First Edition: August 4, 2014

Today's headlines include a variety of health policy stories reflecting developments on the state level.  

Kaiser Health News: Hospital, Insurer Earnings Show Mixed Messages About Health Spending
Kaiser Health News staff writer Jay Hancock reports: “Analysts who fear health spending is accelerating got plenty of evidence in Wall Street's second-quarter results to support their thesis. But so did folks who hope spending is still under control. Now everybody's trying to sort out the mixed message. The answer matters because deficit debates and affordability concerns revolve around forecasts that health spending will speed up as the economy revives. If it doesn't, the future looks better for consumers, employers and taxpayers” (Hancock, 8/4). Read the story.

Kaiser Health News: A Doctor's Perspective On Obamacare Plans
WNPR’s Jeffrey Cohen, working in partnership with Kaiser Health News and NPR, reports: “On a recent afternoon at his office in Hartford, Connecticut, Dr. Doug Gerard examines a patient complaining of joint pain. Gerard, an internist, checks her out, asks her a few questions about her symptoms and then orders a few tests before sending her on her way. For a typical quick visit like this, Gerard could get reimbursed $100 or more from a private insurer. For the same visit, Medicare pays less — about $80. And now, with the new private plans under the Affordable Care Act, Gerard says he would get something in between, but closer to the lower Medicare rates. That's not something he's willing to put up with” (Cohen, 8/4). Read the story. 

The New York Times: Newly Insured, Many Now Face Learning Curve
Advocates of the Affordable Care Act, focused until now on persuading people to buy health insurance, have moved to a crucial new phase: making sure the eight million Americans who did so understand their often complicated policies and use them properly. The political stakes are high, as support for the health care law will hinge at least partly on whether people have good experiences with their new coverage. Advocates of the law also say teaching the newly insured how to be smart health care consumers could advance the law’s central goal of keeping costs down, such as by discouraging emergency room visits, while still improving care (Goodnough, 8/2).

The Washington Post's Wonkblog: There's A Way Around Healthcare.gov, But It's Still Not That Great
Some of the behind-the-scenes functions that consumers don't see, like the systems allowing federal subsidy payments to insurers, still need to be built. But there's another part of the enrollment system that isn't quite ready, and it doesn't sound as if it will be by the time the Affordable Care Act's second enrollment period rolls around. It's known as "direct enrollment," in which a consumer can go to a private online Web broker who provides a similar function that HealthCare.gov does — the brokers can sell a range of ACA health plans and offer insurance subsidies to those who qualify. The federal government reached agreements with several such entities last summer, with the idea that they would provide more opportunities for people to enroll in ACA plans  (Millman, 7/31).

The Associated Press: Oregon Releases 2015 Health Insurance Plan Rates
Oregon will see a much tighter range of premium prices in 2015 for individual and small employer health insurance plans, according to new rates announced Friday by state regulators. The Oregon Insurance Division says Moda, the company that captured nearly two-thirds of the individual market share with some of the lowest prices in 2014, will see a 10.6 percent rate hike on average. ... Some of the smaller carriers will see rate decreases in 2015. Plans from Providence Health and Trillium Community Health will both drop by about 14 percent on average (Wozniacka, 8/1).

Los Angeles Times: Obamacare Loses Some Of Its Campaign Punch For Republicans
Six months ago, a House Republican campaign official listed the top three issues that would propel the party's candidates to victory in the midterm election: "Obamacare, Obamacare, Obamacare." It was a strategy that worked well in 2010, when GOP electoral gains were fueled primarily by a high-profile campaign to repeal the newly passed Affordable Care Act (Memoli and Mascaro, 8/3).

Politico: White House Appeals Obamacare Subsidy Case
The Obama administration Friday asked a federal appeals court to grant another hearing in a case challenging Obamacare subsidies, and hours later, the court gave the subsidies opponents 15 days to respond to that request. The Justice Department filed the petition with the U.S. Court of Appeals for the D.C. Circuit in the case Halbig v. Burwell. In a blow to the Affordable Care Act, a three-judge panel ruled last month that the subsidies can’t flow through the federal exchange, HealthCare.gov, but only through state markets (Winfield Cunningham, 8/1).

Kaiser Health News tracked the news coverage related to the Obama administration's Friday filing (8/2).

The Wall Street Journal: Health Insurer To Stop Covering Uterine Procedure
In the procedure, a bladed device is used to cut up common uterine masses called fibroids, often in hysterectomies, so the tissue can be removed through tiny incisions in minimally invasive surgery. Highmark is the first insurer known to be halting coverage of power morcellation, and the move is the latest in a series of mounting pressures on use of the tool. ... The FDA estimates the instruments were being used in 50,000 hysterectomies a year (Levitz, 8/2).

NPR: Obama Moves To Overhaul VA With Compromise Measure
Two months after VA Secretary Eric Shinseki resigned, President Obama looks set to sign legislation to overhaul the Department of Veterans Affairs, to the tune of nearly $17 billion (8/3).

