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Judge Delays Review Of Partners HealthCare Deal

CommonHealth (WBUR) - Thu, 07/17/2014 - 3:12pm

Update 6:35 p.m.: A judge has granted Attorney General Martha Coakley’s request for an extension. The comment period will now close September 15, and Coakley will have until September 25 to file comments from her office after seeing the full Health Policy Commission report. A new hearing has been set for September 29.

Our original post continues:

BOSTON — Massachusetts Attorney General Martha Coakley is asking a judge to postpone reviewing a settlement between her office and Partners HealthCare that would allow the hospital network to acquire three new hospitals.

Massachusetts Attorney General Martha Coakley (Steven Senne/AP/File)

Coakley’s motion asks a judge to wait until September to hold a hearing on the deal, which aims to limit the market clout of the state’s largest hospital network in exchange for allowing it to acquire South Shore Hospital and Hallmark Health.

A spokesman for the attorney general says Coakley has seen findings from a preliminary review of the deal from the state’s Health Policy Commission, and she believes the court should consider the full report.

The statement reads in full:

“Our office always retained the option to seek to renegotiate portions of this agreement as it relates to Hallmark following a Final Report by the Health Policy Commission.  After reviewing the preliminary findings by the HPC, we believe it is in the interest of the public and the parties involved to wait for the final report before any final consent judgment is considered by the court.”


The deal would allow Partners to acquire the hospitals while meeting several conditions the attorney general’s office says would alter the hospital network’s negotiating power for years to come. WBUR’s Martha Bebinger reported on those conditions last month:

The proposal … would prevent Partners from contracting with affiliate physician groups that are not part of its owned hospital for 10 years. It would also cap health care costs at the rate of inflation across the entire Partners network through 2020, and block further expansion in eastern Massachusetts, including Worcester County, for seven years. (See all the conditions here.)

A judge had previously set up a three-week comment period on the settlement, which ends July 21.

Critics of the deal, including other hospital networks, say it doesn’t do enough to help reestablish a competitive market.

Partners says the merger will help improve care and lower costs.

Earlier:

Categories: Health Care

Survey: Transgender Discrimination In Mass. Public Spots, Health Effects Seen

CommonHealth (WBUR) - Thu, 07/17/2014 - 12:19pm

(Codep08/Compfight)

On a break from her job near South Station, Vivian Taylor was on her way in to use the station’s ladies’ room when a man suddenly blocked her way, she recalls.

“Where do you think you’re going?” he asked her, threateningly.

“I didn’t want to have a confrontation while I was at work, but it was a very unsettling experience,” said Taylor, a transgender woman who served in Iraq in 2009 and 2010. “For about the next half hour, that fella just stood there — as if he was on guard — standing there glaring at me in front of the door to the bathroom.”

A survey out today suggests Taylor’s experience is not uncommon. The results, based on 452 responses, show that almost two-thirds of transgender and gender non-conforming Massachusetts residents experienced discrimination last year in public places, including transportation, retail and health care settings.

The survey, conducted by The Fenway Institute at Fenway Health and the Massachusetts Transgender Political Coalition, found that respondents who reported discrimination had an 84 percent increased risk of adverse physical symptoms associated with stress — such as headaches, upset stomachs and pounding hearts — and a 99 percent increased risk of emotional symptoms compared to respondents who reported no such discrimination in the past year.

“It’s a hard thing to have to go through the world just having to be that conscious of your own safety,” Taylor, who was a respondent on the survey, said. “That’s a very stressful experience, to just always know that it’s possible that somebody is going to come after you for no other reason than what you look like, or how you dress, or what your voice sounds like.”

The survey also found that 20 percent of respondents postponed or did not seek health care because of prior discrimination in a medical setting. Five percent of respondents said a health care provider refused to provide them with care because of their gender identity.

“The fear of not wanting to be discriminated against, the fear of not being seen for who you are and respected, I think, is a really powerful one,” Sari Reisner, an epidemiologist and co-author of the survey, said. “The reality is that for transgender people, being socially gender affirmed is very, very important. So going into an encounter — especially a medical encounter [can] be a pretty vulnerable proposition. Depending on what exam you’re undergoing, you may need to undress, you may need to disclose personal health information.”

Reisner says we can think about trans people’s fear to seek medical care in the context of what’s known as a minority stress model in medical literature, which posits that for racial, ethnic and sexual minorities, social stressors harm health.

“We could talk about a gender identity social stress model, where discrimination that’s enacted, where somebody experiences discrimination, then that makes them anticipate future discrimination,” Reisner said. “So you might see postponement of care as anticipatory: not accessing care because they’ve already been discriminated against.”

While the method — a cross-sectional survey — cannot establish a causal relationship between experiencing discrimination and having negative health outcomes, Reisner says the link is statistically significant.

“The probability of having a particular negative health outcome is increased as a function of people experiencing discrimination,” Reisner said.

The link could be causal, Reisner said, but further studies are needed to determine that.

The survey has a number of recommendations, including providing cultural competency training to health care providers and frontline staff.

Another recommendation in the survey includes adopting a statewide law — now pending in the Legislature — making it illegal to discriminate in public accommodations on the basis of gender identity.

Massachusetts already has a nondiscrimination law that makes it illegal to discriminate on the basis of gender identity in housing, employment, credit and education.

“If there are laws protecting folks, then trans folks don’t have to worry about being at the mercy of an individual’s feelings about trans people,” Taylor said. “If trans people are just left at the mercy of public opinion, then that’s a dangerous place for us to be.”

Categories: Health Care

Senate Democrats Fail To Reverse Hobby Lobby Decision

Kaiser Health News - Thu, 07/17/2014 - 10:24am

The bill, which would have restored employers' mandate to provide birth control to women, did not garner the necessary 60 votes. Republicans argued Democrats were using the issue to gain advantages in the midterm campaign.

NPR: The Two Way: Democratic Effort To Override Hobby Lobby Ruling Fails
A Democratic effort to override the Supreme Court's recent ruling on contraceptive coverage failed in the Senate on Wednesday. Bill sponsors fell four votes short of the 60 votes needed to cut off debate on the measure (Greenblatt, 7/16).

The Wall Street Journal: Senate Bill To Nullify Hobby Lobby Decision Fails
Senate Republicans on Wednesday blocked Democrats' effort to undermine the Supreme Court's Hobby Lobby decision, ending a round of partisan jousting aimed at capturing women's votes in the fall. A bill from Senate Democrats designed to restore employers' responsibility to provide contraception coverage under the Affordable Care Act was defeated 56-43 on a procedural vote. It sought to prevent companies from using a religious-freedom law to avoid complying with a requirement to cover all forms of contraception approved by the government without charging workers a copayment (Peterson, 7/16).

The Associated Press: Dems Seek Gains With Women In Birth Control Loss
Republicans blocked a bill that was designed to override a Supreme Court ruling and ensure access to contraception for women who get their health insurance from companies with religious objections. The vote was 56-43 to move ahead on the legislation — dubbed the "Not My Boss' Business Act" by proponents — four short of the 60 necessary to proceed. But Democrats hope the issue has enough life to energize female voters in the fall, when Republicans are threatening to take control of the Senate. GOP senators said Wednesday's vote was simply a stunt, political messaging designed to boost vulnerable Democratic incumbents. The GOP needs to gain six seats to seize control (Cassata, 7/16).

USA Today: Senate GOP Blocks Bill To Overturn Hobby Lobby Ruling
The Senate on Wednesday torpedoed a Democratic plan to reverse a recent Supreme Court ruling allowing some employers to decline to provide employees insurance coverage for some forms of birth control on religious grounds. The bill failed to get 60 votes needed to cross a procedural hurdle, as Republicans were largely united against it. Three Republican senators voted for the bill: Mark Kirk of Illinois, Lisa Murkowski of Alaska and Susan Collins of Maine. The bill had no hope of passage in the Republican-controlled House; Democrats tried and failed to force a vote in the House on a similar bill Tuesday (Singer and Dekimpe, 7/16).

Politico: Democratic Bid To Reverse Hobby Lobby Fails
A Democratic bill to reverse the Supreme Court’s recent Hobby Lobby decision narrowly failed in the Senate on Wednesday, but it sparked more contentious debate over contraception and religious freedom that both sides hope will mobilize their voters in November. The bill in effect says a 1993 religious freedom law at the heart of the Hobby Lobby case doesn't apply to legally required health benefits. The Supreme Court had cited the Religious Freedom Restoration Act in ruling that certain for-profit businesses can on religious grounds be exempted from the Obamacare requirement that the health plans they offer workers include FDA-approved birth control with no co-pays (Winfield Cunningham, 7/16).

Bloomberg: Birth Control Insurance Bill Rejected In U.S. Senate
Three Republicans, Susan Collins of Maine, Lisa Murkowski of Alaska and Mark Kirk of Illinois, joined Democrats in voting to advance the measure. Senate Majority Leader Harry Reid, a Nevada Democrat, voted no to preserve his ability to bring the bill up again. "We are going to vote again on this issue before this year is out," Reid said at a news conference after the vote (Hunter, 7/16).

