers a reader question about keeping your children on your health plan until they turn 26, even if they were recently released from jail (5/13). Watch the video or read the transcript.

Kaiser Health News: Obama: 'The Law Is Here To Stay' (Video)
Kaiser Health News has a video from President Barack Obama gave Friday speech on the health law, in which he emphasized his administration's commitment to moving forward with a full rollout of all the law's provisions (5/10). Watch the video or read the transcript. KHN also tracked news coverage of the speech (5/10).

Kaiser Health News: Oregon's Medicaid Lottery: A Participant's View
Kaiser Health News staff writer Jordan Rau, working in collaboration with The Washington Post, reports: "After winning the lottery, Mary Carson, 55, was accepted into the Oregon Health Plan, the state's Medicaid program, in 2011. She and her partner live with her three children. They earn about $1,000 a month by making and selling replicas of historic battle knives used in the Civil War and the two World Wars, doing odd jobs and providing respite care for people with cancer. Her comments on a popular blog about some of her own experiences on Medicaid have garnered some attention" (Rau, 5/10). Read the interview.

Kaiser Health News: Capsules: What A Hospital Charges Vs. What Medicare Pays; Competition Spurs Ore. Insurers To Lower Proposed Rates
Now on Kaiser Health News' blog, Alaska Public Radio's Annie Feidt, working in partnership with KHN and NPR, offers this report on hospital charges: "For the first time, the federal government has publicly shared what hospitals bill Medicare for the 100 most common diagnoses and treatments. The information shows hospitals across the country — and across Alaska — bill dramatically different prices for the same things" (Feidt, 5/13).

Also on the blog, Phil Galewitz reports on competition between insurers in Oregon: "Maybe competition among health insurance plans can lead to lower rates. As soon as Oregon this week became the fourth state to publicly list health insurers' proposed 2014 rates for individual and small group coverage, two plans moved to cut their suggested prices, the Oregonian reported Friday. Providence Health Plan and Family Care Health Plans sought to lower their rates when they noticed they were out of whack compared to competitors — five months before the health law's new online marketplaces even open for enrollment" (Galewitz, 5/10). Check out what else is on the blog.

The New York Times: Cabinet Secretary Solicits Large Donations To Publicize Health Care Law
Kathleen Sebelius, the secretary of health and human services, has solicited sizable donations from the Robert Wood Johnson Foundation and H&R Block, the tax preparation service, as part of a multimillion-dollar campaign to ensure the success of President Obama's health care law, administration officials said Sunday, even as a leading Senate Republican raised questions about the legality of her efforts. The foundation is expected to contribute as much as $10 million, while H&R Block is expected to make a smaller donation of about $500,000, the officials said (Pear, 5/12).

The Washington Post: Budget Request Denied, Sebelius Turns To Health Executives To Finance Obamacare
Health and Human Services Secretary Kathleen Sebelius has gone, hat in hand, to health industry officials, asking them to make large financial donations to help with the effort to implement President Obama's landmark health-care law, two people familiar with the outreach said. Her unusual fundraising push comes after Congress repeatedly rejected the Obama administration's requests for additional funds to set up the Affordable Care Act, leaving HHS to implement the president's signature legislative accomplishment on what officials have described as a shoestring budget (Kliff, 5/10).

The Wall Street Journal: Sebelius Sought Industry Funds For Health Law
Because of the way the health law was written, Washington ended up with few resources to try to sign up uninsured people in the 33 states that refused to run their own insurance exchanges. The Obama administration has said before that it wants to try to make up for HHS' limited funding for public outreach work by tapping outside help (Radnofsky, 5/10).

The Associated Press/Washington Post: Senator Takes Issue With Fundraising Pitches By Health And Human Services Secretary
The administration has recently announced it would be directing $200 million to states, private groups and local health centers so that they can hire workers who can help consumers pick the insurance plan best for them. The fundraising pitches appear to be another step along those lines. Beginning Oct. 1, people can start signing up for coverage through new state and federal health exchanges. But Sen. Orrin Hatch, R-Utah, said that soliciting money from health care executives is absurd. "Moving forward, I will be seeking more information from the administration about these actions to help better understand whether there are conflicts of interest and if it violated federal law," Hatch said (5/10).

The Associated Press/Washington Post: Cancer Patients And Others Taking Pricey Drugs Could Pay Thousands In Health Overhaul Plans
Cancer patients could face high costs for medications under President Barack Obama’s health care law, industry analysts and advocates warn. Where you live could make a huge difference in what you’ll pay (5/13).

The Washington Post: Health Insurance Tax 'Scares The Daylights' Out Of Some Small-Business Owners
Many small-business owners worry that a new tax on insurance providers in the health-care law will mean higher premiums for them, undermining the law’s capacity to lower their health-care costs. Starting next year, the federal government will charge a new fee on health insurance firms based on the plans they sell to individuals and companies, known as the fully insured market (Harrison, 5/12).

