Download May 4 to May 8, 2015 - Gold Coast Health Plan

STATE WATCH
MAY 4, 2015
The San Jose Mercury News: Health Care: Illegal Immigrants Would Get Medi-Cal under
California Bill
On Monday, state legislation that would extend free or low-cost health care coverage to immigrants who
are in the country illegally heads to the Senate Appropriations Committee for a key vote. If Senate Bill 4
can make it over that hurdle, through the Assembly and ultimately garner Gov. Jerry Brown's signature,
more than a million low-paid undocumented farm and construction workers, hotel maids and service
workers would qualify for Medi-Cal, the state's health program for the poor. (Seipel, 5/3)
The Sacramento Bee: Injuries, Illness Fuel California Vaccine Bill Partisans
A bill requiring full vaccinations for almost every California school child has charged Sacramento,
mobilizing constituents who arrive from around the state for impassioned, marathon hearings. Much work
at the Capitol can seem obscure and remote from most citizens, but Senate Bill 277 has connected with
people on an emotional level. (White, 5/1)
CAPITOL HILL WATCH
The Hill: Push To Boost Medical Research Gains Traction
An unusual coalition of Democrats and conservative Republicans is calling for increased funding for the
National Institutes of Health, but the lawmakers must contend with spending caps known as the
sequester. Bipartisan legislation introduced this week, called 21st Century Cures, would provide billions of
dollars in new funding for medical research at NIH. The caps provide a major obstacle. But coming on the
heels of a major deal to reform Medicare payments, the passage of the bill would be another bipartisan
accomplishment on healthcare. (Sullivan and Ferris, 5/2)
The Wall Street Journal's Pharmalot: House Draft Bill Drops CME Payment Disclosures to
Sunshine Database
Tucked into a Congressional draft bill for jump starting medical innovation is a passage that would undo a
portion of a federal law requiring drug and device makers to disclose payments to doctors. Specifically,
the 21st Century Cures bill would no longer require these companies to report payments made to doctors
for continuing medical education sessions, medical journal reprints or textbooks. (Silverman, 5/1)
HEALTH LAW ISSUES AND IMPLEMENTATION
Forbes: As States Expand Medicaid, Unpaid Hospital Bills Disappear
With more states expanding Medicaid coverage under the Affordable Care Act, hospital operators are
reporting fewer unpaid medical bills and falling charity and uncompensated care expenses. ... This,
coupled by an improving economy, is boosting revenues for hospital companies like Community Health
Systems, Tenet Healthcare, HCA Holdings and Universal Health that are all seeing major reductions in
numbers of uninsured patients. (Japsen, 5/3)
The New York Times: Health Insurance Deadline Passes For Most, But There Are
Exceptions
The last chance to sign up for health insurance this year under the Affordable Care Act passed on
Thursday, when an extended deadline for enrollment expired. While most people will have to wait until the
next open enrollment period in the fall, there is an exception for those who have a change in
circumstances — like losing your health coverage because of the loss of a job, or getting married or
having a baby. (Carrns, 5/1)
The Washington Post: Almost Half of Obamacare Exchanges Face Financial Struggles in
the Future
Nearly half of the 17 insurance marketplaces set up by the states and the District under President
Obama’s health law are struggling financially, presenting state officials with an unexpected and serious
challenge five years after the passage of the landmark Affordable Care Act. Many of the online
exchanges are wrestling with surging costs, especially for balky technology and expensive customer call
centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees
on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are
weighing turning over part or all of their troubled marketplaces to the federal exchange. (Sun and
Chokshi, 5/1)
CAMPAIGN 2016
USA Today: Report: Ben Carson to run For President
At the 2013 Values Voter Summit, he said Obamacare was "the worst thing that has happened in this
nation since slavery." His fiery rhetoric could appeal to the most conservative primary voters, some of
whom may be wary of more establishment-aligned potential candidates, such as former Florida governor
Jeb Bush and New Jersey Gov. Chris Christie. But garnering support from a wider swath of GOP voters
as a novice to electoral politics could prove challenging. (Allen, 5/4)
The New York Times: Ben Carson on the Issues
Ben Carson, a retired pediatric neurosurgeon, announced Sunday that he is running for the Republican
presidential nomination. A Fox News commentator, he is a fierce critic of President Obama’s health care
law, calling it “the worst thing that has happened in this nation since slavery.” Here is where he stands on
some of the biggest issues of the 2016 campaign. (Mullany, 5/3)
CNN: John Kasich: Likelihood of Presidential Run 'Looks Pretty Good'
John Kasich has more high-level experience in politics than most candidates, starting with his role as the
House's budget chairman during the late 1990s, when the United States enjoyed several years of budget
surpluses. But he's also taken a number of positions that are problematic on the right: Kasich expanded
Medicaid under President Barack Obama's health care law, and he has supported Common Core
education standards and a path to citizenship for undocumented immigrants. (Bradner, 5/3)
USA Today: Jindal Finds Friendship on Road, Hostility At Home
Friday's speech was one of two appearances Jindal, a Republican mulling a presidential bid, made in
Washington this week before supportive audiences that shared his views on school choice, repealing the
Affordable Care Act, immigration reform and other issues. Back home, though, the crowds are a lot less
friendly. In Louisiana, Jindal is widely disliked for refusing to expand Medicaid, proposing drastic cuts to
higher education and other programs, and switching his stance on Common Core education standards.
