First Edition: May 27, 2015

Kaiser Health News: ‘Milestone’ Rules Would Limit Profits, Score Quality For Medicaid Plans
Sweeping proposals disclosed Tuesday would create profit guidelines for private Medicaid plans as well as new standards for the plans’ doctor and hospital networks and rules to coordinate Medicaid insurance more closely with other coverage. “We are taking steps to align how these programs work,” said Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services, which proposed the rules. Privatized Medicaid has grown rapidly as budget-pinched states have responded to commercial insurers’ promise to deliver care for a fixed price. Most beneficiaries of Medicaid — state programs for the poor run partly with federal dollars — now get care through contracted insurers. (Hancock, 5/26)

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Kaiser Health News: Improved Economy, Obamacare Boost Demand For Travel Nurses
[Amy] Reynolds is one of thousands of registered nurses who travel the country helping hospitals and other health care facilities in need of experienced, temporary staff. With an invigorated national economy and millions of people gaining health coverage under the Affordable Care Act, demand for nurses such as Reynolds is at a 20-year high, say industry analysts. That’s meant Reynolds has her pick of hospitals and cities when it’s time for her next assignment. And it’s driven up stock prices of the largest publicly traded travel-nurses companies, including San Diego-based AMN Healthcare Services and Cross Country Healthcare of Boca Raton, Fla. (Galewitz, 5/27)

Kaiser Health News: Tanning Beds And College Campuses – A Public Health Concern
Tanning salons are already under siege – they got taxed by the health law, are newly regulated by the federal government and states, and have become dermatologists’ favorite bad guy. But some policymakers say that’s not enough. Pointing to rising skin cancer rates and increased marketing toward young people, these public health advocates want new national restrictions regarding who can get their indoor tan on. “It’s time we started treating [tanning beds] just like they are cigarettes. They are carcinogen delivery systems,” said Rep. Rosa DeLauro, D-Conn., at a May 20 Capitol Hill briefing on the dangers of indoor tanning. “We do not allow our children to buy cigarettes, yet the tanning industry continues to target adolescent girls. And this is not unlike what we found with the tobacco industry.” (Gillespie, 5/27)

National Journal: The Obama Administration’s New Medicaid Rule Has Health Plans Fuming
The Centers for Medicare and Medicaid Services unveiled reams of proposed managed care rules for the low-income insurance program; this is the first time that the agency is revising the regulations since 2002. They cover everything from network adequacy and beneficiary protections to long-term care, which is new ground for federal regulations. But managed care companies, private health plans that cover Medicaid enrollees while receiving a per-member payment from the government, had been bracing for one proposal in particular: Medical-loss ratio. Medical-loss ratio says that health plans have to spend a certain percentage of money that they are paid on actual health care. (Scott, 5/26)

The Hill: Feds Unveil Long-Awaited Overhaul Of Medicaid Managed Care
The Centers for Medicare and Medicare Services (CMS) is proposing that Medicaid managed care groups align their standards with those in the private marketplace to create more uniform practices across states. Those changes will help to “ease the administrative burden on issuers and regulators” while also providing “an appropriate level of protection for enrollees,” CMS wrote in the rules. But the proposed rule is likely to draw fire from many of the 39 states that have enjoyed considered leeway in their own use of managed care. (Ferris, 5/26)

Bloomberg: Insurers Face Tighter Oversight Of Medicaid Plans In Proposal
In the first major overhaul in more than a decade, the U.S. has proposed new rules for private health insurers who run Medicaid plans covering millions of poor people and children. The proposed rules, issued Tuesday, call for plans to report what portion of the money they collect to care for patients actually gets spent on benefits. They would attempt to broaden access to doctors and hospitals by having states set standards on access to care. The rules would also create a performance-based ratings system for plans. (Tracer, 5/26)

The Wall Street Journal: New Push Ties Cost Of Drugs To How Well They Work
Express Scripts Holding Co., a large manager of prescription-drug benefits for U.S. employers and insurers, is seeking deals with pharmaceutical companies that would set pricing for some cancer drugs based on how well they work. The effort is part of a growing push for so-called pay-for-performance deals amid complaints about the rising price of medications, some of which cost more than $100,000 per patient a year. Some insurers and prescription-benefit managers are pushing back by arguing that they should pay less when drugs don’t work well in certain patients. Drug companies are countering with pricing models of their own, such as offering free doses during a trial period. (Loftus, 5/26)

The New York Times: Tech Rivalries Impede Digital Medical Record Sharing
Since President Obama took office, the federal government has poured more than $29 billion into health information technology and told doctors and hospitals to use electronic medical records or face financial penalties. But some tech companies, hospitals and laboratories are intentionally blocking the electronic exchange of health information because they fear that they will lose business if they share information on patients with competing providers, administration officials said. In addition, officials said, some sellers of health information technology try to “lock in” customers by making it difficult for them to switch to competing vendors. (Pear, 5/26)

The New York Times: New Jersey Lassa Fever Death Prompts C.D.C. Action
After the government spent months constructing a health monitoring system for Ebola that strikes a balance between protecting public safety and preserving personal liberty, a patient in New Jersey seems to have squeezed through it. The patient, who was not identified, died from Lassa fever on Monday night. The viral disease is not nearly as deadly as Ebola, but it is endemic in several West African countries, as well as contagious, and it sent local and federal health officials scrambling to trace the man’s steps in the four days between his hospitalizations. (Tavernise and Hartocollis, 5/26)

