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Tina Gheen Honored – Pic of the Week

In Custodia Legis - 6 hours 51 min ago

I was very excited to see yesterday’s announcement of the Fastcase 50. My next door neighbor at work and fellow In Custodia Legis blogger, Tina Gheen, made the list!  The Fastcase 50 honors “the smartest, most courageous innovators, techies, visionaries, and leaders in the law.”

Tina did an excellent job this year organizing the two legislative data challenges, Markup of US Legislation in Akoma Ntoso and Legislative XML Data Mapping, that the Library of Congress hosted.  Tina also serves on the OASIS LegalDocumentML Technical Committee that is working to make Akoma Ntoso a legal document standard.  She blogged about the new open source web based editor, LIME, that converts non-structured legal documents into Akoma Ntoso XML.

Image from the Fastcase 50 Announcement

The list also included Orin Kerr who was the Law Library Scholar-in-Residence for the Daniel and Florence Guggenheim Foundation Program on Demography, Technology, and Criminal Justice.

Congratulations Tina and to the other 49 who have made this distinguished list!

Categories: Research & Litigation

If You Find A Tick: Why I Resorted To Mooching Pills To Fight Lyme Disease

CommonHealth (WBUR) - 8 hours 33 min ago

A March 2002 file photo of a deer tick under a microscope in the entomology lab at the University of Rhode Island in South Kingstown, R.I. (Victoria Arocho/AP)

I’ve never done anything like this before. I’m a good little medical doobie. I’m wary of pills, take them only with prescriptions, and follow the instructions to the letter. But last month, I “borrowed” a friend’s extra 200 milligrams of doxycycline — the onetime antibiotic dose shown to help prevent Lyme disease soon after a prolonged tick bite.

What brought me to that desperate point? A doctor declined to prescribe the pills, even though this is prime Lyme disease season and the patient, my family member, fulfilled every one of mainstream medicine’s requirements for the single dose aimed at preventing Lyme. To wit:

• The tick was a fully engorged deer tick that had been attached for more than 36 hours.

• We sought treatment within three days of removing it.

• The tick came from a Lyme-endemic area.

• And the patient had no medical reason to avoid antibiotics.

The antibiotics I “borrowed” from a generous friend (Carey Goldberg/WBUR)

But still. The doctor argued that the chances of contracting Lyme from the tick were very small, perhaps 1 in 50, and that overuse of antibiotics contributes to the growing problem of drug-resistant bacteria. This is what he would do for his own family member, he said: skip the doxycycline, wait to see if Lyme develops, and treat it with a full 10-day course of antibiotics if it does.

I was frustrated and frankly a bit appalled. WBUR ran a series on Lyme disease in 2012, and I knew that controversy raged around many aspects of the disease, particularly the use of long-term antibiotics to treat long-term symptoms. But I was just trying to follow the widely accepted guidelines written by the Infectious Disease Society of America, to be found in reputable medical venues like UpToDate. And I knew from that same series that Lyme is rife in New England, and so are personal stories of health and lives ruined or seriously harmed.

Still, maybe I was overreacting? I’ve since sought a reality check from three experts, including the lead author of the guidelines. And here’s what I come away with: No, I was not unreasonable in seeking the preventive doxycycline. Arguably, though I hate to admit it, the doctor was not being totally unreasonable in declining it. The guidelines say a doctor “may” prescribe the antibiotic; it’s not a “must.”

In the end, I think, the crux of the question may lie in how you see the doctor’s role: Is it to lay out the risks and benefits and then let the patient choose? Or to impose his or her own best medical judgment on the patient? (You can guess where I come down on that one.) Also, “better safe than sorry” tends to rule when it comes to my loved ones. But what if the risk is small and the benefit uncertain?

A 2102 map of Lyme disease risk, released by the Yale School of Public Health. Massachusetts is high-risk territory. (AP)

I spoke first with Dr. George Abraham, governor of the American College of Physicians for the state of Massachusetts, a practicing primary care physician and infectious disease specialist, and a professor of medicine at UMass Medical School:

He described the preventive use of doxycycline if all the guideline requirements are met as “Good medicine — scientifically based, it is absolutely sound.”

So why might a physician refuse, and is such resistance widespread?

“There might be a minority of physicians who still feel it might be inappropriate for one of two reasons,” he said. “Either concerns of antimicrobial resistance — although a single dose of antimicrobials is very unlikely to breed resistance, so that might be a bit unfounded — or just lack of awareness.”

I confessed my pill-cadging peccadillo and he responded that it is simply not good medicine to use somebody else’s prescription. “But I think the moral of the story is, if the person in question knows that they’re appropriately asking for an agent and don’t get it, I would seek a second opinion, see a different physician, use a local emergency room,” he said. “Most emergency rooms are pretty savvy on this, just because they deal with this on a more frequent basis. Or even ask for a referral to an infectious disease specialist. It should be relatively easy. But the short answer is, there are ample other ways to get the medication.”

I spoke next with Dr. Alfred DeMaria, medical director for the Bureau of Infectious Disease of the Massachusetts Department of Public Health. He listened to my tale and began with the evidence base:

“There’s one published study on which the recommendations are based and that was a study — I think there were 200 to 250 people in each group, where they treated some people with 200 milligrams of doxycycline after tick attachment and others with placebo. And they found for the people who had an engorged tick — not for people who just had the flat tick attached, for people who had the engorged tick, where the estimation was that the tick could have been attached up to 24-to-72 hours — there was a reduced likelihood of Lyme disease developing if they got the 200 milligrams of doxycycline. Of course, there was also a 30 percent adverse reaction in those who got the doxycycline. I think that needs to be incorporated into the decision. But ultimately it’s the only study that has shown that.

It’s generally felt that if it’s an engorged tick, there are two options: One is to treat with 200 milligrams of doxycycline and watch for Lyme disease. Or just watch for evidence of Lyme disease in terms of a rash. That’s sort of what the recommendation is on our website.

I think what happens is, there are competing concerns about drug reactions and about antibiotic resistance which counterweigh the decision to use the  doxycycline, although 200 milligrams of doxycycline is not a lot of antibiotic therapy. But I think sometimes what happens in the community is that people have a tick attachment and no matter how long it’s attached, they wind up on two weeks of doxycycline, which is really not recommended.

The other thing you have to consider is the risk of an individual tick being infected. What’s good there is that we have Dr. Steve Rich at UMass, who’s been testing ticks, and people on Cape Cod who’ve been testing ticks, and infection rates can vary from year to year, from place to place, anywhere from 5 percent to 50 percent of the ticks. What we’ve learned from some people on the Cape is: They collect ticks from the same place every year, and from year to year it can vary from 5 percent to 50 percent. And it can be 5 percent on one side of the road and 50 percent on the other side of the road. It is highly variable.

The worst probable chance is a roughly 50 percent chance the tick is infected, but that also doesn’t mean every tick that’s infected is going to transmit the disease. So it’s a complicated situation, and I can understand a clinician going one way or another.

I think in an ideal situation a clinician would discuss it with a patient and they would make a judgment about how much risk they wanted to take and come to a conclusion that way. Unfortunately, the health care delivery system does not allow a lot of time to do that. But I would understand why a clinician would be resistant to doing it and I can understand why a clinician would want to do it under the circumstances that we recommend considering it.