(Barfield Barry, 5/2)
The New York Times: Christie’s Camp Mobilizes to Salvage White House Hopes
Mr. Christie, the governor of New Jersey, consulted with advisers, adjusted his jet-black suit and gamely
walked onto a stage before 300 guests eating yogurt parfait and almond croissants. He recited statistics
about Social Security and Medicare costs and projected the air of a man thoroughly unbothered by the
swirling legal drama back in New Jersey, which he left unmentioned. But behind the scenes, his aides, his
allies and even his wife were mobilizing, working the phones and blasting out memos to supporters, trying
to hold on to whatever chance Mr. Christie had to make a run at the presidency, according to interviews.
(Barbaro and Haberman, 5/2)
EDITORIALS AND OPINIONS
Los Angeles Times: Two Bills Protecting Patients in Healthcare Networks Deserve
Passage
The healthcare reforms in the 2010 Patient Protection and Affordable Care Act remain a work in progress,
with some of the law's mandates causing new problems or exacerbating older flaws. One is inaccurate
lists of the healthcare providers in insurers' networks; another is surprise bills by out-of-network providers.
California lawmakers have offered proposals to solve these problems, and the Legislature should pass
them. (5/3)
The New York Times: The Medical Bill Mystery
I have spent the last two and a half years reporting and writing about medical costs, and during that time I
have pored over hundreds of patients’ bills. And while I’ve become pretty adept at medical bill exegesis, I
continue to be baffled by how we’ve come to tolerate the Kafkaesque stream of non-explanations that
follow health encounters. Bills variously use CPT, HCPCS or ICD-9 codes (more about those later). Some
have abbreviations and scientific terms that you need a medical dictionary or a graduate degree to
comprehend. Some have no information at all. Heather Pearce of Seattle told me how she’d recently
received a $45,000 hospital bill with the explanation “miscellaneous.” (Elisabeth Rosenthal, 5/2)
The Washington Post: We Need To Take Better Care Of Our Elderly
Sometimes it seemed as if the only “personalized medicine” my mother received over the two months
before she came home, frail and battle-worn, was when my brother or I brought a spoon with ice chips to
her lips after she requested it. Such is the state of medical care for many of our elderly in our best
hospitals. Aside from spending untold dollars mapping the genomes of Americans, we must — once
again — learn to provide true “personalized care” to every one of the soon-to-be 72 million geriatric
patients in our midst. While not scientifically “precise,” nurturing in caregivers the skillful application of
compassion and empathy it takes to do this work will — in the end — benefit us all. (Jerald Winakur, 5/1)
STATE WATCH
MAY 5, 2015
California Healthline: Floor Vote Next for Nurse Practitioner Bill
A bill that would allow nurse practitioners in California to practice without physician supervision under
certain circumstances passed the Senate Committee on Appropriations in a 5-0 vote on Monday and now
heads to the Senate floor. (Vesely, 5/5)
The San Jose Mercury News: California Health Care Bill for Illegal Immigrants on Hold
Closely watched California legislation that would extend free or low-cost health care coverage to
immigrants who are in the country illegally is on hold until month's end, when it will either be moved to the
full Senate for a vote or shelved. (Seipel, 5/4)
HEALTH LAW ISSUES AND IMPLEMENTATION
Stateline: Federal Money for Charity Care at Risk in Several States
The federal government is quietly warning states that failure to expand Medicaid under the Affordable
Care Act could imperil billions in federal subsidies for hospitals and doctors who care for the poor. In an
April 14 letter to Florida Medicaid director Justin Senior, Vikki Wachino, acting director of the U.S. Centers
for Medicare and Medicaid Services (CMS) wrote: “Uncompensated care pool funding should not pay for
costs that would be covered in a Medicaid expansion.” (Vestal, 5/5)
The Hill: Senators Demand Better Oversight of State ObamaCare Spending
Two Republican committee chairmen are pressing the Obama administration to improve its oversight of
how state-run ObamaCare marketplaces use federal dollars, citing an inspector general report on
potential violations of law. Sens. Orrin Hatch (R-Utah) and Chuck Grassley (R-Iowa) wrote to the head of
the Centers for Medicare and Medicaid Services (CMS) on Monday asking for the agency to issue
clarifying guidance on how the federal dollars can be spent. (Sullivan, 5/4)
The Washington Examiner: Emergency Room Visits Up, Despite Obamacare
Too many Americans get care in emergency rooms instead of doctors offices — and expanded health
coverage is making the problem worse rather than fixing it. Three in four emergency room doctors said
patient visits have increased since the Affordable Care Act's requirement to have health insurance went
into effect, in an email survey released Monday by the American College of Emergency Physicians.