Los Angeles Times: Healthcare Puts Jerry Brown, Capitol Democrats On Different Sides
With California's deficit wiped out and its economy starting to hum, this was to be a year when Gov. Jerry Brown was free of the budget logjams that have paralyzed the Capitol. But instead, the governor has a fight on his hands — with his fellow Democrats. He is on a collision course with them over how to reshape the state's sprawling, complicated healthcare system to conform with President Obama's national overhaul (York and Megerian, 5/10).

Politico: White House Gives Nod To Utah's Dual Exchange
Utah will be the only state in the country next year to run its own Small Business Health Options Program exchange — under a modified set of Obamacare rules — and let the federal government set up the exchange for the individual market. Republican Gov. Gary Herbert announced Friday that Utah had received a crucial nod from the White House that will allow the state to bend Obamacare’s exchange rules to accommodate the state’s small-business exchange (Cheney, 5/13).

The Associated Press/Washington Post: Feds Approve Utah To Become First State To Use Dual-Model Health Insurance Marketplace
The federal government has approved Utah to become the first state to have a dual-model health insurance exchange in which the state and the federal government divide responsibilities. The plan allows Utah to continue to run its existing health insurance marketplace for small businesses, a system that lets employees pick health care plans in an online exchange. The federal government will run the state’s individual exchange. The two marketplaces will operate independently of each other (5/10).

ProPublica/The Washington Post: Dangers Found In Lack Of Safety Oversight For Medicare Drug Benefit
An analysis of four years of Medicare prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive for their patients. Federal officials have done little to detect or deter these hazardous prescribing patterns (Weber, Ornstein and LaFleur, 5/11).

The New York Times: Hospital Mergers Reset Abortion-Access Battle
Politicians seeking to restrict access to abortion, a marked trend this year from North Dakota to Arkansas, tend not to get much traction in this part of the country. Washington is heavily Democratic, leaning left especially on social issues. A majority of voters even put into law a statutory right to abortion in 1970 — the only state ever to do that. The governor, Jay Inslee, a Democrat, is pushing the Legislature even now to pass a law at a special session on Monday requiring health insurers to pay for elective abortions, another first for the state if it makes it to Mr. Inslee’s desk (Johnson, 5/12).

The New York Times: Judge Refuses To Drop His Order Allowing Morning-After Pill For All Ages
A federal judge on Friday stepped up his criticism of the Obama administration, accusing the Justice Department of making “frivolous” and “silly” arguments in its attempt to delay making the morning-after emergency contraceptive pill available to women and girls of all ages without a prescription (Shear, 5/10).

Los Angeles Times: Judge Again Rejects Limits On Emergency Contraception
In yet another scathing critique of government health officials, a federal judge refused Friday to stay his order making emergency contraceptives available to consumers of all ages without a prescription. Calling government efforts to restrict the sale of drugs such as Plan B "frivolous and taken for the purpose of delay," U.S. District Judge Edward R. Korman of New York wrote that the medications would be available to all unless the 2nd Circuit Court of Appeals ruled otherwise by noon Eastern time on Monday (Morin, 5/11).

Los Angeles Times: Vietnam Veterans' New Battle: Getting Disability Compensation
Otte is among hundreds of thousands of veterans from the Vietnam era filing for damages four decades after the war. They account for the largest share of the 865,000 veterans stuck in a growing and widely denounced backlog of compensation claims — some 37%. The post 9-11 wars in Afghanistan and Iraq account for 20%. The remainder are from the 1991 Gulf War, Korea, World War II and times of peace. Basic demographics explain some of the filing frenzy. Vietnam veterans are becoming senior citizens and more prone to health problems. Any condition they can link to their military service could qualify for monthly payments — and for many illnesses, it is easier for Vietnam veterans than other former troops to establish those links (Zarembo, 5/11).

The Associated Press: Ginsburg Says Roe Gave Abortion Opponents Target
One of the most liberal members of the U.S. Supreme Court, Justice Ruth Bader Ginsburg could be expected to give a rousing defense of Roe v. Wade in reflecting on the landmark vote 40 years after it established a nationwide right to abortion. Instead, Ginsburg told an audience Saturday at the University of Chicago Law School that while she supports a woman's right to choose, she feels the ruling by her predecessors on the court was too sweeping and gave abortion opponents a symbol to target. Ever since, she said, the momentum has been on the other side, with anger over Roe fueling a state-by-state campaign that has placed more restrictions on abortion (Keyser, 5/11).

The New York Times: Seeking Clues To Heart Disease In DNA Of An Unlucky Family
Researchers have long known that a family history of early death from heart disease doubles a person’s risk independently of any other factors. Family history is defined as having a father or a brother who were given a diagnosis of heart disease before age 55 or a mother or sister before age 65. Scientists are studying the genetic makeup of each member of the Del Sontro family, searching for telltale mutations or aberrations in the long sequence of three billion chemicals that make up human DNA. Until very recently, such a project almost certainly would have been futile. Picking through DNA for tiny aberrations was so costly and time-consuming that it was impractical to take on for an entire family (Kolata, 5/12).