It truly is a judgment call. I think some people would argue if the chances are only 1 in 10 or 1 in 20 that you’ll get Lyme disease from that tick, you could watch for signs, because early treatment is highly effective, and you could avoid unnecessary antibiotic use. That’s why we sort of say you should consider either option.”

One thing is clear, Dr. DeMaria said: Lyme disease is a huge problem and “this is prime time,” when the young “nymph” ticks are out looking for their “blood meals.” So “the best course of action is to avoid ticks, or do those tick checks.”

For a final word, I spoke with Dr. Gary Wormser, lead author of the IDSA guidelines and chief of infectious disease at New York Medical College. He, too, listened to my tale, and then began with how the team at the Lyme Disease Diagnostic Center at New York Medical College would have reacted:

“If you came to us and said you had the tick bite but didn’t have the tick with you, [then we'd advise] no prophylactic antibiotics. If you had come to us with the tick and we could confirm it was actually a deer tick and it was on you for at least 36 hours, the prophylaxis could be started within 72 hours of tick removal and there were no contraindications to taking doxycycline, we would have offered you the 200 milligrams prophylactically, informing you that it would not necessarily be 100 percent effective and you should still be wary of the possibility of getting Lyme disease and/or other tickborne infections. I don’t know the infection rate of deer ticks where you were, but in our area now 25 percent of the nymphal stage deer ticks are infected.

We have a lot of people who come in here and say they have engorged ticks and then we actually look at the tick, and it isn’t even a tick, or if it’s a tick it’s not a deer tick. We’ve had all kinds of things brought in to us, from scabs to thorns to beetles to pubic lice — you name it, we’ve seen it. And also, the patient’s concept of whether it’s been on for at least 36 hours isn’t very accurate, in our experience.

So it is a little bit tricky. That’s why the IDSA guidelines actually say that routine use of antimicrobial prophylaxis is not recommended, and only under very special circumstances would it be recommended. And so if a person met all those circumstances, we would do it. I think it’s a very interesting question about the long-term implications in terms of antibiotic resistance, which we’re all having to deal with on a day-to-day basis as infectious disease doctors, but in terms of the individual patient with a tick bite, we’re still offering prophylaxis under those very specific circumstances.

Keep in mind that pregnant women and children under 8 aren’t eligible for the doxycycline. And we don’t think it’s 100 percent effective either. So in other words, it would be a little misleading to people at times to believe that it’s 100 percent effective. It isn’t.

Let me give you some statistics you may not be aware of: The fact that you found the deer tick means the odds overall of getting Lyme disease, having done nothing more than finding the tick, are 2.2 percent. If you take doxycycline, the risk of Lyme disease goes from 2.2 percent to 0.8 percent. But the confidence interval — the range of potential possibilities — varies from .02 percent to 2.1 percent. So in other words, it has been shown to be effective but unfortunately the study that was done, which was a pretty large study, wasn’t large enough in terms of numbers of cases of tick bites that were prevented to narrow down the exact efficacy rate. It was 87 percent effective but it could have been as low as 25 percent effective based on pure statistical variation.

So it’s very important to understand the limitations. We know it has some efficacy and we know it’s not like giving a full course of antibiotics. There are data that if you gave patients a 10-day course of antibiotics it would be essentially 100 percent effective. We knew that was being done, but we just didn’t recommend it because, why would you want to treat every tick bite as if the patient actually already had Lyme? The beauty of this [200-milligram dose] was that it’s only a single dose and it has, at least in the study that was done, over 85 percent efficacy. It’s just that we couldn’t be precise, we couldn’t give a precise efficacy rate in what we call the 95 percent confidence interval surrounding the actual efficacy, meaning it could be less effective than that.”

Dr. Wormser confirmed that the preventive doxycycline is a reasonable approach, if you fulfill the requirements. And some more reassurance: Just finding the tick means you’re ahead of the curve.

“There are two ways to look at this,” he said. “One way is to say that if the efficacy study we did was 100 percent accurate, that you have an 87 percent further reduction in the risk of getting Lyme disease. Or you can look at it this way: It’s 2.2 percent risk going down to 0.4 percent or in that range. So if you look at it in those absolute percentages, it doesn’t seem as dramatic.”

I must say, those numbers calmed me down quite a bit. But even a small chance of a frightening possible outcome seems worth trying to head off.

Dr. Wormser understood. “First of all, everything to do with Lyme disease is anxiety-provoking,” he said. “That’s the nature right now of the reputation that this disease seems to have. So that’s one of the reasons we offer this service, in part — not that we think it’s the end of the world if the patient should get a rash at the site of the tick bite, because then we just give them 10 to 14 days of an appropriate antibiotic and everyone gets better. It’s just that given the circumstances — the reputation and implications that people have drawn about this disease, whether they’re accurate or not — it has caused so much anxiety and concern for many people that we’re happy to offer the service of telling them yes, you might benefit from the 200 milligrams.”

Well, if we lived in New York, I’d have been happy to receive that service for my family member.

Readers, what would you do? Say you meet all the requirements, would you want the single dose of antibiotics? How far would you go to get it?

Further Reading:

Categories: Health Care

New Rules On 'Off-Label' Drug Marketing Expected

Kaiser Health News - 11 hours 1 min ago

The FDA is reviewing what kind of data drug companies should be allowed to give doctors about off-label uses with a goal of issuing guidelines by year's end.

The Washington Post: FDA Has Free-Speech, Safety Issues To Weigh In Review Of ‘Off-Label’ Drug Marketing
Prompted in part by recent federal court decisions, the FDA is reviewing its rules on what kind of data drug companies should be allowed to distribute to doctors regarding off-label uses, as well as how they should respond to unsolicited questions from physicians about those uses. Its goal is to issue new guidelines by the end of the year (Dennis, 7/9).

Meanwhile, a doctor quits an FDA safety panel to avoid conflict of interest issues -  

The Wall Street Journal: Doctor Quits Uterine-Device Safety Panel Over Conflict
A member of a panel advising the government on the safety of a medical device that can spread cancer in women stepped down after the U.S. Food and Drug Administration reviewed consulting fees he accepted from a device manufacturer, the agency said Thursday (Levitz, 7/10).

Categories: Health Care

Mass. Fix To Insurance Website Passes Preliminary Test

Kaiser Health News - 11 hours 2 min ago

New software for the health exchange has passed its initial testing and officials say they are cautiously optimistic that the state can run its own marketplace when enrollment begins in the fall. Also, Modern Healthcare examines where small business exchanges stand.

The Boston Globe: New Mass. Health Insurance Website Passes Key Test
A new software system for the state’s health insurance website passed its first key test this week, and a final decision on whether Massachusetts will run its own site or join the federal exchange will be made in early August, a top state official said. Maydad Cohen, special adviser to the governor, told the Massachusetts Health Connector board Thursday morning that the new software from hCentive performed every task required by federal officials, and then some, in a Washington, D.C., demonstration Monday. This success, he said in an interview afterward, leaves him increasingly but cautiously optimistic that the state will be able to employ the hCentive software when open enrollment starts Nov. 15 (Freyer, 7/10).