(Winfield Cunningham, 5/4)
MARKETPLACE
The New York Times: An Uber for Doctor House Calls
New smartphone apps can deliver doctors to your doorstep. Heal is a smartphone app similar to the ondemand car service Uber, but instead of a car, a doctor shows up at your door. Users download the app
and then type in a few details such as address and the reason for the visit. After adding a credit card and
a request for a family doctor or a pediatrician, the physician arrives in 20 to 60 minutes for a flat fee of
$99. Heal began in Los Angeles in February, recently expanded to San Francisco and is set to roll out in
another 15 major cities this year. Heal doctors are on call from 8 a.m. to 8 p.m., seven days a week, said
Dr. Renee Dua, a founder and the chief medical officer of Heal. (Jolly, 5/5)
Reuters: Global Cancer Drug Spending Hits $100 Billion In 2014: IMS Health
Worldwide spending on cancer medicines reached $100 billion in 2014, an increase of 10.3 percent from
2013 and up from $75 billion five years earlier, according to IMS Health's Global Oncology Trend Report
released on Tuesday. The $100 billion, which represents 10.8 percent of all drug spending globally and
includes supportive care drugs to address things like nausea and anemia, was driven by expensive newer
treatments in developed markets, IMS found. ... The United States accounted for 42.2 percent of total
spending, followed by the top-five European markets, comprised of Germany, France, Britain, Spain and
Italy. (Berkrot, 5/5)
Politico: Reimbursement Issues Block Paramedics from Expanded Role
Paramedics are primed to play a larger role in the health care system, which they’re sure will help lower
costs and benefit patients. Yet they’re running into regulatory roadblocks that they say state and federal
officials have to move. Despite the track record of initiatives in places like Nevada and Texas, where
paramedics are providing in-home care, coordinating patient services and saving millions in the process,
Medicare, Medicaid and most private insurance plans still won’t reimburse for such work. (Mershon, 5/4)
Modern Healthcare: Health Net Boosted By Medicaid Expansion, ACA Exchanges
First-quarter profit at Health Net edged slightly upward, but the effects of the Affordable Care Act on the
health insurer's swelling membership and top line was perhaps more notable. Health Net's Medicaid
enrollment increased 31% in the first quarter of 2015 compared with the same period last year, totaling
more than 1.7 million low-income Americans. That's more than half of the company's 3.2 million
members. Health Net sells Medicaid managed-care plans in Arizona and California, both of which
expanded Medicaid under the healthcare reform law to people making up to 138% of the poverty line.
(Herman, 5/4)
Kaiser Health News: Patients Not Hurt When Their Hospitals Close, Study Finds
A hospital closure can send tremors through a city or town, leaving residents fearful about how they will
be cared for in emergencies and serious illnesses. A study released Monday offers some comfort, finding
that when hospitals shut down, death rates and other markers of quality generally do not worsen. (Rau,
5/4)
PUBLIC HEALTH AND EDUCATION
The Washington Post: Va. Attorney General Gives Abortion Rights Advocates A Boost
Virginia Attorney General Mark R. Herring (D) sided Monday with abortion rights advocates seeking to
free clinics from strict, hospital-style building standards, issuing a legal opinion that whipped up those on
both sides of the polarizing issue. Herring’s action reverses an opinion from his Republican predecessor,
Ken Cuccinelli II, and put an issue that has long divided lawmakers back on the front burner. The advisory
opinion has no immediate effect on clinics currently operating, but it could influence the state Board of
Health when members consider an overhaul of rules. (Portnoy and Vozzella, 5/4)
The New York Times: Long-Term Data on Complications Adds to Criticism of
Contraceptive Implant
When a new contraceptive implant came on the market over a decade ago, it was considered a
breakthrough for women who did not want to have more children, a sterilization procedure that could be
done in a doctor’s office in just 10 minutes. Now, 13 years later, thousands of women who claim they
were seriously injured by the implant are urging the Food and Drug Administration to take the device off
the market and to warn the public about its complications. (Rabin, 5/3)
The New York Times: Panera Bread Plans To Drop A Long List Of Ingredients
Acesulfame K. Ethoxyquin. Artificial smoke flavor. The first, an artificial sweetener; the second, a
preservative; and the third, a flavor enhancer, are just a few of the ingredients that Panera Bread wants to
banish from its kitchens by the end of 2016. In doing so, Panera would join the growing ranks of food
companies and restaurants that have announced plans to eliminate a variety of artificial preservatives,
flavors and colors, as well as different kinds of sweeteners and meat from animals raised with antibiotics,
in response to consumer demands for transparency and simplicity in the foods they eat. (Strom, 5/4)
The Washington Post: Pass The Salt, Please. It’s Good for You.