Reuters: U.S. Senate Dems Hobby Lobby Bill Fails To Move Forward
Senate Republicans have announced their own post-Hobby Lobby bill to ensure employers could not block their employees from obtaining birth control. Republican Senators Lamar Alexander of Tennessee and Orrin Hatch of Utah said before Wednesday's vote that the Hobby Lobby ruling was about constitutional religious freedoms, not women's rights. Hatch told Reuters he was not worried the bill would persuade women to vote for Democrats in November (McGinnis and Stephenson, 7/16).

Categories: Health Care

House Panel Begins Hearings On Suit Against Obama

Kaiser Health News - Thu, 07/17/2014 - 10:23am

The Rules Committee hearing highlighted bickering between Republican lawmakers and constitutional law experts. The committee is expected to vote next week on a resolution authorizing a lawsuit.

Reuters:  U.S. Lawmakers, Lawyers Argue Over House Republican Plan To Sue Obama
The Republican effort to sue President Barack Obama over his use of executive powers got under way in Congress on Wednesday at a hearing where lawmakers and constitutional law experts bickered over the move in a taste of the politicking to come. The House of Representatives' Rules Committee is expected to vote next week on a resolution authorizing a lawsuit centering on Obama's delays and other changes to his signature health insurance reform law, with a floor vote before the end of July. House Speaker John Boehner is pursuing the suit to protect Congress' rights from what he calls Obama's "king-like" overreach of executive authority in making unilateral moves to advance his agenda (McGinnis, 7/16).

The New York Times: Partisanship Infuses Hearings On Health Law And Executive Power
Efforts by congressional Republicans to rein in what they say are the legislative and political excesses of the Obama administration played out in simultaneous hearings on Wednesday, further highlighting how election-year politics are overtaking business on Capitol Hill. The first hearing, by the House Committee on Oversight and Government Reform, was quickly adjourned after the administration refused to allow testimony from David Simas, the White House political director, who had been called under a Republican subpoena to answer questions about Democratic campaign activities. The second, a debate in the House Rules Committee on the merits of a lawsuit that Speaker John A. Boehner plans to file against President Obama, exposed simmering partisan tensions as Democrats used the occasion to ridicule the speaker’s move as a hollow ruse (Peters, 7/16).

Categories: Health Care

Acting VA Chief: Fixing Problems Will Cost Billions

Kaiser Health News - Thu, 07/17/2014 - 9:53am

Sloan Gibson, the acting secretary, told lawmakers that the agency needs $17.6 billion over the next three years to hire about 1,500 doctors and 8,500 other staff and to create more space in clinics and hospitals.

The New York Times: V.A. Official Says Fixing Issues At Root of Waiting-List Scandal Will Cost Billions
Fixing the problems that led to the waiting-list scandal at the Department of Veterans Affairs will cost $17.6 billion over the next three years, the agency’s acting secretary told lawmakers Wednesday, requiring the hiring of about 1,500 doctors and 8,500 nurses and other clinicians. The acting secretary, Sloan D. Gibson, told the Senate Veterans Affairs Committee that the money was necessary to “meet current demand” for medical care for veterans by addressing problems that included “shortfalls in clinical staff” as well as not having enough space in clinics and hospitals to see patients on time (Oppel, Jr., 7/16).

Politico: Cost Debate Slows VA Reform Bill 
House and Senate lawmakers negotiating a bill to reform the Department of Veterans Affairs are being weighed down over questions about how much the overhaul will cost. Conference committee members are working with the Congressional Budget Office to get a score that lawmakers can find credible. The nonpartisan office initially put the cost of the reform bills at more than $50 billion — an estimate lawmakers dispute — but has recently reduced that figure to under $33 billion (French and Everett, 7/17).

Los Angeles Times: Acting Head Of VA Says Agency Needs $17.6 Billion To Fix Problems
The Department of Veterans Affairs needs $17.6 billion in additional funds over the next three years to meet patients’ needs and fix the troubled agency’s problems, its acting director said Wednesday. Testifying for the first time on Capitol Hill, interim VA Secretary Sloan Gibson told the Senate Veterans Affairs Committee that the money would help VA medical centers decrease appointment waiting times and hire more doctors (Bratek, 7/16).

The Washington Post: Acting VA Chief Seeks $17.6 Billion
After vigorously defending the progress made in cutting medical-service wait times for veterans since he took over the Department of Veterans Affairs, acting secretary Sloan D. Gibson said the troubled agency needs $17.6 billion in additional funds and 10,000 additional staffers to truly address its systemic problems. Without increasing the number of doctors, staffers and beds in VA facilities, Gibson warned the Senate Veterans’ Affairs Committee, “the wait times just get longer” (Lowery and Hicks, 7/16).

Categories: Health Care

UnitedHealth, HCA See Profits From Obamacare

Kaiser Health News - Thu, 07/17/2014 - 9:52am

The giant insurer saw revenue growth from its Optum unit, which helped fix the federal health insurance website and has since been hired by several states. Meanwhile, the hospital company HCA Holdings Inc. said the health-care reform law contributed to sharply stronger results.

Bloomberg: Insurer That Fixed Obamacare Benefits From Business Boom
UnitedHealth Group Inc., the biggest U.S. health insurer by sales, beat analyst earnings estimates as revenue grew from its technology and consulting unit that helped fix the Obamacare insurance website. Revenue rose 7 percent to $32.6 billion, led by the company’s Optum unit, which works with hospitals, employers and governments to manage health costs. Optum has been credited with helping to fix the U.S. website for people to enroll in insurance under the Patient Protection and Affordable Care Act, or Obamacare, and has since been hired by several state enrollment websites. Sales there grew $2.6 billion, or 28 percent (Pettypiece, 7/17).

The Wall Street Journal: UnitedHealth Tops Expectations, Raises Outlook
UnitedHealth Group Inc. reported a better-than-expected increase of 7.1% in second-quarter revenue as the biggest U.S. health insurer saw growth in its public and senior markets. ... UnitedHealth, which is the biggest health insurer in the U.S., said impacts of the federal Affordable Care Act cut into its after-tax net margin for the most recent period by 90 basis points to 4.3%. This year will be the first to reflect the full implementation of the law, as cuts in government funding for certain provisions are projected to weigh on results. UnitedHealth credited growth in coverage in its public and senior sectors with helping to increase its top line, as well as improvement in its pharmacy services business (Calia, 7/17).

The Wall Street Journal: Hospital Operator HCA Touts Benefits From Health-Care Reform Law
HCA Holdings Inc. said admissions to its hospitals rebounded in the second quarter and greater-than-expected benefits from the health-care reform law contributed to sharply stronger results than estimated. "Results for the second quarter of 2014 exceeded our internal expectations, both in terms of our core operations and health-care reform," Chief Executive R. Milton Johnson said, while raising the company's outlook for the year as well (Jamerson, 7/16).

Categories: Health Care

State Highlights: Georgia Hospitals Brace For Broader Gun-Carry Law

Kaiser Health News - Thu, 07/17/2014 - 9:52am

A selection of health policy stories from Washington, Illinois, Minnesota, Missouri and Florida.  

The Wall Street Journal: Missouri To Allow Med-School Grads To Work As Assistant Physicians
Missouri will allow medical-school graduates to work as "assistant physicians" and treat patients in underserved rural areas, though they haven't trained in residency programs, despite strong opposition from some doctors' groups. At least one year of residency is usually required to practice medicine independently in the U.S.; most young doctors spend at least three years in such programs, which include intense on-the-job training and supervision (Beck, 7/16).

Seattle Times: Plenty Of Room To Improve, Says Report Rating Health Plans
Group Health Cooperative was the overall top-scoring health plan among five graded by the Washington Health Alliance, a collaborative of employers and others working to improve health-care transparency through measurement. What does the Alliance measure in its eValue8 report? For an insurance plan, it looks at processes aimed at ensuring patient safety, closing gaps in care, and improving consumers’ health and the health care they get. It also measures how well a plan controls costs, reduces waste, and whether it educates and encourages consumers to manage their own health well. The five plans that have volunteered to be measured — and have their results displayed publicly — also provide details on how they measure performance of medical providers, and how they pay them (Ostrom, 7/16).

The Wall Street Journal’s Washington Wire: Despite Challenges, Union Seeks To Win Over Home Health Workers
But a more important number might actually be a smaller one in AFSCME’s quest to convert these workers who had been resistant to joining their workplace union: A significant subset of them – more than 21,000— are home health care workers, the very kinds the U.S. Supreme Court recently said can’t be forced to pay dues to unions they don’t want to join. The union, said AFSCME President Lee Saunders, was dealt a “serious blow” last month by the court, which ruled that home care workers in Illinois – and possibly other states — aren’t full-fledged public employees, and therefore can’t be forced to pay dues to a public-sector union that represents them but that they don’t want to join. The ruling set the stage for more legal challenges to these dues, known as agency fees, down the road. It will also make it harder for AFSCME to represent home care workers, Mr. Saunders said (Trottman, 7/16).

Georgia Health News: How Will Broader Gun-Carry Law Affect Hospitals?
Now that Georgia’s controversial gun-carry legislation has taken effect, hospitals across the state are trying to figure out how to respond to it. The new law means different things for different hospitals. Generally speaking, hospitals that are considered government buildings have to comply with it, while those that are privately owned do not. And there are other exceptions, including one that pertains to Grady Memorial Hospital in Atlanta (Miller, 7/16). 

