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Healthcare.gov Undergoes Changes, Faces Scrutiny As Clock Ticks Toward Mid-November Start Of Open Enrollment

Kaiser Health News - Tue, 09/23/2014 - 9:10am

The New York Times reports that a redesign to the federal marketplace will allow a majority of consumers to use a simpler online form when attempting to buy health coverage and The Associated Press details findings out today by the Department of Health and Human Services inspector general that report on government hackers' attempts to breach the site.    

The New York Times: Healthcare.gov Is Given An Overhaul
The Obama administration is redesigning healthcare.gov and says that 70 percent of consumers will be able to use a shorter, simpler online application form to buy health insurance when the second annual open enrollment period begins in mid-November. Federal health officials said Monday that the shorter application had fewer pages and questions, fewer screens to navigate, and would allow people to sign up with fewer clicks of a computer mouse (Pear, 9/22).

The Associated Press: Government Hackers Try To Crack Healthcare.Gov
The government’s own watchdogs tried to hack into healthcare.gov earlier this year and found what they termed a critical vulnerability -- but also came away with respect for some of the health insurance site’s security features. Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud (9/23).

Categories: Health Care

State Highlights: Medicaid Bankruptcy Ruling Could Save Some Nursing Homes; High HIV Rates In Southern States

Kaiser Health News - Tue, 09/23/2014 - 9:09am

A selection of health policy stories from Florida, Texas, California and Colorado.

The Wall Street Journal: Medicaid Bankruptcy Ruling Could Bolster Health-Care Facility Turnarounds
A federal judge's recent ruling blocking Medicaid officials from cutting off a struggling nursing home could help troubled health care facilities survive using bankruptcy, according to restructuring professionals. U.S. Bankruptcy Court Judge Michael Williamson told Medicaid officials that bankruptcy's protective powers meant they must continue paying for patients at the Rehabilitation Center of St. Petersburg while the Florida facility's bankruptcy lawyers work through problems. The nursing home's Medicaid funding was at risk after health inspectors found "rampant, serious problems" at the 159-bed facility earlier this year. After the inspections, Medicaid threatened to terminate the facility's provider agreement (Stech, 9/22).

The Washington Post: Southern States Are Now Epicenter Of HIV/AIDS In The U.S.
Southern states now have the highest rates of new HIV diagnoses, the largest percentage of people living with the disease and the most people dying from it, according to Rainey Campbell, executive director of the Southern AIDS Coalition, a nonprofit serving 16 Southern states and the District. Fifty percent of all new HIV cases are in the South. And the HIV infection rate among African American and Latina women in the South now rivals that of sub-Saharan Africa. In some Southern states, blacks account for more than 80 percent of new HIV diagnoses among women (Wiltz, 9/22).

The Associated Press: Citing Joan Rivers, Texas’ Perry Backs Clinic Law
Republican Texas Gov. Rick Perry on Sunday invoked comedian Joan Rivers’ death at a surgical clinic while defending a law he signed that would close the majority of abortion facilities in the nation’s second-most populous state (9/21). 

Stateline: A New Look At Why Surgical Rates Vary
Several years ago, a California study showed that a half-dozen elective surgeries were being performed far more often in Humboldt County than they were in the rest of the state. The procedures included hip and knee replacements, hysterectomies and carotid endarterectomies, a surgery to remove plaque buildup in the carotid arteries. Geographical variation in the delivery of health care can harm patients and increase costs. That is especially true when it comes to surgery, which is usually more expensive and riskier than less invasive treatments. Medicaid makes up a huge portion of state budgets, so the issue of health care variation is a pressing one for states looking to hold down costs. In Humboldt County, doctors, hospitals, and others involved in health care wondered why surgeons in their area operated so often, and if they could do anything to get closer to the state norms (Ollove, 9/23).

Bloomberg: Nursing Home Neglect Trial Fights Shell Company Transfers
Juanita Jackson died in July 2003, five weeks after she was removed from a Florida nursing home where her family said continual neglect led to multiple bedsores, malnutrition and a fall that injured her head. ... A corporate structure designed to transfer liabilities from the nursing home operator to a shell company without assets also has kept five other families from pursuing wrongful death lawsuits or collecting judgments, said lawyers for the family of Jackson, who was 76 when she died. Trans Healthcare Inc. and Trans Health Management Inc., which the plaintiffs claimed operated the homes, never appealed or paid the 2010 verdict -- $55 million each -- awarded by a state court jury in Bartow, Florida (Fisk, 9/22).

Denver Post: Colorado Veterans Affairs Officials Say Improvements Coming
Veterans Affairs officials said Monday that efforts are underway to ease wait times and improve access to care. Lynette Roff, director of the Veterans Affairs Eastern Colorado Health Care System (ECHCS), addressed a small crowd of veterans and advocates during a town hall meeting for vets and family members at the VA hospital in Denver. Access to VA care has been the focus of scrutiny in recent months. Yet even before the scandal erupted over long waiting times for care in Phoenix and elsewhere, the eastern Colorado system had been working for two years to open new facilities in Golden, Pueblo and Colorado Springs, she said (Draper, 9/22).