In the past, people thought that salt boosted health — so much so that the Latin word for “health” —
“salus” — was derived from “sal” (salt). In medieval times, salt was prescribed to treat a multitude of
conditions, including toothaches, stomachaches and “heaviness of mind.” While governments have long
pushed people to reduce their intakes of sodium chloride (table salt) to prevent high blood pressure,
stroke and coronary heart disease, there are good reasons why cutting down on salt is not an easy thing
to do. Scientists suggest that sodium intake may have physiological benefits that make salt particularly
tempting — and ditching the salt shaker difficult. ( Zaraska, 5/4)
EDITORIALS AND OPINIONS
The New York Times: Runaway Drug Prices
A drug to treat abnormal heart rhythms can cost about $200 on one day and more than $1,300 the next.
A diagnosis of multiple sclerosis can lead to a drug bill of at least $50,000 a year. How companies set
prices of specialty drugs for these and other complex diseases, like cancer and AIDS, has been a
mystery to the patients who need them. Now the Obama administration and some states are tackling that
lack of transparency and the rising costs. Mr. Obama has asked Congress to let Medicare officials
negotiate prices with drug manufacturers.... And several states are considering bills that would require
drug companies to justify their prices to public agencies. (5/5)
NPR: Triage And Treatment: Untold Health Stories From Baltimore's Unrest
Over the last week, Baltimore's unrest has captured the nation's attention. Images of burning cars, the
sounds of angry protesters and then peace rallies have dominated the airwaves and headlines. As the
city's health commissioner, I heard other stories. I spoke with a 62-year-old woman who had a heart
attack a year ago and who had stopped taking her blood pressure and blood-thinning medications. Her
pharmacy was one of the dozen that burned down, and neither she nor the other people in her senior
housing building could figure out where to get their prescriptions filled. ... In the wake of fires and
violence, the initial priority for health officials was to make sure that our acute care hospitals were
protected and that staff and patients could get to them safely. In the immediate aftermath, our focus was
on ensuring that injured patients got triaged and treated. (Leana Wen, 5/4)
The Wall Street Journal: Americans’ Health Priorities Diverge From Washington’s Focus
On Obamacare
Given the never-ending debate about the Affordable Care Act, you might think that when Americans are
asked to name their top health priorities for the president and Congress, they would pick something
related to Obamacare, whether it involves expanding the law, scaling it back, or repealing it. But it turns
out the American people don’t live in the ACA bubble. Their top priority overwhelmingly, and on a
bipartisan basis, was “making sure high cost drugs for chronic conditions were affordable for people who
need them.” (Drew Altman, 5/4)
STATE WATCH
MAY 6, 2015
California Healthline: Study: Quality, Access Not Affected by Covered California Narrow
Networks
Health plans offered through Covered California have narrower hospital networks than commercial
insurance plans but they don’t appear to have lower-quality providers or differences in geographic
access, according to a study published in the May issue of Health Affairs. (Vesely, 5/6)
NPR: Whooping Cough Vaccine's Protection Fades Quickly
Lately, Californians have been focused on a measles outbreak that got its start at Disneyland. But in the
past five years, state health officials have declared epidemics of whooping cough twice — in 2010 and in
2014, when 11,000 people were sickened and three infants died. Now an analysis of a recent whooping
cough epidemic in Washington state shows that the effectiveness of the Tdap vaccine used to fight the
illness (also known as pertussis) waned significantly. For adolescents who received all their shots,
effectiveness within one year of the final booster was 73 percent. The effectiveness rate plummeted to 34
percent within two to four years. (Aliferis, 5/5)
Sacramento Business Journal: Hospital trade group, Kaiser Leads Spending on Health
Lobbying
The California Hospital Association and Kaiser Permanente led the pack in spending on health-care
lobbying in the first quarter of 2015. The hospital trade group ranked No. 1 with $593,369 recorded by
March 31, according to new numbers posted by the California Secretary of State. Kaiser spent $586,157.