WBUR: Cautious Optimism That New State Insurance Site Will Work
The first test of a new Massachusetts health insurance website was a success, a top state official says, leaving him cautiously optimistic that it will be up and running for a critical Nov. 15 deadline. That's Opening Day for anyone who plans to buy insurance through the Health Connector, or is seeking free or subsidized coverage. But Maydad Cohen, a top aide to Gov. Deval Patrick, says he’s not sure yet if the site, developed by hCentive, will be ready (Bebinger, 7/10).

The Associated Press: State Reports Progress In Fixing Health Website
Software ordered by Massachusetts to fix its hobbled health care exchange passed initial tests, renewing hopes that the state could finally have a fully operational website by year's end, officials said Thursday. The breakdown dramatically slowed the state's transition to the federal Affordable Care Act from its own first-in-the-nation universal health insurance law that provided a model for President Barack Obama's plan. Massachusetts severed ties earlier this year with the lead contractor on its health exchange, CGI Group, and has been forced to shuffle more than 200,000 of its residents into temporary Medicaid coverage (Salsberg, 7/10).

Modern Healthcare: Small Business Exchanges Hope For Better 2015 After Rocky Start
Health insurance marketplaces for small businesses have largely been a bust in their first year of operations. That's in large part because online enrollment hasn't been available for businesses in the 32 states relying on the federal HealthCare.gov website. In addition, several state-based exchanges, most notably Covered California, also have required businesses to send in paper applications to enroll. That undoubtedly served as a deterrent for companies with less than 50 employees that might otherwise have considered shopping for coverage through the Small Business Health Options Program (SHOP) (Demko, 7/10).

Categories: Health Care

Michigan Surpasses Medicaid Enrollment Goal In 4 Months

Kaiser Health News - 11 hours 2 min ago

Meanwhile, an ambitious Connecticut plan to overhaul how health care is delivered and paid for worries Medicaid advocates, who fear doctors will have financial incentives to withhold care.

The Detroit News: Michigan Medicaid Expansion Exceeds 322K
More people have enrolled in Medicaid’s expansion in less than four months than were expected to sign up in the entire first year of the program, the Snyder administration announced Thursday. The expansion, called the Healthy Michigan Plan, opened April 1 with a first-year goal of 322,000 sign-ups. The state said it exceeded that projection Thursday with more than 323,022 residents enrolled. The Michigan Department of Community Health estimated 477,000 Michiganians would sign up by the end of 2015 (Bouffard, 7/10).

The CT Mirror: Health System Overhaul Plan Has Medicaid Advocates Worried
State officials are seeking millions of dollars in federal funds with the ambitious goal of redesigning how health care is paid for and delivered to the majority of Connecticut residents. But critics say a late addition to the application has the potential to significantly change Connecticut’s Medicaid program, in ways they worry could make it harder for low-income children and adults to receive care. The goals are big: Improve the health of Connecticut residents; eliminate disparities in health between different groups; improve care quality and access, as well as patient experience and participation -- all while lowering costs. And the aim is to affect the care of nearly everyone in the state (Becker, 7/11).

Kansas Health Institute News Service: Feds Ask Kansas For Plans To Fix Medicaid Delay Issues
Federal officials have asked six states, including Kansas, to submit plans for resolving issues that appear to be delaying the processes to determine Medicaid eligibility, primarily for pregnant women, children and people with disabilities. Letters were sent to each state’s Medicaid director on June 27. "CMS is asking several state Medicaid agencies to provide updated mitigation plans to address gaps that exist in their eligibility and enrollment systems to ensure timely processing of applications and access to coverage for eligible people," said Aaron Albright, a spokesman for the Centers for Medicare & Medicaid Services. The six states – Kansas, Alaska, California, Michigan, Missouri and Tennessee – were asked to respond by July 14 (Ranney, 7/10).

Categories: Health Care

State Highlights: UnitedHealth Sues Calif. To Stop Fine; Va. Wants Long-Term Care Insurance Changes; Mo. Gov. Signs Health Care Legislation

Kaiser Health News - 11 hours 3 min ago

A selection of health policy stories from California, Virginia, Missouri, Vermont, Maryland, Georgia and New York.

Los Angeles Times: UnitedHealth Group Sues California Over Fine
Setting up a major legal fight, UnitedHealth Group Inc. has sued California's insurance commissioner to block his attempt to fine the insurer $173.6 million for violations during a botched 2005 acquisition. The lawsuit, filed Thursday in Orange County Superior Court, is the latest twist in a long-running political drama. Four years ago, California sought a jaw-dropping fine of nearly $10 billion against UnitedHealth, the nation's largest health insurer. The penalty related to problems handling medical claims and policyholder applications after the insurer bought Cypress-based PacifiCare (Terhune, 7/10).

The Associated Press: Va. Changes Regs On Long-Term Care Insurance
Virginia regulators are encouraging long-term care insurance policyholders to take advantage of changes that strengthen protections against unintentional coverage lapses due to nonpayment. The Bureau of Insurance of the State Corporation Commission says insurers have long been required to provide policyholders with the option to designate a third party to receive notice of an impending policy lapse (7/10).

The Associated Press: Missouri Governor Signs Health Care Expansion
Gov. Jay Nixon signed legislation Thursday expanding government-funded prenatal health coverage and allowing some newly trained doctors to go to work more quickly in areas of Missouri where there are physician shortages. The health care provisions are contained in a pair of wide-ranging bills, which also extend the life of a state prescription drug program for seniors. The new Show-Me Healthy Babies Program will provide insurance for pregnant women who earn too much to qualify for traditional Medicaid but don't have affordable private-sector insurance. The program is projected to cover more than 1,800 people annually at an annual cost of $14 million, most of which would come from federal funds (Lieb, 7/10).

The Associated Press:  Vermont Lawmakers Approve Health Care Rules 
Vermont lawmakers on Thursday approved a lengthy set of provisions governing health care, despite an earlier objection from legal advocates. But work will continue to examine possible scenarios that might play out for Vermonters from the rules. The set of provisions on health benefits eligibility and enrollment are part of wider efforts for health care reform in the state, a major goal for Gov. Peter Shumlin and legislators (Garbitelli, 7/10).

Baltimore Sun: Disabled Foster Child Dies At Maryland Group Home
A 10-year-old disabled foster child died last week while under the care of a group home in Anne Arundel County that Maryland health regulators were in the process of closing down, state Health Secretary Dr. Joshua M. Sharfstein confirmed Thursday. Regulators, he said, are conducting investigations into the July 2 death at the Laurel-area home operated by LifeLine Inc., a state contractor that had provided round-the-clock care for such children -- and that was recently warned it would lose its license for having inadequate staff to meet the "health and safety needs of each child" and other issues. In the meantime, 10 other youths have been moved from LifeLine's care. Sharfstein could not specify when the moves took place but said all were completed the day after the boy's death. He did not link the events and said the children were not moved sooner from LifeLine's care because it takes time to find other contractors to provide housing and the necessary medical care (Donovan, 7/10).