The Star Tribune: For Mental Health Patients, An Unmarked Ride To Psychiatric Care
In Minnesota, as in many other states, a patient who suffers a mental-health crisis often faces the added indignity of being taken to the emergency room in an ambulance or the back of a police car — even when there is no public safety risk. The experience can aggravate the patient’s trauma by alerting neighbors and friends to a mental illness they would rather keep private. Now, a number of hospitals and local officials across Minnesota are experimenting with ways to transport mental health patients in a more dignified manner, such as unmarked vehicles with plainclothes paramedics. They aim to reduce the stigma associated with a psychiatric crisis while also reducing the enormous cost of sending ambulances long distances (Serres, 7/16).

The Associated Press: Minnesota Hospitals Test Mental Health Transports
Minnesota hospitals are considering ways to transport mental health patients in unmarked vehicles instead of ambulances. The Star Tribune reports hospitals and local officials across the state are experimenting with ways of responding to a psychiatric crisis if there's no public safety risk. Changes could cut down on ambulance costs and the time police and fire departments spend transporting psychiatric patients (7/17).

Modern Healthcare: Halifax Ruling Supports Hospitals’ Defense in False-Claims Cases
A federal judge in Orlando, Fla., gave hospitals a reason to cheer when he ruled that violating Medicare's conditions of participation doesn't automatically expose providers to the potentially crippling triple-damages available under the False Claims Act. U.S. District Judge Gregory Presnell's recent ruling in the closely watched case of Elin Baklid-Kunz v. Halifax Hospital Medical Center bolstered a growing body of law around the False Claims Act that requires whistle-blowers to prove more than just violations of Medicare administrative rules. Though the ruling was consistent with recent law, the whistle-blower had urged him to decide otherwise (Carlson, 7/16).

Categories: Health Care

Questions Surround How Insurers Are Disclosing -- Or Not -- Their 2015 Proposed Rates

Kaiser Health News - Thu, 07/17/2014 - 9:51am

News outlets from Florida and Iowa report on recent developments in these states.

Health News Florida: How HMOs Hid Rates On State Site
How much will it cost Floridians to buy coverage next year on Healthcare.gov? Lots of people want to know, but the insurers are keeping the prices secret in an unprecedented way (Gentry, 7/16).

Des Moines Register:  Rate Increase Hearing Set For 18k Wellmark Customers
About 18,000 customers of Wellmark Blue Cross & Blue Shield will get the chance next month to sound off about a proposed rate increase, but the hearing will probably draw fewer people than previous ones. The Iowa Insurance Division's Aug. 23 hearing only affects customers holding policies with proposed premium increases of more than 6.1 percent. Wellmark, which is the state's dominant health insurance carrier, has proposed lower rate increases than that for most of its customers. The higher proposed rates this time – of 11.9 percent to 14.5 percent – affect people who bought new individual policies that meet the 2014 rules of the federal Affordable Care Act. Most of Wellmark's customers have older policies, which don't meet all those requirements but face smaller premium increases. State law requires the insurance division to hold public hearings when health insurers propose premium increases over 6.1 percent (Leys, 7/16).

Categories: Health Care

N.C. Senate Plan To Overhaul State Medicaid Program Draws Fire From Doctors And Hospitals

Kaiser Health News - Thu, 07/17/2014 - 9:51am

The North Carolina plan was presented by state senators during a Wednesday meeting of the Senate Rules and Operations Committee. Also, Arkansas Medicaid officials have reportedly said they are restricting access to an expensive cystic fibrosis drug because data don't support its use as a first-line option -- highlighting a wave of drug-coverage questions playing out across the country.  

North Carolina Health News: Newest Medicaid Reform Plan Gets Tepid Reception
Dr. Conrad Flick’s primary care office in Raleigh is not the kind of place where you’ll see a lot of ties. Instead, the eight doctors and nurse practitioners at Family Medical Associates of Raleigh are more likely to wear polo shirts or scrubs and take the time to sit and listen to patients. But Flick’s easy-going demeanor drops away quickly when he starts talking about the Senate’s latest plan to reform North Carolina’s Medicaid program. His voice becomes frustrated and angry. The system Flick refers to is one presented by state senators during a meeting of the Senate Rules and Operations Committee Wednesday morning. In the plan, senators call for moving the state’s Medicaid program to a “fully capitated” managed care system whereby doctors and hospitals are given a set amount of money to care for patients, no matter how complicated, and are compelled to live within that budget (Hoban, 7/17).

Raleigh News & Observer: NC Senate’s Proposal For Medicaid Overhaul Draws Criticism
A new Senate plan to overhaul the state’s Medicaid program drew immediate fire from doctors and hospitals who do not like that the proposal would open the state to commercial managed care for people using the government insurance. The legislature is trying to change Medicaid so the state knows each year about how much the program will cost (Bonner, 7/16).

Here's more on the Arkansas story -

The Wall Street Journal: Costly Vertex Drug Is Denied, And Medicaid Patients Sue
Arkansas officials declined to comment on specific allegations but said they are mainly restricting access because existing data don't support the drug's use as a first option. Cost also appears to be a factor: Emails obtained by the patients' attorneys show officials discussing Kalydeco's cost, and their worries about the expense of future cystic fibrosis drugs. The legal flap is the latest example of the pressure expensive new drugs are putting on cash-strapped government insurance programs (Walker, 7/16).

In other state Medicaid news, Denti-Cal's reimbursement rates in California are affecting access and Floridians with critical needs are starting to receive enrollment letters through the state's Home and Community-Based Services Medicaid waiver.

The California Health Report: Denti-Cal Patients Feel The Pain As Rates Shrink
A few years ago, Kathleen Hamilton became a foster mom to 13 and 14 year old boys, who also happened to be her nephews. Both needed extensive dental work, and the services were to be covered by the state’s Medi-Cal program. But year after year, Hamilton ran into a snag. “It was difficult to find a dentist who would take new Medi-Cal patients,” she recalls, “and every time I would go to make the next appointment, [the previous] dentist wouldn’t see them. I hopscotched all over East County San Diego, driving almost to Mexico,” she says (Johnson, 7/16).

Health News Florida: 1,200 With Critical Needs Off Waiting List
About 1,200 Floridians with critical needs will be getting enrollment letters from the Agency for Persons with Disabilities in the next two weeks. Those with critical needs on the agency’s waiting list as of July 1 will be offered enrollment in the Home and Community-Based Services Medicaid waiver. Overall, there are 21,141 on the waiting list as of June 1, according to Melanie Etters, the agency's communications director (Menzel, 7/16).

Categories: Health Care

Va. Gov. To Visit Free Medical Camp Set Up For Uninsured

Kaiser Health News - Thu, 07/17/2014 - 9:50am

Gov. Terry McAuliffe will fly to southwest Virginia to draw attention to the uninsured as he continues his campaign to expand Medicaid. In Wisconsin, officials release data showing that about one of three people who lost coverage when Gov. Scott Walker changed BadgerCare health insurance later bought plans on the federal health exchange.

The Washington Post: McAuliffe To Visit Free Health Clinic To Expand Health-Care
Gov. Terry McAuliffe, due to return Thursday from an eight-day trade mission to China and London, will hop on a plane the very next day to fly to a free medical clinic in far southwest Virginia. ... the Democrat's trip to the Remote Area Medical expedition in Wise County is intended to highlight the plight of the state's uninsured citizens — and bolster the governor's bid to expand access to health-care. A field hospital springs up every year on the Wise County Fairgrounds near the Kentucky Border. For three days, hundreds of dentists, doctors and other health-care providers volunteer their services, and 1,000 or more people camp out for the chance to get a tooth pulled or various ailments checked out (Vozzella, 7/17).

Milwaukee Journal-Sentinel: One-Third Who Lost BadgerCare Coverage Bought Plans On Federal Marketplace
About one out of three people who lost their BadgerCare Plus health insurance under the state's unusual approach to the Affordable Care Act bought subsidized health plans on the marketplace set up by the federal law, according to figures released Wednesday by the state Department of Health Services. The figures provide the first thorough look at the number of people who gained and lost coverage through BadgerCare Plus, Wisconsin's Medicaid program, under the approach taken by Gov. Scott Walker's administration. The approach expanded coverage through BadgerCare Plus for the poorest adults while dropping coverage for others who would be eligible to buy subsidized health plans on the federal marketplace (Boulton, 7/16).

The Associated Press: Data Shows Most Who Lost Medicaid Coverage In Wisconsin Didn't Buy Insurance Through Exchange
More than 60 percent of the people in Wisconsin who lost state Medicaid coverage earlier this year did not purchase private insurance through the online marketplace, according to official data released Wednesday. Gov. Scott Walker has defended his administration's attempts to reach out to the nearly 63,000 people who lost coverage under the more limited income requirements he put in place. But the new numbers released by the Department of Health Services fueled criticism from opponents who argue it was wrongheaded of Walker to reject federal money for expanded coverage (Bauer, 7/16).

Categories: Health Care

Viewpoints: GOP's 'Cynical' Lawsuit Against Obama; Debt Crisis Is Not Over

Kaiser Health News - Thu, 07/17/2014 - 9:50am

Los Angeles Times: Just How Cynical Can The House Get In Attacking Obama?
There's not much that Republicans like about the 2010 Affordable Care Act, but one thing they particularly dislike is the requirement that employers with 50 or more full-time workers provide comprehensive health insurance. So it's only natural that House Republicans would now be seeking to sue the president for not implementing that mandate on time. Wait, what? (Jon Healey, 7/16). 