The California Medical Association was No. 3 with $466,075 spent in the first quarter. (Robertson, 5/5)
CAPITOL HILL WATCH
Politico: Republicans Finally Get Their Budget
Still, passing a budget lays out Republican priorities: cutting Medicare and Medicaid, repealing
Obamacare and funding the country at levels backed by top military leaders. (Bade, 5/5)
Bloomberg: Senate Budget Allows Republicans to Seek Obamacare Repeal
The budget resolution, S.Con.Res. 11, spells out the Republican Party’s priorities by calling for $5.3
trillion in spending cuts to reach balance in nine years. Most of the reductions, $4.1 trillion, would come
from programs including entitlements like Medicare. (Przybyla, 5/5)
HEALTH LAW ISSUES AND IMPLEMENTATION
Fox News: States Wasting Millions by Keeping Ineligible Recipients on Obamacare’s
Medicaid Rolls, Critics Say
States are wasting millions of taxpayer dollars under ObamaCare's massive Medicaid expansion by
failing to regularly check the eligibility of program recipients, critics charge. (Singman, 5/5)
The Hill: 500 Groups Urge Repeal Of ObamaCare Cost-Cutting Panel
Over 500 organizations are calling on Congress to repeal a Medicare cost-cutting board that is part of
ObamaCare. At issue is the Independent Payment Advisory Board (IPAB), charged with coming up with
ways to cut Medicare spending if it rises above a certain threshold. ... The 500 groups (which include
multiple chapters of the same organization), are largely healthcare providers, and are worried about cuts
in payments under the board. (Sullivan, 5/5)
MARKETPLACE
Bloomberg: Diabetes Drugs Compete with Prices That Rise in Lockstep
On May 30 last year, the price for a vial of the blockbuster diabetes medication Lantus went up by 16.1
percent. On the next day, Lantus’s direct competitor, Levemir, also registered a price increase -- of 16.1
percent. In 13 instances since 2009, prices of Lantus and Levemir -- which dominate the global market for
long-acting injectable insulin with $11 billion in combined sales -- have gone up in tandem in the U.S.,
according to SSR Health, a market researcher in Montclair, New Jersey. (Langreth, 5/6)
The Wall Street Journal's Pharmalot: How Marketing Exclusivity Led to Higher Drug
Costs and Questionable Benefits
Six years ago, the FDA approved a drug called Colcrys to treat acute gout attacks and familial
Mediterranean fever, an inherited inflammatory disorder. The move came as part of an agency initiative to
regulate dozens of medicines that had never been formally approved, but were on the market when the
FDA received authority to oversee the drug approval process. (Silverman, 5/5)
PUBLIC HEALTH AND EDUCATION
NBC News: CDC Releases 1st National Study on Latino Health Risks, Causes of Death
The Centers for Disease Control and Prevention (CDC) released Tuesday its first-ever national study of
the leading causes of death as well as risk factors, disease prevalence and access to health services
among U.S. Hispanics. It found that while the death rate among the nation's fastest-growing ethnic group
is 24 percent lower than non-Hispanic whites, the Latino community is hit hard by certain diseases and
conditions. (Guadalupe, 5/5)
Reuters: IBM's Watson to Guide Cancer Therapies at 14 Centers
Fourteen U.S. and Canadian cancer institutes will use International Business Machines Corp's Watson
computer system to choose therapies based on a tumor's genetic fingerprints, the company said on
Tuesday, the latest step toward bringing personalized cancer treatments to more patients. Oncology is
the first specialty where matching therapy to DNA has improved outcomes for some patients, inspiring the
"precision medicine initiative" President Barack Obama announced in January. (Begley, 5/5)
CAMPAIGN 2016
The New York Times: Huckabee Vows to Protect Programs for Older Americans
Mike Huckabee drew roaring cheers from supporters on Tuesday as the latest entrant in a sprawling field
of Republican presidential candidates by declaring himself the guardian of so-called entitlement
programs, warning, “Let them end their own congressional pensions, not your Social Security!” But his
pledge to fend off any tinkering with the popular Social Security and Medicare programs put him at odds
with his Republican opponents, exposing growing fault lines in the party over an issue that has long been
considered a political third rail. (Haberman, 5/6)
The New York Times: Who Is Running for President (and who’s not)?
At least a dozen Republicans and a handful of Democrats have expressed an interest in running for their
party's 2016 presidential nomination. (Andrews, Parlapiano, Yourish, 5/5)
Los Angeles Times: Mike Huckabee Joins White House Race, Sets Sights On 'Higher
Ground'
If elected president, Huckabee pledged to not cut Social Security and Medicare benefits and to overhaul
the tax system. A balanced federal budget, term limits on the judiciary and Congress, and a muscular
foreign policy would also be top priorities, he said. (Mehta, 5/5)
EDITORIALS AND OPINIONS
The New York Times' The Upshot: Candidates Disagree on Abortion, But Public is in
Surprising Harmony
If you listen to party leaders, you might think that the nation is hopelessly divided on abortion. Recently,
for example, three presidential candidates — Mike Huckabee, Rand Paul and Hillary Rodham Clinton —
addressed the issue in very different ways. .... But unlike the opinions of party activists and pundits, public
opinion about women’s choices during their pregnancies yields surprising points of agreement across
party lines. If you ask them specifics, Americans agree on quite a bit about when and why abortions
should be legal. (Lynn Vavreck, 5/6)
The New York Times: How to Solve the E.R. Problem
Back in 2009, a big selling point of health care reform was the idea that expanding insurance coverage
would increase Americans’ access to preventive and primary care and decrease the unnecessary use of
emergency rooms, saving billions. ... There is one big problem with this logic: data. A new survey by the
American College of Emergency Physicians found that 75 percent of emergency room doctors reported
increases in patient volume since the Affordable Care Act went into effect. ... Opponents of the Affordable
Care Act point to these increases as confirmation that yet another promise of the law was false. But these
failures do not mean that the emergency room problem is unsolvable, just that insurance coverage alone
is insufficient. (Ezekiel J. Emanuel, 5/6)
The Washington Post: Stop Routine Breast-Cancer Screenings. Science Has Shown They
Don’t Save Lives.