Los Angeles Times: As Disability Awards Grow, So Do Concerns With Veracity Of PTSD Claims
As disability awards for PTSD have grown nearly fivefold over the last 13 years, so have concerns that many veterans might be exaggerating or lying to win benefits. Moering, a former Marine, estimates that roughly half of the veterans he evaluates for the disorder exaggerate or fabricate symptoms. Depending on severity, veterans with PTSD can receive up to $3,000 a month tax-free, making the disorder the biggest contributor to the growth of a disability system in which payments have more than doubled to $49 billion since 2002 (Zarambo, 8/3).

The New York Times: The Drawn-Out Medical Degree
Should medical education be shorter? The answer is yes, at least according to administrators at many of America’s leading medical schools. The idea may conjure up images of clueless residents Googling symptoms on their smartphones at the patient’s bedside, but advocates insist that time spent in school can be trimmed without shortchanging education or compromising quality of care. And they say there are compelling reasons to speed up the process: to reduce the crushing debt many face by eliminating a year’s tuition and allowing doctors to start careers, and earn money, earlier (Grady, 8/1).

The New York Times: Going Professional: The Ins And Outs
The nation needs doctors, and students and schools are heeding the call. Last year the number of applicants to medical schools surpassed 48,000, for 20,055 slots, according to the Association of American Medical Colleges. Both numbers were a record.  ... The good news: The number of spots is growing. ... Meanwhile, colleges of osteopathic medicine more than doubled their capacity from 2002 to 2013. ... [But] enrollments are expanding faster than entry-level residency positions are increasing (Hoover, 8/1).

The Wall Street Journal: How Illinois Allocates $84,000 Drug For Hepatitis C
The $84,000-a-patient cost of the Sovaldi hepatitis C treatment has intensified a national debate among lawmakers, insurers and economists about the value of expensive medicines to society at large. The dilemma sparked by Sovaldi, which is made by Gilead Sciences, is also presenting hard choices to state Medicaid programs. In Illinois, for instance, officials recently instituted a new set of 25 stringent criteria for using Sovaldi that includes treating only those patients with the most advanced stage of liver disease and limiting treatment for those with a history of drug use and alcohol abuse (Silverman, 8/3).

The New York Times: California Asks: Should Doctors Face Drug Tests?
At a time when random drug testing is part of the job for pilots, train operators, police officers and firefighters — to name a few — one high-profile line of work has managed to remain exempt: doctors. That may be about to change. California would become the first state to require doctors to submit to random drug and alcohol tests under a measure to appear on the ballot this November. The proposal, which drew approval in early focus groups, was inserted as a sweetener in a broad initiative pushed by trial lawyers (Nagourney, 8/1).

The Wall Street Journal: Texas Trial To Test Higher Standard For State's Abortion Clinics
In a federal trial set to begin here on Monday, abortion-rights supporters are seeking to strike down a new provision of a state law that will require abortion clinics to qualify as "ambulatory surgical centers" starting next month, saying it will force even more of the state's facilities to close. Since Texas Gov. Rick Perry signed a hotly contested law in July 2013 requiring abortion doctors to have admitting privileges at nearby hospitals, the number of licensed Texas clinics providing abortions has declined by half over the past year, to 18 from 36. Many abortion doctors have been unable to obtain admitting privileges from neighboring hospitals, leaving swaths of the sprawling state without any clinics at all (Koppel, 8/3). 

The New York Times: In New Jersey, Workers’ Advocates Aim To Put Paid Sick Time On Ballot
Frustrated in their efforts to make paid sick leave mandatory for businesses throughout New Jersey, workers’ advocates are now pressing their campaign city by city, emboldened by laws recently passed in Newark and Jersey City, as well as in New York City (McGeehan, 8/3). 

The Wall Street Journal: Christie Pushes For Smaller Pension Benefits
Gov. Chris Christie on Friday stepped up his push to scale back the state pension and health benefit system, creating a commission to study the perks of public workers. The five-member New Jersey Pension and Health Benefit Study Commission will be charged with figuring out how to reap savings that will make the underfunded benefits system sustainable, Mr. Christie said (8/1).

The Associated Press: Hospital Killing Shows Safety Gap In Mental Health
When a man opened fire at a hospital outside Philadelphia, fatally shooting his caseworker and wounding his psychiatrist, the doctor saved his own life and probably the lives of others by pulling out a gun and shooting the patient. If Dr. Lee Silverman's decision to arm himself at the office was unusual, the violence that erupted at Mercy Fitzgerald Hospital served as yet another illustration of the hazards mental health professionals face on the job — and, experts say, the need for hospitals to do more to protect them (Rubinkam, 8/3).

The Washington Post: D.C.’s United Medical Center Is On Financial Upswing, But Its Future Is Mired In Politics
Shortly after David R. Small took over as chief executive of D.C.’s United Medical Center last year, a woman at a community meeting gave him some unwelcome news about the facility he’d been hired to run. “It was,” Small recalls being told, “the hospital where you go to die.” The 354-bed hospital on Southern Avenue SE has long suffered from a dismal reputation as a hospital of last resort, an image buttressed by long-standing and well-publicized financial woes and its location, in one of the region’s most concentrated pockets of poverty (DeBonis, 8/3).

Los Angeles Times: California Adopts New Policies On Treatment Of Mentally Ill Inmates
California prison officials adopted sweeping new policies intended to protect mentally ill prisoners from abusive force and punishment, including use of pepper spray and deep isolation in solitary confinement cells (St. John, 8/2).

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