The Washington Post: A Lawsuit With Little Merit
Rep. Pete Sessions, the House Rules Committee chairman who led Wednesday's hearing on Republicans' plans to sue President Obama, presented the legal credentials that have put him in this position of responsibility. "I'm an Eagle Scout," the Texas Republican told his colleagues. "I studied the merit badges that we took about governance, about cities, states, the national government" (Dana Milbank, 7/16).

Politico: Obama's Hilarious Lawlessness
The lawsuit against the president undertaken by House Speaker John Boehner targets the serial delay of Obamacare’s employer mandate, just one of a number of seat-of-the-pants delays and alterations in the law. According to the text of the Affordable Care Act, the mandate was supposed to go into effect on Jan. 1, 2014. The administration nonetheless delayed it for an entire year via a Treasury Department blog post in July 2013. Before his adoring audiences, the president says he has to act because Congress won't. In this case, Congress was happy to act. In fact, the House passed a bill to delay the mandate until Jan. 1, 2015. President Obama threatened to veto it (Rich Lowry, 7/16).

The Wall Street Journal: How To Run Against ObamaCare
Liberal columnists and Democratic strategists have taken to arguing that ObamaCare is working and no longer a political negative, implying that Democratic candidates should tout it on the campaign trail. Republicans should pray they do, assuming the GOP knows how to respond. As presidential scholar George Edwards III observed in his 2012 book "Overreach," the Affordable Care Act is "perhaps the least popular major domestic policy passed in the last century." It remains so today. A June 3 Fox News poll found 38% were "glad the health care law passed" while 55% "wish it had never passed." Only 29% thought "the country is better off" with the law while 44% said America was "worse off" (Karl Rove, 7/16).

The New York Times' Taking Note: The Moderate Revolution In Kansas
A surprising political revolt is now brewing in Kansas. ... But the group's bill of particulars against [Gov. Sam] Brownback — a mini-Declaration of Independence for moderates — goes far beyond what it calls a "reckless tax experiment" that actually raised middle-class taxes and pushing the state's economy below all of its neighbors. It points out that the governor's refusal to expand Medicaid had hurt Kansas hospitals and driven people out of rural counties (David Firestone, 7/16). 

The New York Times' The Upshot: The Global Slowdown In Medical Costs
We tend to think of health care as a local good. Most people use the doctor or hospital in their neighborhood. China does not export medical care. Health and life spans differ from country to country, even county to county. But when it comes to health care spending, the picture is starting to look more global. After decades when health spending in the United States grew much faster than it did in other Western countries, a new pattern has emerged in the last two decades. And it has become particularly pronounced since the economic crisis. The rate of health cost growth has slowed substantially since 2000 in every high-income country, including the United States, Canada, Britain, France, Germany and Switzerland, according to data from the Organization for Economic Cooperation and Development (Margot Sanger-Katz, 7/16).

The Washington Post: No, Washington Hasn't Solved The Country's Debt Problem
Washington has taken an indefinite break from the budget debate that marked the early part of this decade. No one's expecting a grand bargain any time soon. ... Deficits have come down from their historic highs during the Great Recession and its aftermath. Health-care costs have not risen as quickly in the last few years, helping to right the country’s fiscal balance and making the long-term budget outlook a bit more manageable. But the Congressional Budget Office (CBO) on Tuesday rained on this bipartisan parade. In its latest long-term budget projection, the country's arbiter of all things fiscal warned that federal spending remains dangerously unsustainable in the long term. Over the next 25 years, mandatory spending on entitlement programs such as Medicare is set to rise to 14 percent of gross domestic product, double the average over the past several decades (7/16). 

The Wall Street Journal’s Washington Wire: CBO Forecast Points Up The Need For Entitlement Reform
The Congressional Budget Office’s annual long-term budget forecast prompted numerous news articles about a potential slowdown in the growth of health spending and what that would mean for Medicare and other programs. But federal entitlement spending in the short and medium term will be defined much more by the demographics of an aging population–10,000 baby boomers reach retirement age every day–than by whether policymakers can bend the proverbial cost curve in health care (Chris Jacobs, 7/16).

USA Today: Why $1,000 A Pill? Our View
In the good-news/bad-news world of blockbuster drugs, the latest is the launch of Sovaldi, a drug to treat hepatitis C. Sovaldi comes with a cure rate as high as 90% for a disease that afflicts 3 million people in the United States, and with fewer complications than previous treatments. But it also comes with a scary side effect: a price of $1,000 a pill (7/16). 

USA Today: Hepatitis C Drug Worth The Price: Opposing View
If you know how this disease can ravage a patient's body, how painful, lengthy and only partially effective previous treatments were — as well as how expensive it is to care for patients who aren't cured — then you can begin to understand the true personal, clinical and public health value of sofosbuvir. Additionally, by curing patients, this medicine helps to stop the transmission of an infectious disease. When you take into consideration that it works better than other treatments, in half the time, for a comparable price — and will save money for our health care system in the long run — then it's difficult for me to understand why it has come under such disproportionate criticism (Sammy Saab, 7/16). 

WBUR: On The Road With Project Louise, Marveling 'Who Is This Person?'
In my previous job, I spent a fair amount of time on the road each summer, traveling to theaters in the Berkshires and on Cape Cod. (Hey, somebody had to do it.) And I gained weight – because, I told myself, it was impossible not to gain weight when I was traveling so much, eating road food and going to restaurants and so on. Well, that was just plain wrong. I realized that this weekend, when a family event put me on the highway for an eight-hour road trip. (Sixteen, actually, if we’re talking round trip.) And I am here to tell you that, even on the New Jersey Turnpike, you do not have to eat junk (Louise Kennedy, 7/16).

Journal of the American Medical Association: Quality Reporting That Addresses Disparities In Health Care
More than a decade has passed since the landmark Institute of Medicine report Unequal Treatment documented the sizeable and pervasive disparities that affect the US health care system. Yet there has been little evidence of progress toward eliminating, or even reducing, these inequities in care. Furthermore, there is increasing concern that existing policy efforts designed to improve quality may, in fact, worsen disparities in care. Most recently, the Medicare pay-for-performance effort with the largest financial penalties, the Hospital Readmissions Reduction Program, was found to disproportionately penalize safety-net facilities that primarily care for disadvantaged and poor populations (Ashish K. Jha and Alan M. Zaslavsky, 7/16).

Journal of the American Medical Association: Professional Organizations' Role In Supporting Physicians To Improve Value In Health Care
Some of the [federal health] law’s provisions, such as the Physician Value-Based Modifier (PVBM), will include financial incentives that directly affect individual clinicians, thus providing an external force for engaging physicians in efforts to improve health care value. Despite this looming mandate—PVBM will go in effect in 2015 for large physician groups and in 2017 for all physicians—some physicians may lack the tools and motivation necessary to improve the value of their individual care delivery. Notably, the current system does not compel high-value care. Not only is mitigating waste and judiciously ordering tests and referrals disincentivized in the fee-for-service system, doing so is more cognitively taxing and there is a perceived increased risk of legal repercussions (Leah Marcotte, Christopher Moriates and Arnold Milstein, 7/16).

Journal of the American Medical Association: Advancing Telecare For Pain Treatment In Primary Care
Chronic musculoskeletal pain accounts for an estimated 60 million ambulatory care visits in the United States each year and significantly impairs quality of life. Management of chronic musculoskeletal pain is frequently frustrating, both for patients and for their primary care physicians. ... However, in the absence of effective systems for implementing evidence-based approaches for treating chronic pain, improved awareness of pain has resulted in increased and sometimes indiscriminate prescribing of chronic opioids, with harmful effects. Because of the high prevalence of chronic pain and the limited capacity of specialty pain clinics, effective interventions are needed that can be safely and widely implemented by primary care practices (Michael E. Ohl and Gary E. Rosenthal, 7/16).

The New England Journal Of Medicine: Money, Sex, And Religion — The Supreme Court's ACA Sequel
The majority decision, written by Justice Samuel Alito, is a setback for both the ACA's foundational goal of access to universal health care and for women's health care specifically. It is also especially worrisome that abortion is again at the center of the continuing debate over the implementation of the ACA and that the challenge of abortion has been expanded to include birth control. ... Our incremental, fragmented, and incomplete health insurance system means that different Americans have different access to health care on the basis of their income, employment status, age, and sex. The decision in Hobby Lobby unravels only one more thread, perhaps, but it tugs on a quilt that is already inequitable and uneven (George J. Annas,  Theodore W. Ruger and Jennifer Prah Ruger, 7/16).

The New England Journal Of Medicine: Culturally And Linguistically Appropriate Services — Advancing Health With CLAS
Currently, about 20% of the U.S. population speaks a language other than English at home, and 9% has limited English proficiency. By 2050, the United States will be a "majority minority" nation, with more than half the population coming from racial or ethnic minority backgrounds. Diversity is even greater when dimensions such as geography, socioeconomic status, disability status, sexual orientation, and gender identity are considered. Attention to these trends is critical for ensuring that health disparities narrow, rather than widen, in the future. ... Advancing health with CLAS can help us attain the high-quality system of care and prevention that all people, regardless of background, need and deserve (Dr. Howard K. Koh, Dr. J. Nadine Gracia, and Mayra E. Alvarez,  7/17).