A panel of medical experts stood firm against political backlash last month and insisted that biennial
mammograms are unnecessary for women below age 50. The guidance from the U.S. Preventive
Services Task Force affirms long-standing evidence debunking the belief that standard screening of
women as young as 40 for breast cancer reduces deaths. It’s an idea founded more in politics and profit
than in science. (Karuna Jaggar, 5/5)
STATE WATCH
MAY 7, 2015
Stateline: Despite Laws, Mental Health Still Getting Short Shrift
Under federal law, insurance plans that cover mental health must offer benefits that are on par with
medical and surgical benefits. Twenty-three states also require some level of parity. The federal law,
approved in 2008, and most of the state ones bar insurers from charging higher copayments and
deductibles for mental health services. Insurers must pay for mental health treatment of the same scope
and duration as other covered treatments; they can’t require people to get additional authorizations for
mental health services; and they must offer an equally extensive selection of mental health providers and
approved drugs. (Ollove, 5/7)
California Healthline: Scorecard: Less Than Half of Medicare Payments Tied to Value
A scorecard on Medicare payment reform released this week shows progress in transforming Medicare
into a results-oriented payer of health services, but there is much ground left to cover, according to the
report. (Vesely, 5/7)
California Healthline: California Lawmakers Consider Requiring Rx Label Translations
The California Assembly is considering a bill (AB 1073) that would require pharmacists to provide multilingual prescription drug labels and instructions when requested by patients, Capital Public Radio's "KXJZ
News" reports (Bartolone, "KXJZ News," Capital Public Radio, 5/6).
Los Angeles Times: Aetna's Rate Hike Excessive For Small Employers, Regulator Says
For the third time since 2013, California's managed-care regulator has criticized health insurance giant
Aetna Inc. for imposing an excessive rate hike on small employers. The nation's third-largest health
insurer is raising rates by 19.2%, on average, for about 16,000 people covered by small employers. This
change in premiums took effect last month. (Terhune, 5/6)
CAPITOL HILL WATCH
The Hill: Bill Would Create 'National Nurse' Position
A bipartisan pair of senators introduced a bill Wednesday that would create a new “national nurse”
position tasked with preventing diseases like obesity and heart disease. Senator Jeff Merkley (D-Ore.)
and Sen. Shelley Moore Capito (R-W.V.) said the national nurse would focus on education to help to curb
the growing epidemics of obesity, heart disease and cancer. (Ferris, 5/6)
RevCycle Intelligence: ICD-10 Implementation Freeze Proposed by House Bill
The House is pushing to completely cease ICD-10-CM/PCS implementation via the introduction of a new
bill. The primary objective of the bill, H.R. 2126, is to disallow the Secretary of the Department of Health
and Human Services (HHS) from replacing ICD-9 with ICD-10 within HIPAA code set standards
implementation, confirms the American Health Information Management Association (AHIMA). (DiChiara,
5/4)
HEALTH LAW ISSUES AND IMPLEMENTATION
Los Angeles Times: New Study Gives More Evidence of Obamacare Gains for Millions
As congressional Republicans move toward another vote on repealing the Affordable Care Act, new
evidence was published Wednesday about the dramatic expansion of insurance coverage made possible
by the law. Nearly 17 million more people in the U.S. have gained health insurance since the law's major
coverage expansion began, according to a study from the Rand Corp., a Santa Monica nonprofit research
firm. (Levey, 5/6)
CBS News: 17 Million Gain Coverage under Obamacare
As a result of the landmark health-reform law known as the Affordable Care Act, nearly 17 million
previously uninsured Americans now have health coverage, a new analysis reveals. (Reinberg, 5/6)
California Healthline: Study: Quality, Access Not Affected By Covered California Narrow
Networks
Health plans offered through Covered California have narrower hospital networks than commercial
insurance plans but they don’t appear to have lower-quality providers or differences in geographic
access, according to a study published in the May issue of Health Affairs. (Vesely, 5/6)
California Healthline: The ACA Is Changing How Students Become Doctors
From the Medical College Admissions Test to post-graduate residencies, the way U.S. doctors are taught
is changing in the wake of health care reform. (Stockey, 5/6)
QUALITY
Marketplace: Why The Conventional Wisdom on Hospice Care Was Wrong
Conventional wisdom has been that hospice care at the end of life will improve someone’s final days and
save money. It’s certainly cheaper to have a team of caregivers check on someone a few times a day
compared to stays in intensive care units. But it turns out that was wrong, according to a New England
Journal of Medicine report out Wednesday. (Gorenstein, 5/6)
Reuters: Shift Toward Hospice Care Has Increased Medicare Costs
The popularity of hospice care grew between 2004 and 2009 but that didn't bring down Medicare costs for