Georgia Health News: Medicaid Change On Long-Term Care Delayed
A state health agency Thursday delayed approval of a change in the Medicaid eligibility system for people in long-term care whose incomes are above the government program’s thresholds. The Department of Community Health’s board had been set to approve a switch for some lower-income Georgians -- who now use “Qualified Income Trusts” (QITs) to qualify for Medicaid -- to a “medically needy” eligibility program. These people make too much money to qualify for regular Medicaid, but not enough money to pay for their health care needs (Miller, 7/10).

The Associated Press: Prosecutors: Northern NY Hospital To Pay $750,000 
Federal prosecutors say a hospital in northern New York has agreed to pay $750,000 to settle allegations that it submitted 1,900 improper Medicare claims. According to the U.S. attorney's office, Carthage Area Hospital double billed the federal health care program for the elderly for operating room and ambulatory surgery services from 2006 through June 2010 (7/11). 

Detroit News: Detroit's Maternal Death Rate Triple The Nation's
Detroit women are dying from pregnancy-related causes at a rate three times greater than for the nation. Experts blame the same combination of medical conditions and social toxins that kills Detroit babies at a frequency that is the worst of America’s big cities, and even some Third World countries (Boufford, 7/10).

Categories: Health Care

Boehner's Lawsuit Against President Obama Will Target Health Law's Employer Mandate Delay

Kaiser Health News - 11 hours 3 min ago

Speaker of the House John Boehner, R-Ohio, is challenging the Obama administration's failure to enforce parts of the health law.  

The New York Times: Suit Against Obama To Focus On Health Law, Boehner Says
Speaker John A. Boehner’s lawsuit against President Obama will focus on changes to the health care law that Mr. Boehner says should have been left to Congress, according to a statement issued Thursday by the speaker’s office (Weisman, 7/10).

Los Angeles Times: House Lawsuit Over Obamacare To Focus On Employer Mandate Delay
House leaders announced Thursday that their planned lawsuit against President Obama would focus on his failure to enforce provisions of the Affordable Care Act, renewing a fight over his landmark health law. Speaker John A. Boehner had previously announced plans to sue the president over what he said was Obama's failure to fulfill his constitutional duties, but Boehner did not specify what the challenge would be based on (Memoli, 7/10).

The Wall Street Journal’s Washington Wire: House Republicans Lay Out Legislation For Lawsuit Against Obama
House Speaker John Boehner’s (R., Ohio) planned lawsuit challenging President Barack Obama’s executive actions will focus on the White House’s decision to waive the Affordable Care Act’s employer mandate without the consent of Congress, Republican leaders said Thursday. Republicans unveiled a draft House resolution that would authorize the House of Representatives to file a lawsuit against Mr. Obama, which the chamber is expected to vote on this month. Mr. Boehner said that the lawsuit would be about the division of powers between the executive and legislative branches, saying the White House decision to alter the health law violated that separation of authority (Crittenden, 7/10).

Politico: GOP’s Obama Lawsuit To Focus On Employer Mandate
House Republicans will base their lawsuit against President Barack Obama on the administration’s “unilateral” decision to delay the employer mandate provision in Obamacare, Speaker John Boehner said Thursday. Rules Committee Chairman Pete Sessions (R-Texas) released a draft resolution that would authorize the House to move forward with a case against Obama for what House Republicans are characterizing as a broad abuse of executive power. The resolution will be considered by the committee next week and a vote on the House floor is expected by the end of July (French, 7/11).

The Associated Press: House GOP Moves Ahead On Suing Obama
House Republicans took the initial step on Thursday to sue President Barack Obama over the administration's decision to delay the employer mandate of the healthcare law. The office of Speaker John Boehner (R-Ohio) released a draft of the resolution that would authorize the House to file suit amid GOP criticism that the president has declined to faithfully execute the laws of the country (7/10).

The Hill: Boehner Suit Targets Obamacare Delay
Speaker John Boehner's (R-Ohio) lawsuit against President Obama will focus on the delay of the employer mandate in ObamaCare, according to a draft resolution authorizing the litigation released Thursday. The lawsuit will challenge the administration's decision to unilaterally delay a requirement that firms offer health insurance to their employees or pay a penalty, Boehner said in a statement (Sink, 7/10).

NBC News: Boehner Lawsuit Against Obama To Focus On Obamacare
House Speaker John Boehner announced Thursday the Republican-led lawsuit against President Barack Obama will focus on the implementation of the Affordable Care Act and the White House decision to delay the employer mandate. “In 2013, the president changed the health care law without a vote of Congress, effectively creating his own law by literally waiving the employer mandate and the penalties for failing to comply with it. That’s not the way our system of government was designed to work,” Boehner said in a statement. The House Rules Committee will hold a hearing next week to discuss the legislation that would authorize a lawsuit against the president (7/10).

Categories: Health Care

Newly Covered Addicts Unable To Get Residential Care

Kaiser Health News - 11 hours 3 min ago

Under an obscure, 50-year-old rule, Medicaid covers residential addiction treatment only if a center has 16 or fewer beds, severely limiting options for newly covered drug addicts and alcoholics, reports The New York Times. Meanwhile, some Californians whose doctors are not in their plans have been able to switch coverage after the deadline because of the law's "qualifying life events" provision, according to the San Jose Mercury News.

The New York Times: Obscure Rule Restricts Health Law’s Expansion Of Care For Addicts
The law allowed states to expand Medicaid to many more low-income people, meaning that drug addicts and alcoholics who were previously ineligible could now receive coverage for substance abuse treatment, which the law has deemed an “essential health benefit.” But there is a hitch: Under an obscure federal rule enacted almost 50 years ago, Medicaid covers residential addiction treatment in community-based programs only if they have 16 or fewer beds (Goodnough, 7/10).

Earlier, related KHN coverage: Barriers Remain Despite Health Law's Push To Expand Access To Substance Abuse Treatment (Gorman, 4/10).

The San Jose Mercury News: Obamacare: Little-known Provision Allows Californians Stuck In Bad Plans To Switch
Furious after discovering that their longtime doctors weren't part of their new Anthem Blue Cross plans under the federal health care law, many Bay Area residents didn't just get mad. They got even. They called the Covered California health insurance exchange and switched to plans that accept their physicians. Exchange officials say it's possible to change plans even after the mid-April open-enrollment deadline because of a little-known provision under the "qualifying life events" section for special enrollment (Seipel, 7/10).

Modern Healthcare: Most Insurers Hit Medical-loss Ratio Requirements: GAO
Roughly three-quarters of health insurers spent enough money on medical care to avoid paying refunds to their customers in 2011 and 2012, according to a report issued by the U.S. Government Accountability Office. Insurers operating in the individual, small group and large group markets spent a median of 88% on medical care during those two years.  Under the Patient Protection and Affordable Care Act, insurers are generally required to maintain medical-loss ratios of at least 80% for the individual and small group markets, and 85% for the large group market. Health plans that fail to spend enough money on medical care are required to refund money to their customers. (A small group is typically defined as an employer with fewer than 50 employees) (Demko, 7/10).

Fox News: Court Decision Looms In Subsidy Challenge That Could Unravel Obamacare
A few blocks down the street from where the U.S. Supreme Court recently issued its ruling in the Hobby Lobby case, a powerful federal appeals court is preparing its own decision in a case that could cause serious complications for Obamacare. The case, Halbig v Sebelius, is a major legal challenge that cuts to the heart of the Affordable Care Act by going after the legality of massive federal subsidies and those who benefit from them. A ruling could come as early as Friday (Chakraborty, 7/10).