Denver Post: Colorado Regulators Approve Health Insurance Premiums 1 Percent Higher 
State regulators have approved more than 1,000 health insurance plans offered by 20 carriers for 2015 that, on statewide average, will increase premiums 1.18 percent over last year. Mountain resorts and other West Slope rural communities, historically stuck with the most expensive health premiums, benefitted from the Division of Insurance's consolidation of two rating areas into one. Their 2015 rates will decrease by an average of 7.44 percent across all carriers. Likewise, the consolidation of Eastern Plains communities and southern rural areas resulted in a 5.01 percent drop in their average premiums (Draper, 9/22).

Categories: Health Care

Drugmakers Warned Against Giving Coupons To Medicare Beneficiaries

Kaiser Health News - Tue, 09/23/2014 - 9:06am

While brand-name drugmakers regularly use coupons to boost sales, it is illegal to induce Medicare Part D enrollees to use them. Meanwhile, a researcher asks members of the public how they would fix Medicare.

The Wall Street Journal’s Pharmalot: Did Someone Say Kickbacks? HHS Warns About Medicare Part D Coupons
Brand-name drug makers regularly use coupons to woo consumers and boost sales. But inducing Medicare Part D beneficiaries to use coupons is illegal. So drug makers are supposed to use safeguards to ensure these consumers do not use coupons to obtain prescription medicines (Silverman, 9/22).

Modern Healthcare:  Medicare Gives First Glimpse Of ACO Quality Performance
The CMS for the first time publicly released individual performance data for Medicare accountable-care organizations on 33 measures of healthcare quality (Evans, 9/22).

Kaiser Health News: Capsules: How To Fix Medicare? Ask The Public
Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered. Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program (Carey, 9/23).

Categories: Health Care

Police, Parents Learning To Better Handle Mental Illness

Kaiser Health News - Tue, 09/23/2014 - 9:06am

And in Arizona, a judge approved an agreement to expand services for the people with serious mental illnesses, ending a 30-year-old class action lawsuit.

NPR: As Run-Ins Rise, Police Take Crash Courses On Handling Mentally Ill
A number of high-profile police shootings, including that of Michael Brown in Ferguson, Mo., last month, have led to increased scrutiny of police interactions with civilians. One group that is disproportionately subject to police uses of force is people with mental illness. Many local departments hold special sessions to train officers about mental illness and how to help the people they interact with. Walking up and down the aisle of a police academy classroom in downtown St. Louis, Lt. Perri Johnson tells the officers here that responding to calls where a person is in mental distress is never easy (Bouscaren, 9/23).

CBS News: 'Every Mom’s Worst Nightmare': Coping With A Child’s Mental Illness
It was Dec. 14, 2012, and Liza Long headed to work at Carrington College-Boise. It was just another Friday morning until Long, the mother of four children, logged on to Facebook, where news of a mass shooting at Sandy Hook Elementary School in Newtown, Connecticut, was just beginning to emerge. "I just put my head down on my desk and started to cry," Long, 42, told CBS News. But it wasn't that Long knew any of the families that had lost a child. "I had children about that age too. It's every mom's worst nightmare. But I realized right away it's every mom's worst nightmare on two fronts, not just one." Her first thought, she later wrote, was "What if my son does that someday?" (Firger and Augenbraun, 9/22).

Arizona Republic: Judge Ends Long-Running Behavioral-Health Suit
A judge Monday committed to the history books a long-running lawsuit that redefines how services are delivered to the seriously mentally ill in Maricopa County. With his signature, Maricopa County Superior Court Judge Edward Bassett ended the Arnold vs. Sarn case. His action drew cheers from Gov. Jan Brewer, who had made it a priority to settle the case that has rattled around the courts since 1981, when behavioral-health advocates filed a class-action lawsuit (Pitzl, 9/22).

The Associated Press: Judge OKs Agreement Ending 30-year-old Mental Health Suit
A Maricopa County judge on Monday signed off on an agreement that increases housing, employment and other services for the seriously mentally ill. Judge Edward Bassett's action came as he dismissed a lawsuit filed more than 30 years ago challenging the state's funding of mental health services. The terms of the agreement reached in January between Gov. Jan Brewer and lawyers for the mentally ill will apply statewide. No money will be spent beyond an extra $39 million a year pumped into the system more than two years ago as part of an interim agreement ending the lawsuit. The expansion of Medicaid in Arizona that began Jan. 1 will pay for some of the additional costs. Brewer celebrated the dismissal, saying the deal provides needed treatment and puts in place a model community-based behavioral health system (Christie, 9/22).

Categories: Health Care

Hospitals Seek To Control Costs By Setting Standards For Care

Kaiser Health News - Tue, 09/23/2014 - 9:06am

One group in Delaware looked at high spending on cardiac monitoring for patients who really didn't need it, and encouraged doctors to instead use guidelines from the American Heart Association. Costs fell by 70 percent for the monitoring, a study finds.

The Wall Street Journal: Hospitals Cut Costs By Getting Doctors To Stick To Guidelines
A hospital group in Delaware was concerned it was spending too much on cardiac monitoring for patients outside of intensive care who didn't need it. So it changed its computer system to encourage doctors to follow American Heart Association guidelines for using the monitors. The number of patients using the monitors, and the group's daily costs for such monitoring, fell by 70% without any harm to patient care, researchers from Wilmington, Del.-based Christiana Care Health System report in a study in JAMA Internal Medicine (Whalen, 9/22).