Los Angeles Times: Patient Is Out Of Network, Out Of Luck
A worrisome abdominal pain drove Jalal Afshar to seek treatment last year at healthcare giant Kaiser Permanente. ... Kaiser granted his request to see a specialist in Arkansas. But it ultimately declined to pay for his treatment there. By June, Afshar said, Kaiser was arranging for hospice care so that he could die at home. Afshar, 58, refused to accept that. Despite Kaiser's stance, he went back to Arkansas for six months of stem-cell transplants, chemotherapy and other treatments that he says saved his life. Now he owes $2 million for his care and is suing the company in state court for breach of contract and unfair business practices (Terhune, 5/10).

The Associated Press/Washington Post: Tenn. Hospital On Front Lines Of US Pill Epidemic, Treating Babies Born Dependent On Drugs
He’s less than two weeks old, but he shows the telltale signs of a baby agitated and in pain: an open sore on his chin where he’s rubbed the skin raw, along with a scratch on his left check. He suffers from so many tremors that he’s been placed in a special area so nurses can watch him around the clock in case he starts seizing —or worse, stops breathing (5/12).

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Viewpoints: The Threat From 'Contagion Exhaustion;' An Economist Sees Humor In Hospital Pricing

Fri, 10 May 2013 13:18:14 GMT

The New York Times: The Next Contagion: Closer Than You Think
There has been a flurry of recent attention over two novel infectious agents: the first, a strain of avian influenza virus (H7N9) in China that is causing severe respiratory disease and other serious health complications in people; the second, a coronavirus, first reported last year in the Middle East, that has brought a crop of new infections. While the number of human cases from these two pathogens has so far been limited, the death rates for each are notably high. Alarmingly, we face a third, and far more widespread, ailment that has gotten little attention: call it "contagion exhaustion" (Michael T. Osterholm, 5/9).

The New York Times: The Next Pandemic: Not If, But When
Terrible new forms of infectious disease make headlines, but not at the start. Every pandemic begins small. Early indicators can be subtle and ambiguous. When the Next Big One arrives, spreading across oceans and continents like the sweep of nightfall, causing illness and fear, killing thousands or maybe millions of people, it will be signaled first by quiet, puzzling reports from faraway places — reports to which disease scientists and public health officials, but few of the rest of us, pay close attention. Such reports have been coming in recent months from two countries, China and Saudi Arabia (David Quammen, 5/9).

Los Angeles Times: Is $1,721.75 The Bill You'd Expect For Treating A Cut?
Medical costs are often inexplicably high and are almost always kept hidden from patients until the bill arrives. Health insurance, meanwhile, is frequently coverage in name only. The federal government released data this week showing that hospitals nationwide charge wildly differing amounts for the same procedure. ... Medicare and private insurers routinely pay less than what a hospital bills, and different insurers will cut different deals with healthcare providers. The bottom line is that, even with this rare look at medical pricing nationwide, consumers are still in the dark about how much treatments actually cost. All we know for sure is that the prices we pay are typically way above the hospital's true expenses (David Lazarus, 5/10).

The New York Times’ Economix Blog: American Health Care As A Source Of Humor
It is not that I inject humor into our otherwise august debate on health policy. Rather, the health system in the United States is in many ways so risible that it comes across as droll even when a dour German-born economist describes it. One of those risible moments occurred this week when the Centers for Medicare and Medicaid Services of the Department of Health and Human Services delivered a giant spreadsheet on hospital charges and payments (Uwe E. Reinhardt, 5/10).

Los Angeles Times: For Wal-Mart, Should Healthcare Be A Cost Of Doing Business?
Big employers beware -- some California lawmakers want to pressure you to extend health insurance to virtually everyone who lands on your payroll, even part-timers who work less than two hours a day. That's one of the effects that a bill by Assemblyman Jimmy Gomez (D-Echo Park) would have on companies and nonprofits that employ 500 or more people in the state. But it's not the one that Gomez, a former labor leader, emphasizes when talking about the measure, which the Assembly Health Committee approved on a party-line vote April 30 (Jon Healey, 5/9).

The Washington Post: The Successes Of Obamacare
For more than 100 years, leaders from both parties struggled to bring affordable health care to all Americans. When President Obama took up the fight, many people predicted defeat. Three years, 34 repeal votes, one Supreme Court decision and a presidential election later, some are questioning whether government is capable of implementing the historic law. Concern is understandable: The Affordable Care Act (ACA) transforms a health-care system that accounts for one-sixth of the U.S. economy and is central to our lives. But recent history shows that big changes in health-care policy can be implemented (Nancy-Ann DeParle, 5/9).