Categories: Health Care

Viewpoints: Parsing Newest Reports Of Coverage Gains; 'Scientific Fraudsters'

Kaiser Health News - 11 hours 4 min ago

The New York Times: Early Returns On Health Care Reform
It will take a while to understand fully how the Affordable Care Act affects the quality of health care and access to doctors in this country. But a new survey offers encouraging reviews from people who signed up for private plans or Medicaid during the first enrollment period from October 2013 through March 2014 (7/10). 

The New York Times: The State Of Obamacare
The Commonwealth Fund has a new study out on Obamacare enrollment, estimating that about 9.5 million people gained coverage through Medicaid and the exchanges; this is roughly in line with some previous estimates but perhaps slightly more encouraging for the law's supporters (Ross Douthat, 7/10). 

Bloomberg: Success Kills Another Obamacare Myth
The Affordable Care Act was designed to achieve two goals, according to its advocates: it was supposed to increase the number of people with health insurance, and to cut health care costs. Increasingly, the former looks like a solid achievement, and there are increasing signs the latter is being accomplished, too, though it isn't clear the ACA deserves the credit (Jonathan Bernstein, 7/10). 

Bloomberg: The Court Case That Could Kill Obamacare
The Affordable Care Act has overcome a Supreme Court challenge, persistent Republican opposition and the initial dysfunction of its own website. It could still fall victim to another foe: its own language. Any day now, a federal court may rule that in 36 states, the federal government can't offer tax credits to people who buy insurance on Obamacare's exchanges. That's because the law, as written, authorizes those tax credits only in states that have set up exchanges -- and most states refused to do so (Ramesh Ponnuru, 7/10).

Los Angeles Times: Hey Liberals, There's A Logistical Problem With Your Hobby Lobby Boycott
There’s a big problem with all this boycott mania: There’s almost no Venn-diagram overlap between the nearly 18,000 people who "like" the boycott's Facebook page so far and the consumer base that actually shops at Hobby Lobby. Crafts customers -- people who make their own quilts, soaps, scrapbooks, Christmas wreaths and kids’ Halloween costumes -- are certainly overwhelmingly women. But they also tend to be stay-at-home moms (who else has the time?), and it's safe to say that a large percentage of them are religiously and probably politically conservative. Dressing up like an IUD doesn't do it for them. In fact, the whole idea that an employer should be obliged to pay for someone else's birth control, period, probably sticks in the craws of many of them. What's wrong with buying your own contraceptives? (Charlotte Allen, 7/10). 

The Wall Street Journal: A Minimally Invasive Approach To Health-Care Reform
Minimally invasive surgery using a fiber-optic camera and small incisions rather than traditional "open" surgery significantly reduces costly surgical complications. That's been known for some time. But a study that my Johns Hopkins University colleagues and I recently conducted has found that it is still surprisingly common for patients in the U.S. not to be given that surgical option (Marty Makary, 7/10). 

On other health issues --

The New York Times: Crack Down On Scientific Fraudsters
Even though research misconduct is far from rare, Dr. Han’s case was unusual in that he had to resign. Criminal charges against scientists who commit fraud are even more uncommon. In fact, according to a study published last year, "most investigators who engage in wrongdoing, even serious wrongdoing, continue to conduct research at their institutions." As part of our reporting, we've written about multiple academic researchers who have been found guilty of misconduct and then have gone on to work at pharmaceutical giants. Unusual, too, is the fact that Iowa State has agreed to reimburse the government about $500,000 to cover several years of Dr. Han’s salary and that the National Institutes of Health has decided to withhold another $1.4 million that it had promised the university as part of the grant (Adam Marcus and Ivan Oransky, 7/10). 

USA Today: VA Manufactured Its Own Doctor Shortage
Why was the situation so dire that veterans faced months-long waits to see Veterans Affairs physicians? It's not exactly a secret that the VA faces a severe shortage of physicians. More than 800 job openings are listed on the VA website. There are many reasons why it is so hard to recruit physicians to work for the VA, including challenging patients, dwindling financial resources and uncompetitive salaries (Greg Siskind, 7/10). 

New England Journal of Medicine: Drug Companies' Patient-Assistance Programs -- Helping Patients Or Profits?
Assistance programs are a triple boon for manufacturers. They increase demand, allow companies to charge higher prices, and provide public-relations benefits. ... [But Medicare and other payers] worry that patient-assistance programs discourage patients from using generic drugs and other less costly alternatives to new, patent-protected therapies. ... Pharmaceutical manufacturers and patient-advocacy groups are seeking clarification from the DHHS about the legality of patient-assistance programs' providing aid to exchange enrollees. Given the high cost of many new drugs, the DHHS's approach to patient-assistance programs will strike many people as cold and insensitive, but I believe that the DHHS is absolutely right to limit the scope of these programs. Patient-assistance programs help individual patients but are associated with hidden costs for insurers and taxpayers. Cost sharing will accomplish nothing more than cost shifting if assistance programs shield patients from costs (David H. Howard, 7/10). 

Categories: Health Care

Obamacare Lowers Uninsured Rate, Three Studies Find

Kaiser Health News - 11 hours 5 min ago

According to three new studies, the health law has in its first year reduced the number of uninsured adults by between 8 million and 11 million, and the majority of enrollees report satisfaction with their plans.

Politico: The Verdict Is In: Obamacare Lowers Uninsured
A survey by the Commonwealth Fund found that 9.5 million fewer adults are uninsured now than at the beginning of the Obamacare enrollment season. The Urban Institute’s Health Reform Monitoring Survey found a similar drop, with 8 million adults gaining coverage. And Gallup-Healthways survey reported that the uninsured rate has fallen to 13.4 percent of adults, the lowest level since it began tracking health coverage in 2008. That was all on Thursday. In recent months, other surveys in the Gallup series have consistently found the same downward trend, and a RAND survey in April estimated that the law extended health coverage to 9.3 million Americans (Nather, 7/11). 

Los Angeles Times: Health Law Covers At Least 8 Million
President Obama's health care law has reduced the number of uninsured adults by 8 million to 11 million in its first year, according to three new studies, and the vast majority report satisfaction with their new health plans. The studies -- done separately by the Commonwealth Fund, the Urban Institute and the Gallup organization -- use different methods to estimate the effect that the Affordable Care Act has had (Terhune and Lauter, 7/10).

Los Angeles Times: Rate Of Uninsured Californians Is Halved Under Obamacare, Survey Finds
The percentage of Californians without health insurance was cut in half in the last nine months during the federal health law's expansion of coverage, a new survey shows. Nationwide, an estimated 9.5 million adults under the age of 65 gained health insurance between late summer 2013 and last month, according to a survey the Commonwealth Fund released Thursday (Terhune, 7/10).