NPR: Avoid The Rush! Some ERs Are Taking Appointments
Hospitals around the country are competing for newly-insured patients, and one way to increase patient satisfaction, they figure, might be to reduce the frustratingly long wait times in the ER. To that end, Northridge and its parent company Dignity Health started offering online appointments last summer; since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada (Gorman, 9/23).

Read the Kaiser Health News' earlier, related story The Latest In Medical Convenience: ER Appointments (Gorman and Colliver, 7/3).

Meanwhile, federal officials call on nursing homes to reduce the use of antipsychotic medications -

Modern Healthcare:  CMS' Plan To Cut Antipsychotic Use In Nursing Homes Falls Short, Critics Say
Patient-safety advocates say the CMS' new plan to curb the use of antipsychotic medications in nursing home patients with dementia falls short of what's needed to eliminate unnecessary use. Last week, the CMS called for a 25% reduction in use of antipsychotics for this patient population by the end of 2015, and to a total of 30% by the end of 2016 (Rice, 9/22).

And in other marketplace news -

Marketplace: At In-Store Clinics, $4 Checkups For Wal-Mart Workers
You can't buy a lot for $4—maybe a cup of coffee or muffin. But at about a dozen Walmart stores across the South, $4 will get employees a visit to a nurse practitioner at an in-store clinic. It's part of a new primary care program that Walmart is testing in three states. Eric Klein leads the healthcare team at the national law firm Sheppard Mullin Richter and Hampton. He says Walmart could actually come out ahead in the big picture. ... Klein says if employees go to an on-site clinic owned by Walmart, the company could save money on doctor visits and insurance premiums. Cutting out the middle men could bring down the cost of Walmart’s insurance plans (McCammon, 9/23).

Categories: Health Care

Court Dumps Obamacare Lawsuit Brought By Doctors

Kaiser Health News - Tue, 09/23/2014 - 9:06am

A federal appeals court in Chicago tosses a lawsuit challenging the administration's delay of the health law's employer mandate -- a case similar to the one that House Republicans plan to file. Meanwhile, advocates for the drug, device and biotechnology industries raise concerns about the public database set to go live next week, showing how much doctors get from those groups.

Politico: Court Tosses Obamacare Mandate Lawsuit Brought By Doctors
A federal appeals court has summarily tossed a lawsuit challenging the Obama administration’s delay of Obamacare’s employer mandate — a case that is similar to the one that House Republicans plan to file against the president. This suit was filed by the Association of American Physicians and Surgeons, which argued that the delay could hurt doctors financially. But the 7th Circuit Court of Appeals in Chicago on Friday said the plaintiffs don’t have a right to sue (Haberkorn, 9/22).

Milwaukee Journal-Sentinel: Judge Dumps Challenge To IRS Role In Obamacare Penalties
Like U.S. District Judge William Griesbach, the 7th Circuit found that McQueeney and the physicians' group lacked standing to bring the challenge, noting the Supreme Court's repeated rejection of attempts by one person to litigate over someone else's taxes (Vielmetti, 9/22).

The Hill: Court Nixes Obamacare Mandate Delay Lawsuit
A federal appeals court threw out a lawsuit over the delay of ObamaCare's employer mandate, a sign that a similar challenge in the works by House Republicans might not fare well. The 7th Circuit Court of Appeals said the plaintiffs did not have standing to sue, and only parties "seeking to advance the interests" of the mandate could mount a "plausible" case against its delay.  The case was filed by the Association of American Physicians and Surgeons, which argued the administration did not have the authority to defer the requirement that most employers offer health insurance (Viebeck, 9/22).

The Hill: Drug, Device CEOs Voice Concerns About Obamacare Project
Advocates for the drug, device and biotechnology industries are raising concerns about the implementation of a payments database required by ObamaCare. The "Sunshine Act" system will allow the public to search how much money doctors receive from drug and device companies. It is scheduled to launch on Sept. 30, despite complaints about inaccuracies and technical glitches. But the CEOs of PhRMA, AdvaMed and the Biotechnology Industry Organization (BIO) say the Centers for Medicare and Medicaid Services (CMS) has not been clear enough about what data will be posted on the site and how it will be presented (Viebeck, 9/22).

The Associated Press: Spin Meter: Those Changing Health Law Numbers
The Obama administration has had to revise and refine some initial enrollment numbers for health insurance sign-ups after they turned out to be too optimistic. At other times, metrics less favorable to the president’s overhaul leaked out after officials claimed not to have such data. Parsing the numbers is a new pursuit for administration officials from President Barack Obama on down, to lawmakers of both parties and a gaggle of outside analysts (9/22).

Categories: Health Care

Viewpoints: Surgery Surprise: Out-Of-Network Doctors' Bills; Consequences Of Making Medicaid Enrollees Pay Premiums

Kaiser Health News - Tue, 09/23/2014 - 9:05am

Los Angeles Times: The Ugly Surprise Of Out-Of-Network Doctors And 'Balance Billing'
The New York Times' Elisabeth Rosenthal offered an important lesson in healthcare economics over the weekend that's a must-read for anyone about to undergo a major medical procedure. Rosenthal's piece explored how charges from out-of-network providers can magically show up on a hospital bill. She focused on one particularly nasty practice, called "drive-by doctoring," in which physicians call in colleagues not in a patient's network to consult or assist on a procedure. The out-of-network provider charges the retail rate -- in some cases, hundreds of times what the government would pay them for the same work, and invariably far more than what the patient's insurer will cover. The provider then tries to collect the remainder directly from the patient, a process known as "balance billing" (Jon Healey, 9/22).