Categories: Health Care

Insurers Seek Rule Change That Would Boost Profits

Kaiser Health News - Thu, 07/17/2014 - 9:50am

The industry wants to exclude brokers' fees from being factored into administrative costs, which would reduce consumer refunds under the health law's medical loss ratio rule. Currently, the rule requires plans in the small group market to spend at least 80 percent of premiums on medical costs and no more than 20 percent on administrative costs. Other stories look at access to specialty care and predicted Obamacare disasters that never happened.

The Fiscal Times: How An Obamacare Tweak Could Save Insurers Millions
The insurance industry is quietly pushing lawmakers to tweak a very wonky rule in the Affordable Care Act that could save them money and significantly reduce the amount consumers would receive in rebates each year. At issue is the ACA’s medical loss ratio (MLR) which requires insurers to spend at least 80 percent of their revenue from premiums on health care related costs and no more than 15 percent on administrative costs for large groups and 20 percent for small groups. If insurers don’t meet the MLR, they are required to rebate the difference to their customers. ... Right now, the MLR includes payments to brokers and agents as part of insurers’ administrative costs. Industry trade groups want that changed (Ehley, 7/17).

Kaiser Health News: Specialty Care Is A Challenge In Some ACA Plans
Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits. But they’re also causing headaches in the day-to-day work of doctors and clinics. "The biggest problem we’ve run into is figuring out what specialists take a lot of these plans," said Dr. Charu Sawhney of Houston (Feibel, 7/16). 

The Milwaukee Journal Sentinel: One-Third Who Lost Badgercare Coverage Bought Plans On Federal Marketplace
About one out of three people who lost their BadgerCare Plus health insurance under the state's unusual approach to the Affordable Care Act bought subsidized health plans on the marketplace set up by the federal law, according to figures released Wednesday by the state Department of Health Services. The figures provide the first thorough look at the number of people who gained and lost coverage through BadgerCare Plus, Wisconsin's Medicaid program, under the approach taken by Gov. Scott Walker's administration. The approach expanded coverage through BadgerCare Plus for the poorest adults while dropping coverage for others who would be eligible to buy subsidized health plans on the federal marketplace (Boulton, 7/16).

CQ Healthbeat: Skepticism Voiced Over HHS' Ability to Verify Insurance Subsidies
House Republicans expressed doubt Wednesday that the Department of Health and Human Services will have a system in place to verify eligibility for insurance subsidies in time for the Nov. 15 start of open enrollment to buy 2015 coverage in health exchanges. Tens of thousands of undocumented immigrants may get taxpayer subsidies as a result, suggested Rep. Bill Cassady, R-La., at a hearing of the House Energy and Commerce Health Subcommittee. Much of the infrastructure for insurance exchange operations remains incomplete, asserted Energy and Commerce Chairman Fred Upton, R-Mich. (Reichard, 7/17).

The Associated Press: House Passes $20B Bill Cutting IRS Tax Enforcement
The GOP-controlled House passed a $20 billion measure Wednesday that would slash budgets for enforcing tax laws and new financial regulations, and a healthy food initiative that's a pet cause of first lady Michelle Obama. The House passed the bill on a nearly party-line, 228-195, vote. Companion legislation has yet to advance in the Senate and the White House has promised a veto of the House bill for numerous reasons, including a provision that would block the Internal Revenue Service from enforcing the mandate on individuals to buy health insurance under the Affordable Care Act. (Taylor, 7/16).

Vox: 7 Predicted Obamacare Disasters That Never Happened
Back in the fall of 2013, it wasn't exactly a bold move to predict Obamacare would turn out to be a complete disaster. Americans are "not interested" in signing up, talk radio host Rush Limbaugh declared on his radio show in late October. ... These days, Obamacare seems to be working reasonably well. More Americans have health insurance now than did a year ago.  People who bought Obamacare say they're generally pretty happy with their health insurance plans and that they can mostly get a doctor appointment within two weeks. Looking back at expectations set  last fall and this spring shows how terribly pundits and politicians expected Obamacare to go — and how much of the predicted disaster never actually happened (Kliff, 7/15).

Categories: Health Care

Political Cartoon: 'Barack To The Future?'

Kaiser Health News - Thu, 07/17/2014 - 9:49am

Kaiser Health News provides a fresh take on health policy developments with "Barack To The Future" by John Hambrock.

Meanwhile, here's today's haiku:

AN UNCALCULATED RISK

He got a shark bite
and does not have insurance.
Who will pay the bill?
-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

Probate Court Issues Revised Procedures and Forms for Health Care Proxy Disputes

Massachsuetts Trial Court Law Library - Thu, 07/17/2014 - 8:00am
The Probate and Family Court has released new procedures and forms for health care proxy disputes.  Under Massachusetts General Laws chapter 201D, section 17, an action can be filed to remove a health care agent, to determine the validity of a health care proxy, or to override a health care agent's decision about health care treatment.  A document entitled "Procedure for Actions Filed under G.L. c. 201D" (MPC 956) explains what forms are necessary, where to file, filing fees, whether counsel is appointed, notice requirements, and what happens at the hearing.
Categories: Research & Litigation

First Edition: July 17, 2014

Kaiser Health News - Thu, 07/17/2014 - 7:17am

Today's headlines include reports about how Capitol Hill politics are impacting health care policy.  

Kaiser Health News: Specialty Care Is A Challenge In Some ACA Plans
Houston Public Media’s Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: “Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits. But they’re also causing headaches in the day-to-day work of doctors and clinics. 'The biggest problem we’ve run into is figuring out what specialists take a lot of these plans,' said Dr. Charu Sawhney of Houston” (Feibel, 7/16). Read the story.

Kaiser Health News: Capsules: Registered Nurses Increasingly Delay Retirement, Study Finds
Now on Kaiser Health News’ blog, Shefali Luthra writes: “Despite predictions of an impending nurse shortage, the current number of working registered nurses has surpassed expectations in part due to the number of baby-boomer RNs delaying retirement, a study by the RAND Corp. found” (Luthra, 7/16). Check out what else is on the blog.

The New York Times: Partisanship Infuses Hearings On Health Law And Executive Power
Efforts by congressional Republicans to rein in what they say are the legislative and political excesses of the Obama administration played out in simultaneous hearings on Wednesday, further highlighting how election-year politics are overtaking business on Capitol Hill. The first hearing, by the House Committee on Oversight and Government Reform, was quickly adjourned after the administration refused to allow testimony from David Simas, the White House political director, who had been called under a Republican subpoena to answer questions about Democratic campaign activities. The second, a debate in the House Rules Committee on the merits of a lawsuit that Speaker John A. Boehner plans to file against President Obama, exposed simmering partisan tensions as Democrats used the occasion to ridicule the speaker’s move as a hollow ruse (Peters, 7/16).

The Wall Street Journal: Hospital Operator HCA Touts Benefits From Health-Care Reform Law
HCA Holdings Inc. said admissions to its hospitals rebounded in the second quarter and greater-than-expected benefits from the health-care reform law contributed to sharply stronger results than estimated. "Results for the second quarter of 2014 exceeded our internal expectations, both in terms of our core operations and health-care reform," Chief Executive R. Milton Johnson said, while raising the company's outlook for the year as well (Jamerson, 7/16).

The Wall Street Journal: UnitedHealth Tops Expectations, Raises Outlook
UnitedHealth, which is the biggest health insurer in the U.S., said impacts of the federal Affordable Care Act cut into its after-tax net margin for the most recent period by 90 basis points to 4.3%. This year will be the first to reflect the full implementation of the law, as cuts in government funding for certain provisions are projected to weigh on results. UnitedHealth credited growth in coverage in its public and senior sectors with helping to increase its top line, as well as improvement in its pharmacy services business (Calia, 7/17).

NPR: The Two Way: Democratic Effort To Override Hobby Lobby Ruling Fails
A Democratic effort to override the Supreme Court's recent ruling on contraceptive coverage failed in the Senate on Wednesday. Bill sponsors fell four votes short of the 60 votes needed to cut off debate on the measure (Greenblatt, 7/16).

The Wall Street Journal: Senate Bill To Nullify Hobby Lobby Decision Fails
Senate Republicans on Wednesday blocked Democrats' effort to undermine the Supreme Court's Hobby Lobby decision, ending a round of partisan jousting aimed at capturing women's votes in the fall. A bill from Senate Democrats designed to restore employers' responsibility to provide contraception coverage under the Affordable Care Act was defeated 56-43 on a procedural vote. It sought to prevent companies from using a religious-freedom law to avoid complying with a requirement to cover all forms of contraception approved by the government without charging workers a copayment (Peterson, 7/16).

The Associated Press: Dems Seek Gains With Women In Birth Control Loss
Republicans blocked a bill that was designed to override a Supreme Court ruling and ensure access to contraception for women who get their health insurance from companies with religious objections. The vote was 56-43 to move ahead on the legislation — dubbed the “Not My Boss’ Business Act” by proponents — four short of the 60 necessary to proceed. But Democrats hope the issue has enough life to energize female voters in the fall, when Republicans are threatening to take control of the Senate. GOP senators said Wednesday’s vote was simply a stunt, political messaging designed to boost vulnerable Democratic incumbents. The GOP needs to gain six seats to seize control (7/16).