The Washington Post: Why Obamacare Is Oversold
It's the great moral imperative behind the Affordable Care Act ("Obamacare"): People should not be denied health care because they can't afford insurance. Health status and insurance are assumed to be connected, and opponents have often been cast as moral midgets, willing to condemn the uninsured to unnecessary illness or death. The trouble is that health status and insurance are only loosely connected. This suggests that Obamacare may result in more spending and health services but few gains in the public's health (Robert J. Samuelson, 5/9).

Sacramento Bee: Big Issues Await State In Prepping For Health Reform
We have fewer than five months until the October enrollment launch when uninsured Californians will be able to apply for coverage through the state. Depending on their income, uninsured individuals can either buy insurance in the state's exchange, called "Covered California," or get coverage from expanded Medi-Cal, the joint state-federal insurance plan for lower-income people. Yet some big issues remain unresolved. The state needs to decide them quickly so providers, insurers, community groups, state agencies and counties can prepare for the October enrollment period, with insurance coverage to begin in January (5/9).

Boston Globe: Student Health: Fighting Abuse Of Stimulants
Student health centers are a necessity to college life. On-campus medical staffs treat students, many living away from home and their regular doctors, for conditions that range from the common cold to severe depression. An increasing number of clinics, however, are opting out of diagnosing attention deficit hyperactivity disorder among their students or are tightening rules on prescribing the much-misused stimulant medications used to treat it. This is a fair decision as long as schools refer students with legitimate needs to trusted off-campus providers (5/10).

Louisville Courier Journal: Dental Decay A Public Health Crisis
Dental disease continues to be one of Kentucky's worst public health crises but gets scant attention in a state already struggling with high rates of cancer, diabetes, heart disease, obesity and a host of other health problems. Yet it afflicts Kentucky at alarming rates — causing pain and infection in the state's youngest children, some of whom arrive in kindergarten having never had a dental screening and many with rotted baby teeth (5/9).

Research Roundup: Out-Of-Pocket Costs On Individual Market

Fri, 10 May 2013 13:15:00 GMT

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

Health Affairs: Some Families Who Purchased Health Coverage Through The Massachusetts Connector Wound Up With High Financial Burdens – Since many of the people who will gain insurance under the federal health law will likely get such individual plans through the state-based online marketplaces, or exchanges, researchers sought to identify the effects on vulnerable populations, some of whom with incomes above 400 percent of the poverty level and thus will not qualify for Medicaid or receive subsidies. After surveying families who participated in "unsubsidized plans offered in the Massachusetts Commonwealth Health Insurance Connector Authority" - the state's exchange - they found that those with lower incomes, increased health care needs and more children will be at greater risk for financial burden and higher-than-expected out-of-pocket costs. They concluded: "In implementing the Affordable Care Act, policy makers will need to develop strategies to mitigate financial burden and facilitate discussion between patients and providers about the value of health care choices" (Galbraith et al., 5/6).

Health Affairs: Federal Spending On Behavioral Health Accelerated During Recession As Individuals Lost Employer Insurance – In the recent recession, many Americans who became unemployed lost their health insurance coverage. Using data from the Substance Abuse and Mental Health Services Administration, researchers found that: "(The) average annual growth in spending for behavioral health treatment slowed during the recession, from 6.1 percent in 2004-07 to 4.3 percent during 2007-09." In contrast, the federal behavioral health spending growth went from 7.2 percent in 2004-07 to 11.1 percent during the recession, providing a "critical safety net," the authors write. "The Medicaid expansions in eligibility and health insurance marketplace subsidies made available through the Affordable Care Act will relieve some of the budget pressures faced by state mental health and substance abuse authorities in funding behavioral health treatment services," they conclude (Levit et al., 5/6).

JAMA Internal Medicine: Cognition And Take-Up Of Subsidized Drug Benefits By Medicare Beneficiaries –While many low-income beneficiaries are eligible for subsidies to help cover their out-of-pocket costs for prescription drugs in the Medicare Part D program, enrollment has been low. Researchers analyzed 2006, 2008, and 2010 survey data from the nationally representative Health and Retirement Study and found that "Older age, poorer cognition, and poorer numeracy strongly and consistently predicted these apparent failures to take up fully subsided drug benefits." They offer several options for policymakers to improve participation in the subsidies and suggest broader implications as federal officials consider structural changes to the Medicare program: "This evidence suggests that policies that rely on seniors' choices to support efficient competition among plans may be less effective when not coupled with government efforts to regulate choice sets and guide beneficiaries to the best available options" (Kuye, Frank, and McWilliams, 5/6).