The New York Times' The Upshot: Medicaid Gives The Poor A Reason To Say No Thanks
While Medicaid, our safety net program for the poor, has used cost-sharing mechanisms for some time, it has been prohibited from asking people to pay premiums. In the last couple of years, federal regulators have started lifting that prohibition, which is likely to lead to some negative consequences (Aaron E. Carroll, 9/22).

The Washington Examiner: Jindal Says Hospitals Are Shortsighted On Medicaid Expansion
Hospitals have been pushing the issue hard, because they were counting on an expanded Medicaid program to reduce their uncompensated care costs. ... But [Louisiana Gov. Bobby] Jindal, who once served as Secretary of the Louisiana Department of Health and Hospitals, said that if Medicaid were expanded in Louisiana, the number of people who would move to Medicaid from private insurance would exceed the number of uninsured residents who would gain coverage. "I told my hospitals I thought that [supporting Medicaid expansion] was a foolish, shortsighted, short-term position," he said (Philip Klein, 9/22).

The New Republic: How To Save Obamacare: Make It A Women's Issue
The challenge for the next Democratic presidential nominee is thus to break the psychic link—to reshape the way the public thinks about health reform as something more than just a proxy for Obama. And whether she realizes it or not, Hillary Clinton has made a strong case that a female candidate will be better suited to the task than a male candidate. Last Thursday, Clinton joined a Center for American Progress panel about women’s economic security, focused mainly on gendered issues like equal pay and child care. But Obamacare fits neatly into the same framework (Brian Beutler, 9/22).

The New York Times' The Upshot: Why Senate Control Matters
Regardless of which party controls it, Republicans will almost certainly control the House, and Democrats will hold the White House. Given how far apart the two parties are on almost every major issue — climate, health care, inequality, the long-term deficit, immigration and same-sex marriage, for starters — the odds of major legislation becoming law in the next two years are scant. … And yet control of the Senate still very much matters, just not for the most obvious reasons. It matters for climate policy and the Affordable Care Act, among other big issues (David Leonhardt, 9/23). 

The Wall Street Journal’s Political Diary: Kentucky's Desperate Democrat
One motif that's been largely missing from Democratic campaigns this year is the Republican war on Medicare. Lo, Kentucky Democrat Alison Lundergran Grimes has disinterred the trope in a new ad that implicates Mitch McConnell in her grandfather's incapacitation. Really classy (Allysia Finley, 9/22). 

The New York Times' Room For Debate: Hiring A Woman For Her Womb
People unable to bear children have increasingly turned to women who bear children for them, often by transferring an embryo created by in-vitro fertilization. Because legal and social views on surrogacy vary from nation to nation (and even state to state), prospective parents often engage surrogates in the United States and in developing countries. Controversy has clouded this issue (9/22). 

Los Angeles Times: Dad Pleads: Don't Let Health Insurance Offer My Daughters Birth Control!
Remember the prediction that the Supreme Court's decision to let Hobby Lobby opt out of Obamacare contraception coverage would open the floodgates for more of the same? Well, it's not a flood, but it is a one-man trickle. A Missouri Republican legislator is suing in federal court for a personal opt-out for his family (Patt Morrison, 9/22). 

The Washington Post: Has The Department Of Health And Human Services Politicized FOIA Requests?
The Department of Health and Human Services (HHS) is denying an allegation by a top Associated Press journalist that the agency has politicized the handling of requests under the Freedom of Information Act (FOIA). "FOIA requests are handled by career staff," Kevin Griffis, an HHS spokesman, told the Erik Wemple Blog in a brief interview on Friday. Griffis was responding to a much-shared AP post summarizing "8 ways the Obama administration is blocking information," an inventory of press restrictions compiled by AP Washington Bureau Chief Sally Buzbee and presented at a meeting of the American Society of News Editors, the Associated Press Media Editors and the Associated Press Photo Managers. Under obstruction No. 7, Buzbee alleged, "The administration uses FOIAs as a tip service to uncover what news organizations are pursuing. Requests are now routinely forwarded to political appointees" (Eric Wemple, 9/22).

Categories: Health Care

Political Cartoon: 'Suits Me?'

Kaiser Health News - Tue, 09/23/2014 - 8:57am

Kaiser Health News provides a fresh take on health policy developments with 'Suits Me?' by Harley Schwadron.

And here's today's health policy haiku:

MORE THAN A FIXER-UPPER?

Confucius might say
Healthcare.gov not perfect
Enemy of good
-Beau Carter

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: September 23, 2014

Kaiser Health News - Tue, 09/23/2014 - 7:19am

Today's headlines include reports about work being done on healthcare.gov in anticipation of the next open enrollment period, which begins in mid-November.  