USA Today: Senate GOP Blocks Bill To Overturn Hobby Lobby Ruling
The Senate on Wednesday torpedoed a Democratic plan to reverse a recent Supreme Court ruling allowing some employers to decline to provide employees insurance coverage for some forms of birth control on religious grounds. The bill failed to get 60 votes needed to cross a procedural hurdle, as Republicans were largely united against it. Three Republican senators voted for the bill: Mark Kirk of Illinois, Lisa Murkowski of Alaska and Susan Collins of Maine. The bill had no hope of passage in the Republican-controlled House; Democrats tried and failed to force a vote in the House on a similar bill Tuesday (Singer and Dekimpe, 7/16).

Politico: Democratic Bid To Reverse Hobby Lobby Fails
A Democratic bill to reverse the Supreme Court’s recent Hobby Lobby decision narrowly failed in the Senate on Wednesday, but it sparked more contentious debate over contraception and religious freedom that both sides hope will mobilize their voters in November. The bill in effect says a 1993 religious freedom law at the heart of the Hobby Lobby case doesn’t apply to legally required health benefits. The Supreme Court had cited the Religious Freedom Restoration Act in ruling that certain for-profit businesses can on religious grounds be exempted from the Obamacare requirement that the health plans they offer workers include FDA-approved birth control with no co-pays (Winfield Cunningham, 7/16).

The Wall Street Journal: Costly Vertex Drug Is Denied, And Medicaid Patients Sue
Arkansas officials declined to comment on specific allegations but said they are mainly restricting access because existing data don't support the drug's use as a first option. Cost also appears to be a factor: Emails obtained by the patients' attorneys show officials discussing Kalydeco's cost, and their worries about the expense of future cystic fibrosis drugs. The legal flap is the latest example of the pressure expensive new drugs are putting on cash-strapped government insurance programs (Walker, 7/16).

Politico: Cost Debate Slows VA Reform Bill 
House and Senate lawmakers negotiating a bill to reform the Department of Veterans Affairs are being weighed down over questions about how much the overhaul will cost. Conference committee members are working with the Congressional Budget Office to get a score that lawmakers can find credible. The nonpartisan office initially put the cost of the reform bills at more than $50 billion — an estimate lawmakers dispute — but has recently reduced that figure to under $33 billion (French and Everett, 7/17).

The New York Times: V.A. Official Says Fixing Issues At Root of Waiting-List Scandal Will Cost Billions
Fixing the problems that led to the waiting-list scandal at the Department of Veterans Affairs will cost $17.6 billion over the next three years, the agency’s acting secretary told lawmakers Wednesday, requiring the hiring of about 1,500 doctors and 8,500 nurses and other clinicians. The acting secretary, Sloan D. Gibson, told the Senate Veterans Affairs Committee that the money was necessary to “meet current demand” for medical care for veterans by addressing problems that included “shortfalls in clinical staff” as well as not having enough space in clinics and hospitals to see patients on time (Oppel, Jr., 7/16).

Los Angeles Times: Acting Head Of VA Says Agency Needs $17.6 Billion To Fix Problems
The Department of Veterans Affairs needs $17.6 billion in additional funds over the next three years to meet patients’ needs and fix the troubled agency’s problems, its acting director said Wednesday. Testifying for the first time on Capitol Hill, interim VA Secretary Sloan Gibson told the Senate Veterans Affairs Committee that the money would help VA medical centers decrease appointment waiting times and hire more doctors (Bratek, 7/16).

The Washington Post: Acting VA Chief Seeks $17.6 Billion
After vigorously defending the progress made in cutting medical-service wait times for veterans since he took over the Department of Veterans Affairs, acting secretary Sloan D. Gibson said the troubled agency needs $17.6 billion in additional funds and 10,000 additional staffers to truly address its systemic problems. Without increasing the number of doctors, staffers and beds in VA facilities, Gibson warned the Senate Veterans’ Affairs Committee, “the wait times just get longer” (Lowery and Hicks, 7/16).

The Associated Press: New Guidelines Could Help Many Pregnant Workers
New federal guidelines on job discrimination against pregnant workers could have a big impact on the workplace and in the courtroom. The expanded rules adopted by the bipartisan Equal Employment Opportunity Commission make clear that any form of workplace discrimination or harassment against pregnant workers by employers is a form of sex discrimination — and illegal (7/16).

The Wall Street Journal’s The Numbers: Does Sexual Orientation Matter When It Comes To Health?
The 2013 survey was the first time the annual National Health Interview Survey included questions to measure sexual orientation. The survey collected information from 34,557 people over 18 in the U.S. It showed about 96.6% of adults in the United States identified themselves as straight, 1.6% identified as gay or lesbian and 0.7% identified as bisexual. A little over 1% didn’t respond to the sexual orientation question. Looking at health-related behavior, there were some significant differences based on sexual orientation. Overall, gays/lesbians and bisexual people were much more likely to smoke cigarettes than a straight person. When broken down by gender, there wasn’t much significant difference with men, but gay/lesbian women (25.7%) and bisexual women (28.5) were much more likely than their straight counterparts (15%) to smoke (Sparks, 7/16).

The Washington Post: McAuliffe To Visit Free Health Clinic To Expand Health-Care
Gov. Terry McAuliffe, due to return Thursday from an eight-day trade mission to China and London, will hop on a plane the very next day to fly to a free medical clinic in far southwest Virginia. While McAuliffe’s overseas journey was meant to boost trade and investment in Virginia, the Democrat’s trip to the Remote Area Medical expedition in Wise County is intended to highlight the plight of the state’s uninsured citizens — and bolster the governor’s bid to expand access to health-care (Vozzella, 7/17).

The Wall Street Journal: Missouri To Allow Med-School Grads To Work As Assistant Physicians
Missouri will allow medical-school graduates to work as "assistant physicians" and treat patients in underserved rural areas, though they haven't trained in residency programs, despite strong opposition from some doctors' groups. At least one year of residency is usually required to practice medicine independently in the U.S.; most young doctors spend at least three years in such programs, which include intense on-the-job training and supervision (Beck, 7/16).

The Wall Street Journal’s Washington Wire: Despite Challenges, Union Seeks To Win Over Home Health Workers
But a more important number might actually be a smaller one in AFSCME’s quest to convert these workers who had been resistant to joining their workplace union: A significant subset of them – more than 21,000— are home health care workers, the very kinds the U.S. Supreme Court recently said can’t be forced to pay dues to unions they don’t want to join. The union, said AFSCME President Lee Saunders, was dealt a “serious blow” last month by the court, which ruled that home care workers in Illinois – and possibly other states — aren’t full-fledged public employees, and therefore can’t be forced to pay dues to a public-sector union that represents them but that they don’t want to join. The ruling set the stage for more legal challenges to these dues, known as agency fees, down the road. It will also make it harder for AFSCME to represent home care workers, Mr. Saunders said (Trottman, 7/16).

Los Angeles Times: Swimmer Bitten By Shark Has No Insurance, Mounting Medical Bills
More than 20 people spoke during the public comment period of the council meeting, echoing ongoing debate ignited when a long-distance swimmer was bitten by a juvenile great white shark July 5. It's believed the shark was thrashing to free itself from a fisherman's line when it bit Steven Robles, 50, in the side not far from the pier. … Robles continues to recover from his injuries and had more stitches removed from his abdomen Monday. He said he has no health insurance and is facing large medical bills (Troung, 7/16). 

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Categories: Health Care

How Playing Music Affects The Developing Brain

CommonHealth (WBUR) - Thu, 07/17/2014 - 6:04am

A cellist at the Conservatory Lab Charter School in Boston plays during a recital rehearsal. Research has found music instruction has beneficial effects on young brains. (Jesse Costa/WBUR)

Remember “Mozart Makes You Smarter”?

A 1993 study of college students showed them performing better on spatial reasoning tests after listening to a Mozart sonata. That led to claims that listening to Mozart temporarily increases IQs — and to a raft of products purporting to provide all sorts of benefits to the brain.

In 1998, Zell Miller, then the governor of Georgia, even proposed providing every newborn in his state with a CD of classical music.

But subsequent research has cast doubt on the claims.

Ani Patel, an associate professor of psychology at Tufts University and the author of “Music, Language, and the Brain,” says that while listening to music can be relaxing and contemplative, the idea that simply plugging in your iPod is going to make you more intelligent doesn’t quite hold up to scientific scrutiny.

“On the other hand,” Patel says, “there’s now a growing body of work that suggests that actually learning to play a musical instrument does have impacts on other abilities.” These include speech perception, the ability to understand emotions in the voice and the ability to handle multiple tasks simultaneously.

Patel says this is a relatively new field of scientific study.

“The whole field of music neuroscience really began to take off around 2000,” he says. “These studies where we take people, often children, and give them training in music and then measure how their cognition changes and how their brain changes both in terms of its processing [and] its structure, are very few and still just emerging.”

Patel says that music neuroscience, which draws on cognitive science, music education and neuroscience, can help answer basic questions about the workings of the human brain.

“How do we process sequences with complex hierarchical structure and make sense of them?” he asks. “How do we integrate sensation and action? How do we remember long and difficult sequences of information? These are fundamental neuroscience questions, and music can help us answer some of these questions, because it’s in some ways simpler than language, but it’s still of sufficient complexity that it can address these very deep and important aspects of human brain function.”