NPR: How Worried Should We Be About Lassa Fever?
An unidentified New Jersey man died after returning home from West Africa, where he had contracted Lassa fever, a virus that has symptoms similar to those of Ebola. Federal health officials are treating the case with caution because the virus, which commonly is spread by rodents, can occasionally spread from person to person. Lassa fever can cause internal bleeding. Other symptoms include respiratory distress, vomiting, facial swelling, and back and abdominal pain. Dr. Tom Frieden, who heads the Centers for Disease Control and Prevention, says the virus is not nearly as deadly as Ebola. Ninety-nine percent of people with Lassa fever survive. (Harris, 5/26)

The Wall Street Journal's Pharmalot: Consumers Sue Anthem For Denying Coverage For A Gilead Hepatitis C Drug
The controversy over the new crop of hepatitis C treatments has taken yet another turn as consumers are starting to file lawsuits against insurers that deny them access to the medicines. Over the past two weeks, two different women alleged that Anthem Blue Cross refused to pay for the Harvoni treatment sold by Gilead Sciences because it was not deemed “medically necessary.” The issue emerges after more than a year of debate over the cost of the medicines and complaints by public and private payers that the treatments have become budget busters. The new hepatitis C treatments, which are sold by Gilead Science and AbbVie, cure more than 90% of those infected and, in the U.S., cost from $63,000 to $94,500, depending upon the drug and regimen, before any discounts. (Silverman, 5/26)

The Los Angeles Times: Bernie Sanders Launches Presidential Campaign With Populist Pitch
Liberal Sen. Bernie Sanders of Vermont publicly declared his presidential candidacy Tuesday with a demand for what he labeled the nation's billionaire class: "Your greed has got to end." ... Sanders, a self-declared socialist, reiterated his key issues -- income inequality, economic uncertainty, campaign finance reform and climate change -- and outlined what he called a "simple and straightforward progressive agenda" to deal with them. ... He also proposed going beyond the Affordable Care Act to a Medicare-for-all system, as well as free public colleges and universal preschool. (Memoli, 5/26)

The New York Times: Bernie Sanders Challenges Hillary Clinton At His First Rally
Senator Bernie Sanders of Vermont began drawing implicit contrasts with Hillary Rodham Clinton on Tuesday in the race for the 2016 Democratic presidential nomination, as he played the liberal purist in throwing down policy gauntlet after gauntlet – a $15 minimum wage, $1 trillion for public works jobs, a “Medicare-for-all” system of universal health care — in his first campaign rally since declaring his candidacy last month. (Healy, 5/26)

The New York Times: Jeb Bush Signals More Funding And Faster Drug Approval For Alzheimer’s
Former Gov. Jeb Bush opened up last week about his mother-in-law’s affliction with Alzheimer’s disease and, on Tuesday, shed some light on what he thinks should be done to fight the illness. In an email exchange with Maria Shriver, the journalist, activist and author, Mr. Bush wrote that he has been getting a lot of feedback since revealing that his family has firsthand experience with the disease. As for how he would address Alzheimer’s disease, which according to the Centers for Disease Control afflicts five million Americans, Mr. Bush called for more research funding and a faster drug approval process. (Rappeport, 5/26)

The Associated Press: West Virginia 20-Week Abortion Ban Takes Effect
A law prohibiting abortions 20 weeks after conception took effect Tuesday in West Virginia, despite Gov. Earl Ray Tomblin twice vetoing the ban over concerns that a court could strike it down. Amid the Democratic governor’s worries over constitutionality, state Attorney General Patrick Morrisey, a Repubilcan, has vowed to defend the ban against potential legal action. (5/26)

The Washington Post's Wonkblog: Already Deep In Debt, Puerto Rico Now Faces A New Crisis
Puerto Rico has been laid low for nearly a decade by crippling debt and a near-perpetual recession that has triggered a migration to the U.S. mainland unmatched since the 1950s. Now, a growing number of people on the island worry that another crisis is looming: the collapse of the island’s health-care system. More than 2 million patients—roughly 60 percent of Puerto Rico’s population—rely on Medicare, Medicare Advantage or Medicaid to pay for their health care. Doctors practicing in Puerto Rico are forced to get by with much smaller Medicare and Medicaid reimbursement rates than those received by their counterparts on the mainland. The difference stems from a formula that Puerto Rico advocates say underestimates commercial rents, while not fully accounting for high costs of malpractice insurance, medical equipment and utilities. (Fletcher, 5/26)

The Wall Street Journal: Big Bets On Proton Therapy Face Uncertain Future
Six new proton-beam centers are set to start delivering state-of-the-art radiation to cancer patients around the country by year’s end. ... The projects, long in the works, will enter an uncertain market. Proton-beam therapy, a highly precise form of radiation, has been dogged by a lack of evidence that it is better than traditional radiation despite costing significantly more. Many insurers including UnitedHealth Group Inc. and Aetna Inc. have stopped covering it for prostate cancer, once seen as a main source of patients. One center closed last year and several others have racked up millions of dollars in losses. (Beck, 5/26)

NPR: Injection Drug Use Fuels Rise In Hepatitis C Cases
The rise in injection drug use across the country, especially the eastern U.S., is fueling an outbreak of hepatitis C. Outreach workers are offering clean needles and testing to contain the spread. (Gourlay, 5/26)

USA Today: Waiting A Few Minutes To Cut Umbilical Cord Helps Baby
Cutting the cord is a momentous event in a baby's life. For nine months, the developing fetus is attached to its mother by the umbilical cord. Then, moments after birth, that cord is severed. Now, research suggests there may be benefits to keeping mom and baby attached a few minutes longer. (Weintraub, 5/26)

NPR: Delayed Umbilical Cord Clamping May Benefit Children Years Later
A couple of extra minutes attached to the umbilical cord at birth may translate into a small boost in neurodevelopment several years later, a study suggests. Children whose cords were cut more than three minutes after birth had slightly higher social skills and fine motor skills than those whose cords were cut within 10 seconds. The results showed no differences in IQ. (Haelle, 5/26)