Kaiser Health News: Insurers Hesitant To Cover Many Proton Beam Therapy Treatments
Kaiser Health News consumer columnist Michelle Andrews writes: “Everyone seems to agree that proton beam therapy--a type of radiation that can attack cancerous tumors while generally sparing the surrounding tissue--is an exciting technology with a lot of potential. But some insurers and disease experts say that, until there’s better evidence that proton therapy is more effective at treating various cancers than traditional types of less expensive radiation, coverage shouldn’t be routine” (Andrews, 9/23). Read the column.

Kaiser Health News: Capsules: How To Fix Medicare? Ask The People
Now on Kaiser Health News’ blog, Mary Agnes Carey reports: “Washington is full of ideas to overhaul Medicare. Some would increase the program’s eligibility age, others would charge higher-income beneficiaries more for their coverage. There’s movement to link payment to the quality — rather than the quantity — of care delivered. Marge Ginsburg decided to ask ordinary Americans how they would change the federal entitlement program” (Carey, 9/23). Check out what else is on the blog.

The New York Times: Healthcare.gov Is Given An Overhaul
The Obama administration is redesigning HealthCare.gov and says that 70 percent of consumers will be able to use a shorter, simpler online application form to buy health insurance when the second annual open enrollment period begins in mid-November. Federal health officials said Monday that the shorter application had fewer pages and questions, fewer screens to navigate, and would allow people to sign up with fewer clicks of a computer mouse (Pear, 9/22).

The Associated Press: Government Hackers Try To Crack Healthcare.Gov
The government’s own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability — but also came away with respect for some of the health insurance site’s security features. Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud (9/23).

Politico: Court Tosses Obamacare Mandate Lawsuit Brought By Doctors
A federal appeals court has summarily tossed a lawsuit challenging the Obama administration’s delay of Obamacare’s employer mandate — a case that is similar to the one that House Republicans plan to file against the president. This suit was filed by the Association of American Physicians and Surgeons, which argued that the delay could hurt doctors financially. But the 7th Circuit Court of Appeals in Chicago on Friday said the plaintiffs don’t have a right to sue (Haberkorn, 9/22).

The Associated Press: Spin Meter: Those Changing Health Law Numbers
The Obama administration has had to revise and refine some initial enrollment numbers for health insurance sign-ups after they turned out to be too optimistic. At other times, metrics less favorable to the president’s overhaul leaked out after officials claimed not to have such data. Parsing the numbers is a new pursuit for administration officials from President Barack Obama on down, to lawmakers of both parties and a gaggle of outside analysts (9/22).

Los Angeles Times: 30,000 Californians Face Obamacare Enrollment Delays, Dropped Coverage
California's health insurance exchange is vowing to fix enrollment delays and dropped coverage for about 30,000 consumers before the next sign-up period this fall. Covered California said it failed to promptly send insurance applications for 20,000 people to health plans recently, causing delays and confusion over their coverage. Another group of up to 10,000 people have had their insurance coverage canceled prematurely because they were deemed eligible for Medi-Cal based on a check of their income, officials said (Terhune, 9/22).

The Wall Street Journal: Hospitals Cut Costs By Getting Doctors To Stick To Guidelines
A hospital group in Delaware was concerned it was spending too much on cardiac monitoring for patients outside of intensive care who didn't need it. So it changed its computer system to encourage doctors to follow American Heart Association guidelines for using the monitors. The number of patients using the monitors, and the group's daily costs for such monitoring, fell by 70% without any harm to patient care, researchers from Wilmington, Del.-based Christiana Care Health System report in a study in JAMA Internal Medicine (Whalen, 9/22).

NPR: Avoid The Rush! Some ERs Are Taking Appointments
Hospitals around the country are competing for newly-insured patients, and one way to increase patient satisfaction, they figure, might be to reduce the frustratingly long wait times in the ER. To that end, Northridge and its parent company Dignity Health started offering online appointments last summer; since then, more than 22,000 patients have reserved spots at emergency rooms in California, Arizona and Nevada (Gorman, 9/23). Read the Kaiser Health News' earlier, related story The Latest In Medical Convenience: ER Appointments (Gorman and Colliver, 7/3). 

The Wall Street Journal’s Pharmalot: Did Someone say Kickbacks? HHS Warns About Medicare Part D Coupons
Brand-name drug makers regularly use coupons to woo consumers and boost sales. But inducing Medicare Part D beneficiaries to use coupons is illegal. So drug makers are supposed to use safeguards to ensure these consumers do not use coupons to obtain prescription medicines (Silverman, 9/22).

NPR: As Run-Ins Rise, Police Take Crash Courses On Handling Mentally Ill
A number of high-profile police shootings, including that of Michael Brown in Ferguson, Mo., last month, have led to increased scrutiny of police interactions with civilians. One group that is disproportionately subject to police uses of force is people with mental illness. Many local departments hold special sessions to train officers about mental illness and how to help the people they interact with. Walking up and down the aisle of a police academy classroom in downtown St. Louis, Lt. Perri Johnson tells the officers here that responding to calls where a person is in mental distress is never easy (Bouscaren, 9/23).