Urban Institute/Robert Wood Johnson Foundation: Limiting The Tax Exclusion Of Employer-Sponsored Health Insurance Premiums: Revenue Potential And Distributional Consequences – As officials seek to stabilize the federal budget and lower the deficit, one proposal often mentioned is to tax employer-provided health insurance coverage. The authors write: "In this brief, we provide estimates of the revenue potential and distributional consequences of limiting the exclusion from income and payroll taxes at the 75th percentile of 2013 premiums, indexing by GDP. The policy would produce $264.0 billion in new tax revenues over the coming decade while preserving 93 percent of the tax subsidies available under the current policy." While that tax threshold "would affect public-sector employers to a greater extent," they conclude that "limiting the tax exclusion for employer-sponsored insurance could be an important component of a broad-based federal debt-reduction package, while having minimum impacts on those with lower incomes" (Clemans-Cope, Zuckerman and Resnick, 5/8).

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

MedPage Today: Hospitals Move to Shut Down Elective Deliveries
Nearly two-thirds of all U.S. hospitals have instituted policies to eliminate non-medically indicated deliveries prior to 39 weeks' gestation and those policies may be having a positive impact on fetal outcomes, according to a pair of studies presented here at the annual meeting of the American Congress of Obstetricians and Gynecologists (Laino, 5/9).

Reuters: Insurance Law Tied To More Breast Reconstruction
Many more breast cancer patients had breast reconstruction following a 1998 federal law mandating insurance coverage for the procedure, according to a new study. … As a percentage of all the women treated for breast cancer in a given year, the number who got reconstructions rose from roughly 13 percent in 2000 to 36 percent in 2009, the team reports in the medical journal Cancer (Grens, 5/3).

Medscape: Little Benefit in Routine Imaging After Benign Breast Biopsy
Routine imaging studies that are conducted less than a year after a benign breast biopsy are unnecessary, according to a new study. "Our data do not support the routine use of interval imaging following benign concordant breast biopsy," said study author Demitra Manjoros, MD, a breast fellow at Bryn Mawr Hospital in Pennsylvania, during a press briefing at the 14th Annual Meeting of the American Society of Breast Surgeons, held in Chicago, Illinois (Nelson, 5/3).

Medscape: Pediatricians: Fewer Malpractice Claims, Equivalent Payments
Pediatricians have much lower rates of malpractice claims and indemnity payments than other physicians, but similar rates of payments that exceed $1 million, according to an analysis of the malpractice claims of 40,916 physicians (1630 pediatricians) from 1991 to 2005. Anupam B. Jena, MD, PhD, an assistant professor of health care policy and medicine at Harvard Medical School and an assistant physician and professor in the Department of Medicine at Massachusetts General Hospital in Boston, and colleagues present their findings in an article published online May 6 in Pediatrics (Brown, 5/6).

Reuters: Religious Support Tied To Intensive End-Of-Life Care
People with advanced cancer tend to get more aggressive care at the end of life and spend more time in the intensive care unit if they receive spiritual support from their religious communities, according to a new study [in JAMA Internal Medicine]. The report's lead researcher said in that finding was "quite the opposite" of what her team was expecting -- in part because of evidence that spiritual support coming from within a patient's medical team leads to less aggressive care and more use of hospice (Pittman, 5/7).

Calif. Senate Leader Readies Mental Health Service Expansion

Wed, 08 May 2013 13:24:00 GMT

The California Senate leader is proposing increasing mental health services to reduce how many end up in jail or ERs. In Massachusetts, officials plan greater scrutiny of how insurers cover mental health care.

Los Angeles Times: California Senate Leader Proposes Mental Health Program Expansions
State Senate leader Darrell Steinberg (D-Sacramento) on Tuesday proposed a plan to significantly increase mental health services in California with the goal of reducing the number of people ending up in prison, jail and emergency rooms. Steinberg said the plan is in response to the Newtown, Conn., school massacre, in which a gunman killed 20 students and six adults, as well as a scandal involving a Nevada hospital dumping patients in other states, and the recent order by a federal court to further cut the number of inmates in California prisons (McGreevy, 5/7).

Boston Globe: State Vows Scrutiny For Insurers On Mental Health Coverage
Seven health insurance companies have agreed in recent years to pay the state and consumers $5.6 million for failing to cover mental health care and other services that state law requires. Last month, U.S. Fire Insurance Company agreed to pay $625,000, and Transamerica in March said it would pay more than $1.3 million after the state alleged the companies failed to cover maternity care, pap tests, mammography, preventive care for children, along with mental health services (Conaboy, 5/7).

And in Georgia, nursing homes have cut their "off-label" use of antipsychotic drugs in nursing homes --

Georgia Health News: Nursing Homes Rein In Use Of Antipsychotic Drugs
Georgia nursing homes have cut their "off-label" use of antipsychotic medications by 16 percent, the biggest reduction in the nation, industry officials say. The Centers for Medicare and Medicaid Services has pushed for a decrease in the use of antipsychotics in managing dementia patients in nursing homes. Prescribing these drugs for behavior problems is considered "off-label" use, meaning they are being employed in a way that's different from their FDA-approved purposes. Off-label prescribing is a legal and very common practice (Miller, 5/8).