Reuters: Californians Lacking Health Insurance Halved Under Obamacare: Study
The number of Californians without health insurance has been cut in half since the implementation of Obamacare, according to a survey published Thursday. The study by the Commonwealth Fund, a healthcare research foundation, showed that about 11 percent of adults in the most populous U.S. state were uninsured as of last month, down from 22 percent in the summer of 2013. California was the first state to pass legislation to set up its own marketplace allowing consumers and small businesses to purchase highly regulated coverage under the Affordable Care Act, and the state has also expanded its Medicaid program, providing insurance to more low-income residents (7/10).

Politico: More Signs That Health Coverage Is Growing Under Obamacare
Millions of Americans have gained health insurance since Obamacare went into effect, according to several new surveys that show the law is bringing down the nation’s uninsurance rate after its “train wreck” of a start. Three new surveys released in rapid succession Thursday found substantial numbers of newly insured adults. None of those findings will put to rest the political debate about the cost, structure and wisdom of the Affordable Care Act but they do give advocates firm evidence that the law is meeting coverage goals (Wheaton, 7/10).

Another study finds increased health plan enrollment in areas that saw heavy advertising against the law --

The Hill: Anti-Obamacare Ads Might Have Increased Sign-ups
Millions of dollars in conservative ads against ObamaCare might have backfired and actually boosted enrollment in key states, according to a new study.  A fellow with the Brookings Institution found a "positive association" between ad spending against ObamaCare and enrollment in health plans under the law. The trend appeared strongest in states with competitive Senate races this year, where conservative groups are spending widely on ads against the Affordable Care Act (Viebeck, 7/10).

Categories: Health Care

Research Roundup: Clinics And Electronic Records; Young Adults Baffled By Exchange; Medicare Spending Slowdown

Kaiser Health News - 11 hours 5 min ago

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

Health Affairs: Adoption And Use Of Electronic Health Records Among Federally Qualified Health Centers Grew Substantially During 2010–12 
We found that in 2012 nine out of ten health centers had adopted a EHR system, and half had adopted EHRs with basic capabilities. Seven in ten health centers reported that their providers were receiving meaningful-use incentive payments from the Centers for Medicare and Medicaid Services (CMS). Only one-third of health centers had EHR systems that could meet CMS’s stage 1 meaningful-use core requirements. Health centers that met the stage 1 requirements had more than twice the odds of receiving quality recognition, compared with centers with less than basic EHRs (Jones and Furukawa, 7/8).

Health Affairs: Progress And Challenges: Implementation And Use Of Health Information Technology Among Critical-Access Hospitals
Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied (Hufstader Gabriel, Jones, Samy and King, 7/8).

Annals of Internal Medicine: The Experience Of Young Adults On HealthCare.gov: Suggestions For Improvement: A Case Report
We observed 33 highly educated young adults, aged 19 to 30 years, navigating the HealthCare.gov Web site in Philadelphia .... Participants were challenged by poor understanding of health insurance terms that were inadequately explained. Although participants expressed their preferred benefits (for example, preventive care and dental coverage), they had difficulty matching plans with their preferences, partially because they perceived that the amount of information was overwhelming. Young adults qualifying for affordability provisions were confused by discount applications that made more-comprehensive plans (such as silver) cheaper than less comprehensive alternatives (such as catastrophic). ... Using a systematic approach, we identified 6 actionable improvements for HealthCare.gov (Wong et al., 7/8).

Plos One: Premarket Safety And Efficacy Studies For ADHD Medications In Children
We identified all ADHD medications approved by the Food and Drug Administration (FDA) and extracted data on clinical trials performed by the sponsor and used by the FDA to evaluate the drug’s clinical efficacy and safety. ... A total of 32 clinical trials were conducted for the approval of 20 ADHD drugs. The median number of participants studied per drug was 75. Eleven drugs (55%) were approved after <100 participants were studied and 14 (70%) after <300 participants. The median trial length prior to approval was 4 weeks, with 5 (38%) drugs approved after participants were studied <4 weeks and 10 (77%) after <6 months. ... Clinical trials conducted for the approval of many ADHD drugs have not been designed to assess rare adverse events or long-term safety and efficacy. ... better assurance is needed that the proper trials are conducted either before or after a new medication is approved (Bourgeois, Kim and Mandl, 7/9).

The Kaiser Family Foundation/Urban Institute: Medicaid Spending Growth In The Great Recession And Its Aftermath, FY 2007-2012
During [the FY 2007 – 2012 period], Medicaid enrollment rose from 42.3 million to 54.1 million and spending on medical services (that is, excluding administrative and other non-service spending) rose from $292.7 billion in FY 2007 to $383.6 billion in FY 2012–an average annual increase of 5.6 percent. ... In 2012, however, spending growth slowed to near record lows. ... Managed care is playing an increasingly dominant role in Medicaid spending. Growing at 14.1 percent on average per year, managed care grew steadily and faster than any other service category .... Medicaid spending on services for families grew much faster than Medicaid spending on services for the aged and individuals with disabilities. ... Medicaid spending per enrollee on medical services grew more slowly than underlying medical care inflation, national health expenditures per capita, and the growth in private health insurance spending per enrollee (Young and Clemans-Cope, 7/3). 

The Kaiser Family Foundation: The Mystery Of The Missing $1,000 Per Person: Can Medicare's Spending Slowdown Continue?
Based on our comparison of CBO’s August 2010 and April 2014 baselines, Medicare spending this year will be about $1,000 lower per person than was expected in 2010, soon after passage of the Affordable Care Act (ACA), which included reductions in Medicare payments to plans and providers and introduced delivery system reforms that aimed to improve efficiency and reduce costs. By 2019, Medicare spending per person is projected to be nearly $2,400 lower per person than was expected following passage of the ACA. Medicare spending projections in CBO’s August 2010 and subsequent baselines take into account the anticipated effects of the ACA, along with other factors that are expected to affect future Medicare spending. So it seems that the ACA may be having a bigger than expected effect, but something else may be going on here too (Neuman and Cubanski, 7/8).

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

Examiner.com: Too Many Seniors Suffer From Malnutrition
Malnutrition continues to be a serious problem in older adults. Nutrition screenings should be regular part of geriatric health assessment, ... In a special review article published July 3, 2014 in the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)'s Nutrition in Clinical Practice journal, Dr. Rose Ann DiMaria-Ghalili, an Associate Professor of Nursing at Drexel University, examines each component of the [Comprehensive Geriatric Assessment]  and outlines how nutrition screenings would fit into each individual domain: physical/medical, mental, functional, and social (Hart, 7/4).

Reuters:  Preventative Services Differ Between Primary Care Docs And OB/GYNs
The services women receive during annual preventive care visits may partially depend on what type of doctor they see, suggests a new report. Women who saw primary care doctors for their annual checkup tended to receive a broader range of services, compared to those who saw obstetrician/gynecologists (OB/GYNs), researchers found (Seaman, 7/7).

Reuters:  Rural Residents With Disabilities Less Likely To Get Colon Cancer Screening
People with disabilities are less likely to get screened for colon and rectal cancer if they live in rural areas, according to a new study. Researchers said that means rural residents with disabilities may be at higher risk of getting diagnosed with late-stage cancer than their urban counterparts (Storr, 7/7). 