The Wall Street Journal: Medicaid Bankruptcy Ruling Could Bolster Health-Care Facility Turnarounds
A federal judge's recent ruling blocking Medicaid officials from cutting off a struggling nursing home could help troubled health-care facilities survive using bankruptcy, according to restructuring professionals. U.S. Bankruptcy Court Judge Michael Williamson told Medicaid officials that bankruptcy's protective powers meant they must continue paying for patients at the Rehabilitation Center of St. Petersburg while the Florida facility's bankruptcy lawyers work through problems. The nursing home's Medicaid funding was at risk after health inspectors found "rampant, serious problems" at the 159-bed facility earlier this year. After the inspections, Medicaid threatened to terminate the facility's provider agreement (Stech, 9/22).

Politico: Scott Brown Splits With New Hampshire GOP On Abortion
Republican Scott Brown has something to run against besides Democrat Jeanne Shaheen: His state GOP’s abortion stance. The New Hampshire Republican Party adopted Saturday a socially conservative party platform that supports “the pre-born child’s fundamental right to life and personhood under the Fourteenth Amendment” as well as the “Life at Conception Act.” Those policies are at odds with the New Hampshire GOP’s Senate nominee’s stances on abortion, and Brown’s Democratic opponent Shaheen attacked him on Monday for the “disturbing” message sent by the New Hampshire Republicans (Everett, 9/23).

The Washington Post: Southern States Are Now Epicenter Of HIV/AIDS In The U.S.
Southern states now have the highest rates of new HIV diagnoses, the largest percentage of people living with the disease and the most people dying from it, according to Rainey Campbell, executive director of the Southern AIDS Coalition, a nonprofit serving 16 Southern states and the District. Fifty percent of all new HIV cases are in the South. And the HIV infection rate among African American and Latina women in the South now rivals that of sub-Saharan Africa. In some Southern states, blacks account for more than 80 percent of new HIV diagnoses among women (Wiltz, 9/22).

The Associated Press: Citing Joan Rivers, Texas’ Perry Backs Clinic Law
Republican Texas Gov. Rick Perry on Sunday invoked comedian Joan Rivers’ death at a surgical clinic while defending a law he signed that would close the majority of abortion facilities in the nation’s second-most populous state (9/21). 

 

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Categories: Health Care

Insurers Hesitant To Cover Many Proton Beam Therapy Treatments

Kaiser Health News - Tue, 09/23/2014 - 5:01am

Everyone seems to agree that proton beam therapy--a type of radiation that can attack cancerous tumors while generally sparing the surrounding tissue--is an exciting technology with a lot of potential. But some insurers and disease experts say that, until there’s better evidence that proton therapy is more effective at treating various cancers than traditional types of less expensive radiation, coverage shouldn’t be routine.

That approach doesn’t sit well with proponents, some of whom say that insurance coverage is critical for necessary research of the controversial therapy’s uses.

Meanwhile, the number of proton therapy centers -- huge structures that can cost more than $200 million -- continues to increase. Fourteen are in operation in the United States and a dozen more under development, according to Leonard Arzt, executive director of the National Association for Proton Therapy.

Critics assert that the rush to build the centers is putting a very large cart before the horse. 

In general, “the evidence has failed to demonstrate that there is a significant improvement in outcomes with proton beams,” says J. Leonard Lichtenfeld, deputy chief medical officer at the American Cancer Society. “It’s fair to question whether the number of facilities that are being constructed really reflect the proven value of proton beam therapy.”

A 2012 study published in the journal Radiotherapy and Oncology, for example, found proton beam therapy to be superior to traditional photon therapy for some childhood cancers affecting the central nervous system as well as large cancers of the eye and tumors at the base of the skull. In the case of prostate and liver cancers, there was evidence that the therapy worked, but not that it was superior to photon-based treatment, according to the study. It found that there wasn’t enough evidence to recommend the proton beam therapy for lung cancer, head and neck cancer, gastrointestinal malignancies and other pediatric cancers.

In addition, a 2013 study of Medicare patients published in the Journal of the National Cancer Institute found the cost of proton beam therapy to treat prostate cancer was roughly 70 percent more than photon therapy. Experts say costs are often even higher, with a course of proton beam treatment running three to six times the cost of conventional radiation.

The use of proton beam therapy has accelerated rapidly in recent years as medical centers have raced to capitalize on its clinical and financial potential. At the same time, those efforts have drawn increasing criticism from some consumer and health care advocates who suggest that the therapy is a clear illustration of how new technology can drive costs higher for consumers and insurers without necessarily improving care.

Last month, the proton beam center at the University of Indiana, one of the country’s first, announced it was closing. Among the reasons were the center’s aging equipment, the large number of newly designed  facilities and falling insurance reimbursements. 

Prostate cancer has become a particularly controversial coverage area. The most common cancer among men, it accounts for roughly a third of patients at proton centers, and even more at some centers, says Arzt. But research has generally failed to show that proton therapy results in better outcomes or fewer side effects than traditional radiation despite its higher cost, and some insurers have stopped covering it for prostate cancer.  

Insurance coverage for proton beam therapy varies widely and changes as research emerges. Some insurers, such as Cigna, cover proton therapy only for cancer of the eye. Others, including UnitedHealthcare, cover the therapy for additional conditions, including skull-based tumors and arteriovenous malformations in the brain as well as some pediatric illnesses. Although Medicare doesn’t have a national coverage policy for proton therapy, the therapy is generally covered with few limitations, according to a spokesman for the Centers for Medicare & Medicaid Services.