In addition, Patel says music neuroscience research has important implications about the role of music in the lives of young children.

“If we know how and why music changes the brain in ways that affect other cognitive abilities,” he says, “this could have a real impact on the value we put on it as an activity in the schools, not to mention all the impact it has on emotional development, emotional maturity, social skills, stick-to-itiveness, things we typically don’t measure in school but which are hugely important in a child’s ultimate success.”

El Sistema At One Boston School

Kathleen Jara, co-director of the El Sistema program at the Conservatory Lab Charter School in Boston, directs orchestra students during a rehearsal for their year-end recital. (Jesse Costa/WBUR)

At the Conservatory Lab Charter School in Boston, every student receives music instruction.

“It doesn’t matter whether they have had music instruction before or not,” says Diana Lam, the head of the school.

The school, which accepts new students by lottery, is bucking a national trend, as more and more cash-strapped school districts pare down or eliminate music programs.

Lam says music is part of her school’s core curriculum because it teaches students to strive for quality in all areas of their lives — and because it gets results.

“Music addresses some of the behaviors and skills that are necessary for academic success,” she says. “Since we started implementing El Sistema, the Venezuelan music program, as well as project-based learning, our test scores have increased dramatically.”

Musically Trained Kids With Better Executive Functioning Skills

But what does the latest scientific research tell us? The question, according to neuropsychologist Nadine Gaab, is not simply whether music instruction has beneficial effects on young brains.

“There’s a lot of evidence,” Gaab says, “that if you play a musical instrument, especially if you start early in life, that you have better reading skills, better math skills, et cetera. The question is, what is the underlying mechanism?”

At her lab at Boston Children’s Hospital, Gaab leads a team of researchers studying children’s brain development, recently identifying signs in the brain that might indicate dyslexia before kids learn to read, as we discussed in an earlier report from this series. Gaab and her colleagues are also looking for connections between musical training and language development.

“Initially we thought that it’s training the auditory system, which then helps you with language, reading and other academic skills,” she says.

Instead, in a study published last month, Gaab and her team delineated a connection — in both children and adults — between learning to play an instrument and improved executive functioning, like problem-solving, switching between tasks and focus.

“Could it be,” Gaab asks, “that musical training trains these executive functioning skills, which then helps with academic skills?”

MRI scans show brain activation during executive functioning testing. The top row, row A, is of musically trained children. The bottom row, row B, is of untrained children. There’s more activation in the musically trained children. (Courtesy Nadine Gaab)

To find out, researchers gave complex executive functioning tasks to both musically trained and untrained children while scanning their brains in MRI machines.

“For example,” Gaab says, “you would hear the noise of a horse, ‘neigh,’ and every time you hear the horse, whenever you see a triangle you have to press the left button and whenever you see a circle you have to press the right button. However, if you hear a frog, the rule switches.”

While noting the children’s ability to follow the rules, the scientists also watched for activity in the prefrontal cortex of the brain, known to be the seat of executive functioning.

“We were just looking at how much of the prefrontal cortex was activated while they were doing this ‘neigh-froggy’ task in the scanner,” Gaab says. “And we could show that musically trained children and professional adult musicians have better executive functioning skills compared to their peers who do not play a musical instrument. We could further show that children who are musically trained have more activation in these prefrontal areas compared to their peers.”

So does music-making enhance executive functioning?

Gaab hastens to add, “We don’t know what’s the egg and what’s the hen.” That is, whether musical proficiency makes for better executive functioning, or vice-versa.

But Gaab cites other studies which imply the former.

“It’s most likely the musical training that improves executive functioning skills,” she says. “You could just hypothesize that playing in an orchestral setting is particularly training the executive functioning skills because you have to play in a group; you have to listen to each other.”

And Gaab says that’s analogous to what happens in the brain of a musician.

“There are a lot of different brain systems involved in successfully playing even a small musical piece: your auditory system, your motor system, your emotional system, your executive function system; this playing together of these brain regions, almost like in a musical ensemble.”

Changing ‘Brain Plasticity’

But the question remains: Why would acquiring musical skills influence language and other higher brain functions? Neuropsychologist Patel has developed a theory he calls the OPERA hypothesis.

“The basic idea is that music is not an island in the brain cut off from other things, that there’s overlap, that’s the ‘O’ of OPERA, between the networks that process music and the networks that are involved in other day-to-day cognitive functions such as language, memory, attention and so forth,” he says. “The ‘P’ in OPERA is precision. Think about how sensitive we are to the tuning of an instrument, whether the pitch is in key or not, and it can be painful if it’s just slightly out of tune.”

That level of precision in processing music, Patel says, is much higher than the level of precision used in processing speech. This means, he says, that developing our brains’ musical networks may very well enhance our ability to process speech.

“And the last three components of OPERA, the ‘E-R-A,’ are emotion, repetition and attention,” he says. “These are factors that are known to promote what’s called brain plasticity, the changing of the brain’s structure as a function of experience.”

Patel explains that brain plasticity results from experiences which engage the brain through emotion, are repetitive, and which require full attention. Experiences such as playing music.

“So this idea,” he says, “that music sometimes places higher demands on the brain, on some of the same shared networks that we use for other abilities, allows the music to actually enhance those networks, and those abilities benefit.”

One striking example of this is the use of singing to restore speech. At the Music and Neuroimaging Lab at Beth Israel Deaconess Medical Center, Dr. Gottfried Schlaug has pioneered singing as a therapeutic method of rehabilitating victims of stroke and other brain injuries, as well as people with severe autism.

And some of the most recent music neuroscience research is using music as a tool to better understand, and even predict, language-based learning disabilities.

But not all of the ideas behind this research, or even the methods, have come from scientists.

Using Music To Test Literacy Ability

Paulo Andrade teaches music at Colegio Criativa, a private school in Marilia, Brazil. He and his wife Olivia, who’s also a teacher there, became interested in the relationship between musical and language skills among their elementary school students.

“We both work with the same children,” Andrade says, “and we started to exchange information about how the children were going. I could relate the musical development of children to their language ability and literacy.”

Andrade developed some collective classroom tasks to identify children at risk of learning disabilities. He asked his second-grade music class to listen to him play a series of chord sequences on the guitar, and identify each one.

“I asked [the] children to write visual symbols to represent the sound sequence they were hearing,” he explains, “a simple line to express chords in the high register and a circle to represent the chords played in the low register.”

Andrade made the students pause before writing down the identifying symbol. This would test their working memory, a kind of mental Post-it note crucial to language comprehension.

“What I presented to children was simple rhythm, for instance, [Andrade imitates the sound of his guitar] ti-tum-tum-chi. I counted the meter one, two, three, four, and then they start to write.”

[Watch on YouTube]

What Andrade saw was that the kids who had severe difficulty with the task were also struggling with reading and writing. He knew he had good data, but he needed help from a scientist to analyze his data and methodology, and to write up the findings for publication.

“I read some papers by Nadine Gaab, and I searched for the page on the Internet and found Harvard and emailed her,” he says.

Recently, Andrade was in Boston on a Harvard fellowship, working on a follow-up to his research at the Gaab lab.

“We have found that this task, given to second-graders, can predict their literacy ability in the fifth grade,” Andrade says.

About her collaboration with the Brazilian music teacher, Gaab says, “I think that’s a really nice example of neuroeducation, bridging neuroscience and education.”

And she adds that Andrade’s musical test is particularly useful, in that it can be administered cheaply and easily to whole classrooms, regardless of the students’ native language.

“What we would love to do is replicate this study in the U.S.,” Gaab says, “but there’s no funding right now, so we’re working on that.”

Funding Concerns

Patel, the Tufts professor, says that getting funding for research in music neuroscience is often a challenge. It’s still a young field, he says, “and funding bodies tend to be very conservative, in terms of the kind of research they fund.”

The difficulty in sustaining funding may be similar to what music educators are facing.

“In terms of music in the schools,” Patel says, “it’s interesting that music is often the very first thing to be cut when budgets get tight, and as far as I know, that’s never based on any research or evidence about the impact of music on young children’s lives; it’s based on the intuition that this is sort of a frill.”

Gaab, Patel’s fellow neuropsychologist, agrees.

“Currently there’s a lot of talking about cutting music out of the curriculum of public and private schools, and I think it may be the wrong way to go,” Gaab says. “It may cut out some of the important aspects, such as to train executive functioning and have fun and emotional engagement at the same time.”

Both Gaab and Patel believe that music neuroscience is paying off, not only in showing the tremendous practical importance of music education, but also to help answer fundamental questions about the deepest workings of the human brain.

Categories: Health Care

Specialty Care Is A Challenge In Some ACA Plans

Kaiser Health News - Wed, 07/16/2014 - 4:22pm

Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits.

But they’re also causing headaches in the day-to-day work of doctors and clinics. “The biggest problem we’ve run into is figuring out what specialists take a lot of these plans,” said Dr. Charu Sawhney of Houston.

Dr. Charu Sawhney of Hope Clinic in southwest Houston listens to the lungs of Mang Caan, a refugee from Burma. Dr. Sawhney has run into trouble finding specialists to treat some of her patients newly covered by Affordable Care Act insurance plans (Photo by Carrie Feibel/Houston Public Media)

Sawhney is an internist at the Hope Clinic, a federally qualified health center in southwest Houston, in the bustling heart of the Asian immigrant community. Her patients speak 14 different languages, and many of them are immigrants or refugees from places as far flung as Burma and Bhutan. Most of her patients are uninsured, which means she is familiar with problems of access.