people dying in nursing homes, according to a new study of three quarters of a million U.S. nursing home
residents. "We found that although hospice use was associated with a reduction in aggressive end-of-life
care, it was also associated with a net increase of $6,761 in Medicare expenditures per decedent in the
last year of life,” writes the research team, led by Dr. Pedro Gozalo of Brown University. (Emery, 5/6)
EDITORIALS AND OPINIONS
Bloomberg: Life Under Obamacare
What will the market for individual insurance look like once Obamacare is in full effect? Policies for 2016
will be the first ones priced after insurers have a full year of claims data. The prices will increasingly also
reflect the disappearance of a safety net: the reinsurance and risk corridor programs that were designed
to protect insurers from unexpectedly high claims. ... Republicans complained that this amounted to a
slush fund to pay off insurers for keeping premiums low (at taxpayer expense), the administration
promised to make sure the risk corridors didn't pay out more than they took in .... A new report from
Standard & Poor's shows just how much difference that could make: S&P expects there will be enough
money to pay only 10 percent of claims. This suggests that at least a substantial minority of insurers are
expecting to lose a lot of money on the policies they have already written. The typical response of
insurers who lose money is to raise premiums in future years. (Megan McArdle, 5/6)
Huffington Post: Pennsylvania's Fight over Paid Sick Days Could Be the Presidential
Campaign's Next Issue
You’ve got a nasty head cold, or maybe your kid is home with the flu. If you’re a waitress and you call in
sick, should the law forbid your employer from withholding your day's wages? A big debate over that
question is taking place in Pennsylvania, pitting conservative state lawmakers in Harrisburg against liberal
city officials in Philadelphia. It's the latest in a series of such clashes that have taken place across the
country. Underscoring the high stakes of the outcome, the battle is also drawing attention from highprofile Democrats, including Hillary Clinton, in what could be the early stages of an argument that will play
out during the 2016 presidential campaign. (Jonathan Cohn, 5/6)
STATE WATCH
MAY 8, 2015
California Healthline: Senate Select Committee Hears Strategies to End Child Poverty in
California
Ending poverty must be a “sustained and broad-based effort,” according to testimony this week at a state
Senate hearing examining child poverty in California. The goal of the Senate Select Committee on
Women and Inequality is to develop a “tangible, measurable plan to reduce if not end poverty for
California’s children,” said state Sen. Holly Mitchell (D-Los Angeles), select committee chair. (Vesely, 5/8)
Los Angeles Times: Blue Shield's $1.25-Billion Deal for Care1st Faces More State
Scrutiny
Bowing to demands from consumer advocates, state regulators will hold a hearing next month on Blue
Shield of California's proposed acquisition of Medicaid insurer Care1st for $1.25 billion. The California
Department of Managed Health Care said both companies will explain their rationale for the deal at the
June 8 hearing in Sacramento. The public will also have a chance to chime in. (Terhune, 5/7)
California Healthline: Drug Price Transparency Bill Shelved in California, Push Continues
Drug makers won skirmishes in California and Oregon last month, but the fight against high prices for
specialty drugs appears to be spreading to other states, as well as the national theater. A bill in the
California Legislature asking pharmaceutical manufacturers to explain their prices was shelved last month
in the face of stiff opposition. Thought to be the first legislative attempt of its kind in the country, AB 463 -by Assembly member David Chiu (D-San Francisco) -- is back on the drawing board after it became clear
Chiu wouldn't get the 10-vote minimum needed to get the bill out of the Assembly Committee on Health.
(Lauer, 5/7)
Reuters: San Bernardino to Slash Retiree Health Care in Bankruptcy Plan
The southern California city of San Bernardino has proposed virtually eliminating retiree health insurance
costs under a bankruptcy exit plan it must produce by May 31, according to an attorney involved in
negotiations with city officials. Steven Katzman, who represents a committee of retirees in talks with the
bankrupt city, says a tentative deal has been struck under which retirees would sacrifice the city subsidies
they currently receive for health care coverage in exchange for a guarantee that San Bernardino
continues to fund and not cut current pension benefits. (Reid, 5/7)
HEALTH LAW ISSUES AND IMPLEMENTATION
Modern Healthcare: GOP-Led Medicaid Expansion States Test Limits of CMS Flexibility
on Waivers
Republican-led states that already expanded Medicaid now are coming back to the Obama administration
with requests to move their expansion programs in more conservative directions, including higher cost
sharing for beneficiaries, work requirements, and coverage time limits. These moves may test the limits of
the administration's flexibility and could lead to rollbacks in Medicaid expansion across the country.