Some advocates for proton beam therapy say insurers need to provide more support for the clinical trials that they believe will show the treatment is superior.

Steven Frank, the medical director of the proton therapy center at the MD Anderson Cancer Center in Houston, is trying to recruit patients for a randomized clinical trial to test proton therapy against photon therapy in head and neck cancer.

“The biggest struggle we’re coming up against is that the insurers don’t want to pay for it,” he says.

Under the health law, most insurers are required to cover routine patient costs associated with participating in approved clinical trials for cancer or other life-threatening conditions. So if a patient suffers side effects or other medical problems during the trial, insurers are responsible for covering those costs, among others. But they don’t have to pay for costs related to the investigational part of the trial, in this case the pricey proton beam therapy.

Some say this situation is no different than testing a cancer drug: The insurer covers the routine costs, but the drug manufacturer is often responsible for providing the drug and testing it.

"Drugs should prove whether they are equal or superior to an existing treatment," says Lichtenfeld. "Why should proton beam be any different?"

Proton beam therapy proponents counter that it is different because they already know the therapy works. 

How the standoff will be resolved is unclear, but as long as it continues, there’s one clear loser: the patient.

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

Categories: Health Care

ACLU Comment on ICE Opening of Additional Detention Facility in Texas

ACLU -- Criminal Justice News - Tue, 09/23/2014 - 12:00am

FOR IMMEDIATE RELEASE
CONTACT: 212-549-2666, media@aclu.org

WASHINGTON - U.S. Immigration and Customs Enforcement (ICE) announced today that it will open and operate a new family detention center in Dilley, Texas in response to the influx of families apprehended along the southwest border.

The facility is expected to open in early November, making it the fourth facility the Department of Homeland Security (DHS) is using to detain families that cross the Southwest border.

"We're extremely disappointed in the administration's decision to dramatically expand the warehousing of vulnerable mothers and children fleeing violence in Central America," said Laura W. Murphy, Director of ACLU’s Washington Legislative Office. "In just a few short months, the family detention system will have increased from just 90 beds to almost 4,000. History shows us that imprisoning families limits access to due process, harms the physical and mental health of parents and children, and undermines the family structure by stripping parents of their authority. Rather than incarcerating thousands of mothers and children, DHS should be investing in effective, humane, and far less costly alternatives to detention."

Categories: Prisoners Rights

ACLU Demands Government Provide Chelsea Manning Necessary Medical Care

ACLU -- Criminal Justice News - Tue, 09/23/2014 - 12:00am

FOR IMMEDIATE RELEASE
CONTACT: 212-549-2666, media@aclu.org

WASHINGTON – Today, Chelsea Manning filed a lawsuit in federal court in the District of Columbia against Secretary of Defense Chuck Hagel and other Department of Defense (DOD) and Department of the Army officials for their failure to provide necessary medical treatment for her gender dysphoria, a condition with which she was originally diagnosed by Army doctors more than four years ago.

The complaint is accompanied by a motion for preliminary injunction demanding that Ms. Manning be provided hormone therapy, permission to follow female grooming standards, and access to treatment by a medical provider qualified to treat her condition. Ms. Manning is currently serving a thirty-five year prison sentence at the United States Disciplinary Barracks at Ft. Leavenworth Kansas, and though the military recognizes that she has gender dysphoria requiring treatment, critical care has been withheld without any medical basis.

"The government continues to deny Ms. Manning’s access to necessary medical treatment for gender dysphoria, without which she will continue to suffer severe psychological harms," said Chase Strangio, attorney in the ACLU Gay Lesbian Bisexual and Transgender project and co-counsel on Ms. Manning’s case. "Such clear disregard of well-established medical protocols constitutes cruel and unusual punishment."

Ms. Manning is represented by the American Civil Liberties Union (ACLU), the ACLU of the Nation’s Capital, the ACLU of Kansas and civilian defense counsel David E. Coombs. Last month, Ms. Manning’s legal team sent a letter to the DOD and Army officials demanding that she receive treatment for gender dysphoria in accordance with medical standards of care, including hormone therapy and permission to follow female grooming standards.  Her treatment needs have continued to be unmet and her distress has escalated.

"I am proud to be standing with the ACLU behind Chelsea on this very important issue." said David E. Coombs, "It is my hope that through this action, Chelsea will receive the medical care that she needs without having to suffer any further anguish."

Gender dysphoria is a serious medical condition that requires hormone therapy and changes to gender expression, like growing hair, to live consistently with one’s gender identity as part of accepted standards of care.

Without necessary treatment, gender dysphoria can cause severe psychological distress, anxiety, and suicidality. For this reason, the National Commission on Correctional Health Care and the American Psychological Association have issued policy statements that support providing treatment to prisoners diagnosed with the condition in accordance with established standards of care, as the Federal Bureau of Prisons and many state corrections agencies are already doing. 