The New York Times: Weekend Dangers At The E.R.
A new study suggests that emergency surgery done on children during the weekend results in more complications and deaths than similar surgery done during the week. The study, published in the July issue of The Journal of Pediatric Surgery, used a large national database to match 112,064 weekend operations on children younger than 18 with 327,393 operations performed on weekdays. ... Only about 1 percent of cases had complications, and less than one-tenth of 1 percent of the children died. But even after controlling for sex, age, race, the type of surgery and other factors, patients having a procedure on the weekend were 40 percent more likely to sustain an accidental puncture or cut, 14 percent more likely to receive a transfusion, and 63 percent more likely to die (Bakalar, 7/7).

Reuters: Adoption Of New Surgical Technology Linked To Complications
Patients may be more likely to have complications when a new surgical device is first being adopted, suggests a new study looking at prostate removal. Based on the results, the process of how new surgical technologies are introduced to the healthcare system should be improved, researchers suggest. There is currently no formal process for introducing new surgical technologies into hospitals after they are approved by the U.S. Food and Drug Administration (Seaman, 7/8).

JAMA News: Gene Researchers Work To Engineer HIV-Resistant Cells
Ever since the evolution of the HIV/AIDS pandemic, researchers have long sought effective strategies to prevent HIV infection or help the body keep the virus in check after infection has occurred. In addition to a decades-long effort to develop an effective vaccine and continuing research to find less toxic drugs, some researchers are focusing on another strategy—modifying the genes of host cells to make them resistant to infection (Hampton, 7/9).

Baltimore Sun: Study Shows Minimally Invasive Surgery Underused
Minimally invasive surgery leads to fewer infections and other complications than traditional open surgery but not all hospitals are regularly offering such procedures, according to a new study from Johns Hopkins University. The researchers looked at a database of more than seven million hospitals stays at more than 1,000 hospitals and found laparoscopic methods were underused in several specific surgeries -- appendectomies, colectomies and hysterectomies, which studies have shown have better outcomes when they are done using minimally invasive techniques (Cohn, 7/9). 

Reuters: Older Adults And Their Children Move Closer Together After Health Issues
Seniors who have a stroke or heart attack are more likely to end up living closer to their adult children afterward, according to a new study. Adult children often serve as informal caregivers when their parents become disabled after an illness, researchers note. But living far apart can make caregiving more difficult (Lehman, 7/9).

The Pacific Standard: The Ongoing Mental Health Benefits Of Neighborhood Diversity
Hope to have robust mental health well into your senior years? Seeking safety and stability, you might opt to move to a gated community, but new research from England suggests that might be a bad idea. Examining health information on more than 10,000 seniors, plus localized data on home prices, researchers led by Alan Marshall of the University of Manchester found lower levels of depression in older people who live in economically diverse neighborhoods (Jacobs, 7/3). 

Categories: Health Care

Political Cartoon: 'Cringe Benefits?'

Kaiser Health News - 11 hours 6 min ago

Kaiser Health News provides a fresh take on health policy developments with "Cringe Benefits?" by Larry Lambert.

Meanwhile, here's today's haiku:

A CONFUSING CAUSE OF ACTION

Boehner suing prez
for failing to enforce law
he tried to repeal. 

Is suit frivolous?
Barack Obama says so...
John Boehner says no.
-Anonymous

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Categories: Health Care

First Edition: July 11, 2014

Kaiser Health News - 13 hours 14 min ago

Today's headlines include coverage of surveys that offer insight into how the health law is doing in terms of reducing the nation's rate of uninsurance.

Kaiser Health News: A Reader Asks: Does Selling Your House Affect Eligibility For Assisted Living?
Kaiser Health News consumer columnist Michelle Andrews answers this reader’s question (7/11). Read her response.

Politico: The Verdict Is In: Obamacare Lowers Uninsured
A survey by the Commonwealth Fund found that 9.5 million fewer adults are uninsured now than at the beginning of the Obamacare enrollment season. The Urban Institute’s Health Reform Monitoring Survey found a similar drop, with 8 million adults gaining coverage. And Gallup-Healthways survey reported that the uninsured rate has fallen to 13.4 percent of adults, the lowest level since it began tracking health coverage in 2008. That was all on Thursday. In recent months, other surveys in the Gallup series have consistently found the same downward trend, and a RAND survey in April estimated that the law extended health coverage to 9.3 million Americans (Nather, 7/11). 

Los Angeles Times: Health Law Covers At Least 8 Million
President Obama's healthcare law has reduced the number of uninsured adults by 8 million to 11 million in its first year, according to three new studies, and the vast majority report satisfaction with their new health plans. The studies — done separately by the Commonwealth Fund, the Urban Institute and the Gallup organization — use different methods to estimate the effect that the Affordable Care Act has had (Terhune and Lauter, 7/10).

Los Angeles Times: Rate Of Uninsured Californians Is Halved Under Obamacare, Survey Finds
The percentage of Californians without health insurance was cut in half in the last nine months during the federal health law's expansion of coverage, a new survey shows. Nationwide, an estimated 9.5 million adults under the age of 65 gained health insurance between late summer 2013 and last month, according to a survey the Commonwealth Fund released Thursday (Terhune, 7/10).

Politico: More Signs That Health Coverage Is Growing Under Obamacare
Millions of Americans have gained health insurance since Obamacare went into effect, according to several new surveys that show the law is bringing down the nation’s uninsurance rate after its “train wreck” of a start. Three new surveys released in rapid succession Thursday found substantial numbers of newly insured adults. None of those findings will put to rest the political debate about the cost, structure and wisdom of the Affordable Care Act but they do give advocates firm evidence that the law is meeting coverage goals (Wheaton, 7/10).

The New York Times: Suit Against Obama To Focus On Health Law, Boehner Says
Speaker John A. Boehner’s lawsuit against President Obama will focus on changes to the health care law that Mr. Boehner says should have been left to Congress, according to a statement issued Thursday by the speaker’s office (Weisman, 7/10).

Los Angeles Times: House Lawsuit Over Obamacare To Focus On Employer Mandate Delay
House leaders announced Thursday that their planned lawsuit against President Obama would focus on his failure to enforce provisions of the Affordable Care Act, renewing a fight over his landmark health law. Speaker John A. Boehner had previously announced plans to sue the president over what he said was Obama's failure to fulfill his constitutional duties, but Boehner did not specify what the challenge would be based on (Memoli, 7/10).

The Wall Street Journal’s Washington Wire: House Republicans Lay Out Legislation For Lawsuit Against Obama
House Speaker John Boehner’s (R., Ohio) planned lawsuit challenging President Barack Obama’s executive actions will focus on the White House’s decision to waive the Affordable Care Act’s employer mandate without the consent of Congress, Republican leaders said Thursday. Republicans unveiled a draft House resolution that would authorize the House of Representatives to file a lawsuit against Mr. Obama, which the chamber is expected to vote on this month. Mr. Boehner said that the lawsuit would be about the division of powers between the executive and legislative branches, saying the White House decision to alter the health law violated that separation of authority (Crittenden, 7/10).