NIH Official Raises Concerns About New Psychiatry Manual

Wed, 08 May 2013 13:24:00 GMT

The director of the National Institute of Mental Health says the American Psychiatric Association's DSM-5 lacks validity, and his organization plans to launch a possible replacement diagnostic tool.

Medscape: NIMH, APA Clash Over Upcoming DSM-5
Two of the biggest organizations in the field of psychiatry are clashing over the soon-to-be-released Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which will be released by the American Psychiatric Association (APA) on May 18. ... In a blog post published on the National Institute of Mental Health (NIMH) Web site, the organization's director, Thomas Insel, MD, states that the upcoming manual is reliable but lacks validity and that "patients with mental disorders deserve better." ... Dr. Insel also reported that the NIMH is launching the new Research Domain Criteria (RDoC) project as a possible replacement diagnostic tool sometime in the future and as "a first step towards precision medicine." It will incorporate genetics, imaging, and other data into a new classification system. In addition, the organization noted that it "will be re-orienting its research away from DSM categories" (Brauser, 5/7).

In other news about medical quality issues -

Reuters: Many Medical Guidelines Don't Consider Costs
Professional medical societies don't often consider costs when they're developing their treatment guidelines for specific conditions, according to a new study. Researchers found that just over half of the top medical societies with at least 10,000 members considered costs when developing best practices. The other half either implicitly considered costs or didn't address them at all (Seaman, 5/7).

Modern Healthcare: HHS To Providers: Check Lists Of Excluded Medicare Personnel
HHS maintains a list of 51,588 people who are categorically excluded from providing even indirect care to Medicare patients, and new guidelines that will be published today recommend healthcare providers check their personnel rosters against the list once a month. That obligation extends to temporary nurses and doctors who work under contract from staffing firms. And it might not hurt to print out screen shots proving that the list was checked, the new guidance says (Carlson, 5/8).

Viewpoints: Assessing The Oregon Medicaid Experiment; Health Insurance Hysteria; In Florida, 'Toxic Politics' Beats Out Common Sense

Mon, 06 May 2013 13:40:44 GMT

The Washington Post: Here's What The Oregon Medicaid Study Really Said
So here's what happened in the first two years of the Oregon Medicaid experiment: Medicaid proved itself good health insurance. The people who got Medicaid used more health care, and seem to have done so smartly — they got preventive care, they got their diabetes diagnosed and began managing it, they treated their depression, and so on. But the health care itself didn't work as well as we hoped — at least not in terms of cutting rates of hypertension and cholesterol (Ezra Klein, 5/2).

The New York Times: What Health Insurance Doesn't Do
As liberals have been extremely quick to point out, these findings do not necessarily make a case against the new health care law, which includes a big Medicaid expansion as well as subsidies for private insurance. After all, the first purpose of insurance is economic protection, and the Oregon data shows that expanding coverage does indeed protect people from ruinous medical expenses. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is not a small policy achievement. This is true. But it's also true that the health care law was sold, in part, with the promise (made by judicious wonks as well as overreaching politicians) that it would save tens of thousands of American lives each year (Ross Douthat, 5/4).

Bloomberg: Yes, The Oregon Health Study Matters
But the lesson of the Oregon Health Study is nonetheless that there’s cost-effectiveness information out there that Medicaid and other health insurers aren’t exploiting. And even though conservatives have generally done a terrible job of explaining why, conservative ideas about increasing consumer direction in health care could help to exploit that information and make health care more cost-effective -- without repealing Obamacare or stopping the Medicaid expansion (Josh Barro, 5/3).

The Wall Street Journal: An ObamaCare Penalty On Hospitals
Under the Affordable Care Act's Hospital Readmissions Reduction Program, hospitals that readmit "excessive" numbers of Medicare patients within 30 days of discharge now face significant penalties. The maximum penalty is 1% of a hospital's Medicare reimbursement, but that will increase to 3% in 2015. That may not sound like a lot, but for hospitals already struggling financially—especially those serving the poor—losing 1%-3% of their Medicare reimbursements could put them out of business (Stephen Soumerai and Ross Koppel, 5/5).

Bloomberg: Beware Of Hysteria Over New Health Insurance Rates
Last month, Maryland made public the premiums that health insurers want to charge next year under the Affordable Care Act, one of the first states to do so. Premiums for non-employer health-insurance coverage were eye-popping, with a proposed average increase of 25 percent. As insurers submit their proposals in every state this spring, a pattern of such large premium increases may emerge. And opponents of the 2010 health-care law will pounce. But the news media and the public shouldn't succumb to their hysteria (Topher Spiro, 5/5).