But the limited options of some of the HMOs sold on the marketplace surprised even her.

“I was so consumed with just getting people to sign up,” she said, “I didn’t take the next step to say ‘Oh by the way, when you sign up, make sure you sign up for the right plan.’”

Understandably, a lot of Sawhney’s patients picked lower-cost plans, “and we’re running into problems with coverage in the same way we were when they were uninsured.”

One of her patients is a Chinese immigrant who purchased a Blue Cross Blue Shield HMO silver plan, and soon after was diagnosed with stomach cancer.  Sawhney found a Mandarin-speaking oncologist who participated in the plan, but she and the oncologist soon ran into trouble trying to schedule treatments. “The process just isn’t as easy as we thought it would be,” she says.

It was tough to find participating Houston hospitals and doctors. The two largest hospital chains in Houston, Houston Methodist and Memorial Hermann, are not in that plan’s network. Neither is Houston’s premier cancer hospital, MD Anderson Cancer Center.

Those are precisely the hospitals that the patient’s oncologist, Dr. Paul Zhang, calls on the most. He says coordinating surgery or radiation usually isn’t a problem, because most of his patients have insurance plans with wide networks.

“I could not find a surgeon,” Zhang said. When he finally found a surgeon who actually took the insurance, it wasn’t someone he had ever worked with before. He said he would have preferred a surgeon who specialized primarily in cancer, because the patient’s cancer was complicated and had spread to 30 lymph nodes.

“You have limited options,” he said of the patients in the HMO. “So you’re like a second-class citizen, you know? That’s my feeling, you have this insurance and you cannot see certain doctors.”

Sawhney was less surprised by the barriers. Medicaid patients have similar problems finding doctors, and her uninsured patients have always struggled to find care.  But she thought the Affordable Care Act would be an improvement.

“I work so hard to get people into specialists, and I feel like you know, we have a break,” she said, recalling her hopes for the marketplace plans. “And then I realize ‘Oh, well never mind, we still have to work just as hard to get that same amount of care.’”  

The biggest irony, she added, is that even Harris Health, the county-wide public hospital system in Houston, doesn’t take all the new marketplace plans.  Yet Sawhney can still send uninsured patients there for cancer treatment.  

The patient with stomach cancer said the referral process was bewildering. (He asked not to be identified because he has not shared his diagnosis with close family members.)  

“The (insurance) agent said that lots of doctors will accept that insurance,” the patient said. “But when I got sick I found out nobody wants that kind of insurance.” 

Narrow provider networks are not new, but they’ve attracted attention again with the rollout of the ACA. Analysts point out that narrow networks are a powerful tool for insurance companies seeking to control costs – especially since they can no longer control costs by excluding sick people or adjusting premiums by gender or age.

Louis Adams, a spokesman for Blue Cross Blue Shield of Texas, says if patients want access to more hospitals and more specialists, it’s available, but usually at a price. 

"Our goal was to offer an array of plan choices,” he said. “We created more focused networks as a way to offer a broad range of plans with lower premium prices, both on the exchange and in the retail market in general."

But consumer advocates note that many people who bought marketplace plans don’t understand the trade-offs involved in picking a plan with a narrow network.

“They might never have had health insurance, they might not understand what a network is, much less a provider directory,” said Stacey Pogue, a health policy analyst with the Center for Public Policy Priorities, a left-leaning think tank in Austin. “These people might not actually understand when they’re signing up for an HMO that it’s a very narrow network.”  

And not everyone is having trouble with their network. A survey from the Commonwealth Fund found 73 percent of people who had purchased a new marketplace plan were satisfied. When it came to accessing doctors, however, the results were mixed: 54 percent reported their new plan had “all” or “some” of the doctors they wanted. But 39 percent didn’t know which doctors were included in their plans. Five percent said the new plans had none of the doctors they wanted.

Sawhney worries that when patients learn that some medical doors are closed, they will decide insurance is simply not worth the money.

“I don’t want patients to get discouraged,” she said. “I don’t want patients when they have a choice again to say, ‘You know what? I’m just not going to sign up because it doesn’t matter if I have insurance or I don’t have insurance, I still have problems getting health care.’”

The president of the Harris County Medical Society, Dr. Elizabeth Torres, said she fears there could also be a backlash among primary care doctors. Not because the narrow-network HMOs have lower reimbursements, she said, but simply because it’s too hard to find the specialists.

“If it’s going to cost us a lot of hassle, administratively and as far as finding the specialists, then it’s going to be less likely and less favorable for us to actually want to be part of the plan,” said Torres, an internist in the Houston suburb of Sugar Land.

Torres points out that the provider directories of insurance websites, which should make it easy to find in-network specialists near a certain zip code, can be inaccurate or outdated.

“There’s no guarantee because you see their name on the website, that they’re actually participating, and that’s an issue,” Torres said.

The Affordable Care Act requires plans sold on the marketplaces to include a provider directory and to include a notification if a provider is not accepting new patients. But federal regulators left it up to states to determine whether marketplace plans offered patients “reasonable access” to enough hospitals and specialists.

That could change going forward. CMS regulators have told insurers they will be examining the new batch of plans in 2015, to make sure plans offer “reasonable access” – particularly in the areas of hospitals, mental health, oncology and primary care. Regulators also hinted they might develop rules in the future that are more specific: for example, a limit on how far a patient must travel to reach an in-network specialist, or a limit on how long a patient must wait for an appointment.

Back in Houston, Sawhney and Zhang continued to work the phones on behalf of their patient. They eventually found a hospital where the patient could get chemotherapy and radiation, and he is currently in the middle of those treatments.

Despite the delays and difficulties, Sawhney still calls herself a believer in the law. 

“I want this to work,” she said. “The health care exchanges make sense to me, but when the networks are so limiting I’m not certain how it’s going to pan out over the next couple of years. I think these networks need to change for this to be a reasonable solution to our healthcare issues.”

When enrollment resumes in November, she’ll tell her patients to shop more carefully, taking into account not just price, but whether they have a chronic illness and need access to a certain type of specialist or even a particular doctor or hospital.

It won’t be about the cheapest plan anymore, but rather the best plan.

Categories: Health Care

An Interview with Jessica Ho-Wo-Cheong, Global Legal Research Intern

In Custodia Legis - Wed, 07/16/2014 - 4:13pm

Today’s interview is with Jessica Ho-Wo-Cheong, an intern with the Global Legal Research Directorate’s Foreign, Comparative, and International Division I.

Jessica Ho-Wo-Cheong, Law Library intern

Describe your background.

I am a proud Canadian, born and raised in Montreal, Quebec.  I just graduated from l’Université de Montreal with a civil law degree.  Beforehand I completed my undergraduate degree at McGill University, Honors Sociology with a minor in Politics, Law and Society.  In August I will be completing my common law degree at Osgoode Hall, York University.  I am also passionate about traveling and have been fortunate enough to participate in exchanges at Sciences Po Aix-en-Provence (in France) and the University of Kent (in England).

Throughout the past few years, I have worked in different spheres of the legal profession including: general counsel, arbitration, and academic research.  I have also volunteered at a legal aid clinic and as a judge of the International Court of Justice at a Model United Nations conference.  My favorite aspect of law is the fact that it demands constant learning and re-evaluation; new laws come into effect, different areas of law emerge and new important questions arise.

How would you describe your job to other people?

The Law Library of Congress provides legal research and reports to Congress pursuant to their requests, and it often entails some aspect of comparative law.   It also receives requests from other parts of the federal government, and from private patrons.  As an intern with the Global Legal Research Directorate, I conduct research and write reports in response to requests.  Under the supervision of Foreign Law Specialist Nicolas Boring, I cover not only Canadian law but also French civil law jurisdictions including countries such as Mali, Cameroon and Burundi.  Ultimately, I come into work every day ready to take on whatever task needs to be done!

Why did you want to work at the Law Library of Congress?

For any young lawyer, the opportunity to be surrounded by such an immense and vast collection is remarkable.  Not only is the collection impressive, but what is equally impressive is having the research information analysts, experts in their own field, able to help refine searches and find materials.  This collection, combined with the possibility of working with lawyers from across the globe, made me want to be a part of this remarkable team.

I also appreciate the public service aspect of working for government and being able to provide reference answers to citizens.  The ‘Ask a Librarian’ service is open to anyone, anytime, anywhere.  The range of questions we receive is quite astounding.  It is exciting to face a new challenge every day and constantly learn about legal traditions across the globe.

What is the most interesting fact you have learned about the Law Library of Congress?

The moment I entered the Law Library of Congress, I sensed the friendly and collaborative spirit that this department embodies.  This comes not only from having such a diverse range of ethnicities represented but also a commitment to producing a high standard of work.  I was amazed to learn about the entire process from receiving a question to submitting a response.  The foreign law specialists, information specialists, collections specialists, administrative staff, and editorial team all play an important role and are happy to support one another.  All of these steps ensure the accuracy, clarity and relevance of the work produced.

What’s something most of your co-workers do not know about you?

I have a basic understanding of Creole, and I am half African; my father is from a tiny island in the Indian Ocean called Mauritius.

Categories: Research & Litigation

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