Politico: GOP’s Obama Lawsuit To Focus On Employer Mandate
House Republicans will base their lawsuit against President Barack Obama on the administration’s “unilateral” decision to delay the employer mandate provision in Obamacare, Speaker John Boehner said Thursday. Rules Committee Chairman Pete Sessions (R-Texas) released a draft resolution that would authorize the House to move forward with a case against Obama for what House Republicans are characterizing as a broad abuse of executive power. The resolution will be considered by the committee next week and a vote on the House floor is expected by the end of July (French, 7/11).

The New York Times: Obscure Rule Restricts Health Law’s Expansion Of Care For Addicts
The law allowed states to expand Medicaid to many more low-income people, meaning that drug addicts and alcoholics who were previously ineligible could now receive coverage for substance abuse treatment, which the law has deemed an “essential health benefit.” But there is a hitch: Under an obscure federal rule enacted almost 50 years ago, Medicaid covers residential addiction treatment in community-based programs only if they have 16 or fewer beds (Goodnough, 7/10).

The Washington Post: Michigan Reached Its Health Insurance Enrollment Goals 8 Months Early
Michigan Gov. Rick Snyder (R) announced Thursday that the state had reached its first-year goal of signing up 322,000 residents for the Healthy Michigan Plan eight months early. About 477,000 Michigan residents are eligible for the Health Michigan Plan, the state’s expanded Medicaid program for low-income residents. To be eligible, individuals cannot qualify for or be enrolled in Medicare or other Medicaid programs and must have income at or below 133 percent of the poverty level (Schwartz, 7/10).

The Wall Street Journal: Doctor Quits Uterine-Device Safety Panel Over Conflict
A member of a panel advising the government on the safety of a medical device that can spread cancer in women stepped down after the U.S. Food and Drug Administration reviewed consulting fees he accepted from a device manufacturer, the agency said Thursday (Levitz, 7/10).

The Washington Post: FDA Has Free-Speech, Safety Issues To Weigh In Review Of ‘Off-Label’ Drug Marketing
Prompted in part by recent federal court decisions, the FDA is reviewing its rules on what kind of data drug companies should be allowed to distribute to doctors regarding off-label uses, as well as how they should respond to unsolicited questions from physicians about those uses. Its goal is to issue new guidelines by the end of the year (Dennis, 7/9).

Los Angeles Times: UnitedHealth Group Sues California Over Fine
Setting up a major legal fight, UnitedHealth Group Inc. has sued California's insurance commissioner to block his attempt to fine the insurer $173.6 million for violations during a botched 2005 acquisition. The lawsuit, filed Thursday in Orange County Superior Court, is the latest twist in a long-running political drama. Four years ago, California sought a jaw-dropping fine of nearly $10 billion against UnitedHealth, the nation's largest health insurer. The penalty related to problems handling medical claims and policyholder applications after the insurer bought Cypress-based PacifiCare (Terhune, 7/10).

The Associated Press: Va. Changes Regs On Long-Term Care Insurance
Virginia regulators are encouraging long-term care insurance policyholders to take advantage of changes that strengthen protections against unintentional coverage lapses due to nonpayment. The Bureau of Insurance of the State Corporation Commission says insurers have long been required to provide policyholders with the option to designate a third party to receive notice of an impending policy lapse (7/10). 

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Categories: Health Care

A Reader Asks: Does Selling Your House Affect Eligibility For Assisted Living?

Kaiser Health News - 15 hours 19 min ago

Q. I’m a realtor who’s listing a client’s home. She is on Social Security and is moving into assisted-living housing. Will the proceeds from the sale of her home affect her eligibility for housing, which is based on her income?

A. This is an unusual question because assisted-living facilities typically do not have special eligibility criteria for low-income residents, experts say. 

In general, assisted living is privately funded, paid for by people with their Social Security benefits and other income, supplemented when necessary by other resources.  

More From This Series Insuring Your Health

“It’s common to sell your home to finance your care,” says Maribeth Bersani, senior vice president of public policy at the Assisted Living Federation of America, a trade group.

Assisted-living facilities enable people who need help with daily activities like bathing or eating to remain in a residential setting rather than a nursing home. The average monthly cost for a private one-bedroom apartment was just over $3,000 in 2009, according to ALFA.

However, some assisted-living facilities accept a certain number of low-income people who meet income and/or asset standards and could not afford the regular fees, says Bonnie Burns, a consultant for California Health Advocates, a Medicare advocacy organization.  It appears that this facility may be one of them, she says.

If that’s the case, it is possible, according to Burns, that this homeowner would be ineligible for housing if the proceeds from the sale push her beyond the income or asset limits set by the facility.

“It depends on how the assisted living facility evaluates her income and assets,” she says.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Health Care

Congress Should End – Not Extend – the Ban on State and Local Taxation of Internet Access Subscriptions

Center on Budget and Policy Priorities - Thu, 07/10/2014 - 5:08pm
The Internet Tax Freedom Act (ITFA), enacted in 1998 and temporarily renewed in 2001, 2004, and 2007, imposed a moratorium on new state and local taxes on monthly Internet access fees while preserving (“grandfathering”) existing Internet access taxes.  The House Judiciary Committee recently approved a bill to eliminate the grandfather provision and permanently ban all state and local taxation of Internet access subscriptions.  This represents the first time that Congress has …
Categories: Benefits, Poverty

Congress Considering Extending Harmful Ban on State Taxation of Internet Access Charges

Center on Budget and Policy Priorities - Thu, 07/10/2014 - 4:19pm
The House is expected to vote next week on a bill that would cost states as much as $7 billion in potential annual revenue by permanently extending a moratorium on new state and local sales taxes on monthly Internet access fees and banning existing taxes, a new Center on Budget and Policy Priorities report explains. The seven states that have these taxes (Hawaii, New Mexico, North Dakota, Ohio, South Dakota, Texas, and Wisconsin) would lose roughly $500 million in annual revenue, …
Categories: Benefits, Poverty

The State of Obamacare

Medicare -- New York Times - Thu, 07/10/2014 - 11:29am
Just how optimistic should the law’s supporters be feeling?
Categories: Elder, Medicare

Survey: People With New Health Law Insurance Are Happy

Kaiser Health News - Thu, 07/10/2014 - 10:19am

About 9.5 million Americans gained coverage during the health law's open enrollment period, and the uninsured rate for working-age adults fell from 20 percent to 15 percent, according to a survey by the Commonwealth Fund.  

The New York Times’ The Upshot: Newest Health Insurance Customers Are Generally Happy
We’ve known for a few months now that lots of people signed up for health insurance this year in new marketplaces. A new survey shows that the people who did so are also pretty happy with their purchases (Sanger-Katz, 7/10).

McClatchy: Survey: 9.5 Million People Gained Health Coverage In First Marketplace Enrollment Period
Some 9.5 million Americans gained health coverage during the recent marketplace enrollment period as the uninsured rate for working-age adults fell from 20 percent to 15 percent, according to a new national survey by the Commonwealth Fund. Young adults ages 19-34, whose participation in the Affordable Care Act’s coverage initiative was crucial but always uncertain, saw some of the largest coverage gains. Their uninsured rate fell from 28 percent to 18 percent. Uninsured rates for Latinos fell from 36 percent to 23 percent, the survey found. And low-income adults earning less than 138 percent of the federal poverty level saw their uninsured rate drop from 35 percent to 24 percent (Pugh, 7/10).

Categories: Health Care

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