(Dickson, 5/7)
MARKETPLACE
The Wall Street Journal's Pharmalot: Drug Maker Sues FDA Over Free Speech Right to
Promote Off-Label
In a move that may have broad ramifications for the pharmaceutical industry, a small drug maker called
Amarin has filed a lawsuit against the FDA to argue that its right to distribute information about
unapproved uses of a medicine is protected by the First Amendment. Amarin wants to be able to provide
doctors with clinical trial data that does not directly pertain to the approved uses of its Vascepa
prescription fish-oil pill, the lawsuit states. The FDA endorsed drug to treat people with very high levels of
triglycerides, a type of fat in the blood that can lead to heart disease. (Silverman, 5/7)
Los Angeles Times: California Supreme Court Revives Generic Cipro Lawsuit
The California Supreme Court on Thursday revived a class-action lawsuit that accuses German
pharmaceutical giant Bayer of paying another drug company to delay introducing a generic version of a
Bayer antibiotic. The practice is known as “pay to delay” and can violate antitrust law, according to a 2013
U.S. Supreme Court decision. (Dolan, 5/7)
HEALTH POLICY RESEARCH
Morbidity and Mortality Weekly Report: Cancer Screening Test Use — United States, 2013
Regular breast, cervical, and colorectal cancer (CRC) screening with timely and appropriate follow-up and
treatment reduces deaths from these cancers. Healthy People 2020 targets for cancer screening test use
have been established based on the most recent U.S. Preventive Services Task Force (USPSTF)
guidelines. National Health Interview Survey (NHIS) data are used to monitor progress toward the targets.
CDC used the 2013 NHIS, the most recent data available, to examine breast, cervical, and CRC
screening use. Although some demographic subgroups attained targets, screening use overall was below
the targets with no improvements from 2010 to 2013 in breast, cervical, or CRC screening use. Cervical
cancer screening declined from 2010 to 2013. Increased efforts are needed to achieve targets and
reduce screening disparities. (Sabatino et al., 5/8)
The Kaiser Family Foundation: Medicaid at 50
The Medicaid program, signed into law by President Lyndon B. Johnson on July 30, 1965, will reach its
50th anniversary this year, a historic milestone. At the Kaiser Commission on Medicaid and the
Uninsured, where we have closely studied and analyzed Medicaid for nearly 25 years, we are recognizing
this important occasion by documenting Medicaid’s evolution and its role in our health care system today.
This report reflects on Medicaid’s accomplishments and challenges and considers the issues on the
horizon that will influence the course of this major health coverage and financing program moving
forward. (Paradise, Lyons and Rowland, 5/6)
The Washington Post: A Step toward Making Everybody a Universal Blood Donor
Every two seconds someone in the United States needs donated blood, the equivalent of more than
41,000 three-pint donations every day. There’s a perennial need for more donors — particularly donors of
type O-negative blood, which doesn’t have the A- or B-type antigens that can provoke an immune
reaction in some people. But fewer than 7 percent of Americans have O-negative blood. In a new study
published in the Journal of the American Chemical Society, researchers describe a way to transform A
and B blood into a type that, like O, could be universally donated. (Szokan, 5/4)
EDITORIALS AND OPINIONS
The Washington Post's Plum Line: What if a 2016 GOP Candidate Told the Truth About
Obamacare?
If you’re a Republican presidential candidate, there aren’t too many ways you can distinguish yourself
from your primary opponents on the issue of health care — I hate Obamacare, you hate Obamacare, we
all hate Obamacare. But maybe there’s another way, for someone who has the courage to shift his
rhetoric and present themselves as a bold truth-teller. (Paul Waldman, 5/7)
National Journal: Will The Supreme Court Revisit Part of its Landmark Obamacare
Decision?
Many have dismissed Rick Scott's lawsuit against the Obama administration over Medicaid funding as
meritless, but the Florida governor might actually be doing everybody a favor. The case could help
answer a huge constitutional question left over from the 2012 Supreme Court decision on Obamacare. ...
What [Chief Justice John] Roberts didn't say in his ruling was where exactly the line is that separates the
federal government's lawful discretion to persuade states to participate in a program from such illegal
intimidation. He explicitly avoided creating a definitive test for it. ... If the Florida case gets to the high
court, it would give the justices a chance to be a little more precise. (Dylan Scott, 5/7)
New England Journal Of Medicine: The Children's Cliff — Extending CHIP
CHIP enjoys political advantages that give it a strong bipartisan foundation: insuring children is a popular
cause, the costs of doing so are modest, the program's block-grant structure and state flexibility appeal to
conservatives, and it has a strong constituency among state officials. ... CHIP, in other words, is not
Obamacare, and the bipartisan coalition behind it remains largely intact. ... The bipartisanship that
underlay CHIP's extension and [Medicare doctor payment] reform does not, however, mark the
emergence of new, less polarizing health care politics. That Congress can agree on the necessity of
continuing insurance coverage for children and payments to doctors seeing Medicare patients does not
mean that Democrats and Republicans see eye to eye on other issues. (Jonathan Oberlander and David
K. Jones, 5/6)