The Wall Street Journal: A Jobs Fillip
One big negative in the April report is the increase in part-time employment. ... All of this suggests that ObamaCare is beginning to skew hiring patterns. Employers will soon have to offer health-insurance or pay a penalty for full-time workers, which the health law defines as anyone who works at least 30 hours a week. Many small businesses appear to be limiting their employees to fewer than 30 hours, perhaps with job-sharing or even by splitting employees with other employers (5/3).

Miami Herald: On Medicaid, GOP Politics Trumps Common Sense
Surely the people of Florida had a right to expect that during the 60 days of the annual legislative session lawmakers would find a way to accept the federal government's offer of $51 billion over the next decade to expand Medicaid. And yet House Republicans, led by Speaker Will Weatherford, R-Wesley Chapel, failed to reach a workable compromise with their counterparts in the Republican-led Senate, effectively killing any deal for now and leaving Florida's uninsured in jeopardy. This is a huge loss for the people of Florida, the triumph of toxic politics over common sense (5/4).

Tampa Bay Times: The Legislature's $51 Billion Failure
They PURRED like cats, listened to an auto-reader named Mary speed-read bills and honored golfer Jack Nicklaus. They raised university tuition, outlawed Internet sweepstakes cafes and banned texting while driving. They gave state workers raises for the first time in seven years and spent millions on pet projects such as a rowing center in Sarasota, a Bay of Pigs museum in Miami and an aquarium in Clearwater. But state lawmakers refused to accept $51 billion in federal money to provide health care to 1 million uninsured Floridians, and that leaves a permanent stain on the 2013 Florida Legislature (5/3).

New Orleans Times Picayune: Expanding Medicaid Is Crucial For Louisiana Residents
Gov. Jindal argues that over a decade Louisiana might have to spend $1.7 billion on the expansion, that Medicaid is inefficient and that there are too many uncertainties. He also says that too many Louisianians would be dependent on the government for health care under the expansion. Frankly, none of that is persuasive (5/5).

Toledo Blade: Drop The Teacup, Lawmakers, And Expand Medicaid
The Republicans who control Ohio’s General Assembly are making an instructive choice. They are denying health insurance to hundreds of thousands of working-poor Ohioans — and defying the governor of their party — so they can pander to the hard-right bloc of GOP voters. These lawmakers are betting that they will be rewarded, not punished, at the polls next year for working against the best interests of the state and its taxpayers. And given the way Ohio rigs its legislative elections, that calculation may be smart politics, even though it's terrible public policy (David Kushma, 5/4).

Boston Globe: Health Insurance: A Painfully Long Wait
One million hours. That's how much time new Harvard research suggests psychiatrists spend each year obtaining insurance approval to hospitalize suicidal or mentally ill patients. That translates into time taken away from patient care but also, more importantly, means patients in crisis are stuck in emergency rooms for a median of 8.5 hours, more than twice the length for most other admissions. This bureaucratic roadblock needs to be streamlined (5/6)

The New York Times' Opinionator: How Colonoscopies Are Like Home Renovations
So what should contractors do? They could promptly repair every problem the moment a homeowner identifies it. But that would be costly and seems unlikely. Perhaps instead they should consider picking something the homeowner really cares about and exceeding expectations on that one repair — but only at the very, very end. One friend told me that her contractor gave her an espresso machine when the job was finished. Even if she ultimately paid for the gift, her memories of the experience were sweeter than mine. The good thing is that, like a colonoscopy, once the remodeling is over, you won't need another one for years (Ezekiel J. Emanuel, 5/6).

State Highlights: New Health Care Oversight Laws In Md.

Fri, 03 May 2013 13:34:00 GMT

A selection of health policy stories from Maryland, Texas, New York, New Jersey, Colorado, California, Oregon, Florida and Massachusetts.

The Washington Post: Three New Md. Health Laws Offer More Patient Protection
Maryland Gov. Martin O’Malley signed three laws Thursday that will give more protection for patients. The measures provide more state oversight of cosmetic surgery centers, pharmacies that make sterile medications and staffing agencies that find temporary jobs for health care professionals (Sun, 5/2).

Texas Tribune: Public, Private Hospitals To Negotiate With Dewhurst
Officials from more than a dozen hospital systems -- some private, some public -- will gather at the Capitol with Lt. Gov. David Dewhurst on Friday afternoon to try to iron out a solution to how they are reimbursed for uncompensated care. ... The House version of the budget includes a rider private hospitals support: It calls for the state to fully maintain the Disproportionate Share Hospital program, or DSH, under which the state’s large public hospital systems use local taxpayer dollars to draw down federal matching money to cover indigent care at both public and private hospitals. The Senate version of the budget, preferred by the public hospitals, does not contain such a measure (Ramshaw, 5/2).

Kaiser Health News: Colorado Weighs Reopening A Psychiatric Hospital To Serve The Homeless
Last summer's mass shooting at the movie theatre in Aurora, Colo., led Gov. John Hickenlooper to call for stricter gun control and big new investments in mental health care. Several significant gun bills passed, and a package of mental health reforms are moving forward, but there may not be enough support to win funding for 300 new in-patient psychiatric beds (Whitney, 5/2).

The New York Times: Park Slope Food Co-op Takes Up New Cause: Saving A Hospital
In a letter written "on behalf of the 16,000 members" of the co-op, its general manager, Joseph Holtz, and a member, Dr. Saul Melman, call on Gov. Andrew M. Cuomo to "take a leadership role" in developing a plan to save the money-losing hospital, known as LICH, which serves a large swath of food co-op territory from its perch in Cobble Hill in northern Brooklyn (Hartocollis, 5/2).

The Associated Press/Washington Post: NJ Gov. Signs Good Samaritan Bill to Help Overdose Victims; Bon Jovi Says It Will Be Lifesaver
The New Jersey law seeks to assure timely medical treatment for overdose victims by encouraging people to seek help without fear of being arrested for drug possession (5/2).

The Associated Press: CA Prison Mental Health Spends More On Anti-Psychotic Meds Than Other States
California's prison mental health system has been spending far more on anti-psychotic drugs than other states with large prison systems, raising questions about whether patients are receiving proper treatment. While the amount has been decreasing in recent years, anti-psychotics still account for nearly $1 of every $5 spent on pharmaceuticals purchased for the state prison system, according to figures compiled by The Associated Press (Thompson, 5/2).

The Lund Report: Nurse Practitioners And Chiropractors Want More Workers' Comp Patients
People who suffer an injury on the job will get better access to a nurse practitioner or their favored chiropractor under a Senate bill that should become law. Senate Bill 533 extends the time that a nurse practitioner can provide services to an injured worker from 90 days to 180 days; it also allows injured workers to use their regular doctor or chiropractor, even if the provider is not a member of the worker’s assigned managed care organization (Gray, 5/2).

Texas Tribune/KUT News: Bill Would Give Foster Kids a Say in Medication Use (Audio)
Texas lawmakers are weighing a bill that would allow some teenagers in foster care to refuse medication. The legislation comes amid reports that despite recent reforms, rates of psychotropic drug use among Texas foster children remains high (Zaragovia, 5/2).

Health News Florida: Hospital Chain Under SEC Investigation
Fast-growing Health Management Associates has received a subpoena from the Securities and Exchange Commission, the Naples-based hospital company told investors on Thursday. HMA was already under investigation by the Justice Department, a probe announced last summer that allegedly involved emergency room admissions. Now the SEC wants information on the chain's accounting practices. The agency asked for documents related to Medicare, Medicaid and private insurance, the company said in a news release (Gentry, 5/3).

Boston Globe: Beth Israel Deaconess, Cambridge Health To Partner
Beth Israel Deaconess Medical Center, a Boston hospital aggressively courting health providers in the suburbs, has formed a partnership with Cambridge Health Alliance, the two hospital systems announced Thursday. The collaboration gives doctors with the Cambridge health system greater bargaining power with health insurance companies and a formal relationship with a major teaching hospital that provides many services they do not, such as advanced cancer care and neurosurgery (Conaboy, 5/3).

California Healthline: Committee Votes To Repeal Medi-Cal Cut
AB 900 would reverse the Medi-Cal provider rate cuts imposed in 2011. Cuts have not been implemented, pending a federal court decision in a lawsuit challenging them. Because of the delay in implementation, providers in California face the prospect of retroactively paying back two years' worth of 10 percent reductions. If the cuts are approved in federal court, the retroactive clawback would amount to 5 percent a year over four years, making the Medi-Cal provider rates dip by 15 percent for four years (Gorn, 5/2).

California Healthline: Reform May Improve Access To Pediatric Specialties
Children with special health care needs in Los Angeles County should not be treated as "small adults," according to pediatric specialists who see health care reform as a golden opportunity to design tailored systems of care for children with complex, chronic and rare health conditions. … More than one million California children age 17 and younger have special health care needs, according to a new policy note from the UCLA Center for Health Policy Research. California has 1,700 pediatric subspecialists, or one for every 5,454 children age 17 and under, lower than the national average of one to 4,373, according to the report (Stephens, 5/2).

Reuters: Los Angeles Launches Probe Of Alleged 'Patient Dumping' By Nevada
Nevada health officials acknowledged on Thursday that a state-run hospital improperly bused 10 newly discharged psychiatric patients out of the state with deficient plans for their care, while Los Angeles launched a criminal probe into the alleged "patient dumping." Rawson-Neal Psychiatric Hospital has been under fire since last month, after a Sacramento Bee investigative series reported that hospital staff gave as many as 1,500 patients one-way Greyhound bus tickets from Las Vegas to California and 46 other states over the past five years (Cohen, 5/2).