Categories: Prisoners Rights

In Context, Health Premium Increases Don’t Actually Look Like Increases

Medicare -- New York Times - Tue, 09/23/2014 - 12:00am
When inflation and the cost of old insurance markets are considered, the premiums available to consumers willing to shop around are remarkably low.
Categories: Elder, Medicare

Census Data Show Uninsured Rate Edged Down Slightly in 2013

Center on Budget and Policy Priorities - Mon, 09/22/2014 - 3:50pm
The percentage of Americans without health coverage fell slightly in 2013, the Census Bureau announced September 16, marking the third consecutive year of decline from a recent high point in 2010. The number of uninsured Americans also declined slightly, to 45.2 million in 2013 from 45.6 million in 2012. No substantial change was expected in 2013 given that the Affordable Care Act’s (ACA) major coverage expansions didn’t take effect until January 2014. While …
Categories: Benefits, Poverty

Poverty Fell and Health Coverage Improved in 2013, But Economic Recovery Is Slow to Reach Many

Center on Budget and Policy Priorities - Mon, 09/22/2014 - 3:35pm
The poverty rate dropped significantly in 2013 for the first time since 2006 and only the second time since 2000, Census data released September 16 show. Incomes were unchanged for middle-income households, and income inequality remained at or near record levels by a number of measures. The improvements in income and poverty occurred primarily among children and their families. While median income was statistically unchanged among households overall, it rose $1,305 for …
Categories: Benefits, Poverty

Winning Ideas In Contest On ‘How To Make The Breast Pump Not Suck’

CommonHealth (WBUR) - Mon, 09/22/2014 - 2:50pm

A team at the MIT “hackathon” on “How To Make The Breast Pump Not Suck” presents its ideas. (Carey Goldberg/WBUR)

Anyone who’s ever had a close encounter with a breast pump knows that it sucks in multiple ways: It sucks out breast milk, and it sucks because it makes mothers feel like milk cows at the mercy of a loud, dumb, unwieldy, uncomfortable machine.

“Pumping is the worst, it really is,” said Erin Freeburger, a mother and a user-experience designer who was attending her first-ever “hackathon” this weekend: the MIT Media Lab’s “Make The Breast Pump Not Suck!” contest. “That’s why we’re all here. No one here is like, ‘What? It’s fine, how it is!’ It’s awful. But we love our babies more than we hate our pumps, so that’s why we’re motivated to be here today.”

Freeburger’s team was among ten squads of brainstormers who took on the intense weekend challenge of improving upon current breast pump designs — and her team won the first prize of $3,000 and a trip to Silicon Valley to court investors. Their concept: The “Mighty Mom” utility belt, is “a fashionable, discreet, hands-free wearable pump that automatically logs and analyzes your personal data.” Milk data, that is.

The concept, she explained, involves both hardware — the utility belt to hold pumping parts needed on the go — and software: It imagines a “smart” breast pump that would collect and track data and upload it to the cloud: milk volume, even fat and protein content as analyzed by infrared sensors. (My reaction: So it’s, like, the iPump?)

The team that would ultimately win the “Make the Breast Pump Not Suck” hackathon with its “Mighty Mom” utility belt. (Photo: Mason Marino)

Other winners, according to the contest site: Second prize of $2,000 to “a sturdy, easy-to-clean, minimal-parts, hands-free compression bra designed by nursing moms. The bra helps women manually express breastmilk (a technique proven to be as effective as electric pumps) without their hands.”

And third prize of $1,000 to “an open software and hardware platform to make the breast pumping experience smarter, more data-rich and less isolating. PumpIO puts pumping women in touch with lactation consultants and communities as they are pumping, when they have questions and to help reinforce their commitment to their baby.”

And special recognition goes to “a breast pump that mimics the way that a baby suckles with massage and compression. This team also designed soft, low-profile flanges to be worn discreetly.” And more special recognition to this winner of the popular vote:

Compress Express: A breast pump that mimics the natural and age-old art of hand expression, instead of archaic vacuum technology that dominates the market. Inspired by the simplicity of blood pressure cuffs, this project’s gentle compression technology enables efficient milk expression and creates a discreetly wearable, virtually silent and hands-free breast pumping experience.

Debra Abbaszadeh, a founder of Simple Wishes, a hands-free bra company based in San Francisco, said she thought “the whole idea of compression versus expression was really interesting. I think it requires a lot of work. I think the concepts, exactly as they are, are not quite there, but it’s a very interesting idea.”

You might think, given the huge market for breast pumps in a country where most women work and most mothers breastfeed, that pump makers would already have been racing to improve on designs.

So why should a hackathon — an intense team brainstorming session that originated in computer engineering — even be needed?

Despite the commercial efforts, clearly, “Most women are still dissatisfied,” said Victoria Solan, a historian of architecture and design who attended the hackathon. “There’s a lot of talk about how they’re painful, they’re uncomfortable, they don’t work well. So I think the organizers’ original claim — that there’s no reason that the breast pump shouldn’t be as well designed as the iPhone — is true. It’s not. It’s not an iPhone, it’s a mortar and pestle.”

But as some hackathon participants discovered, improving upon it is not necessarily easy.

“When I first came in, I was surprised to see so many of the [breast-pump] vendors here, because we pretty much just attacked their product,” Erin Freeburger said. “And then, a few hours in, I realized: It’s really hard, some of the mechanics we were trying to do. We’re working with gravity, we’re working with suction, we’re working with parts that have to be cleaned within so many hours because we’re working with milk, the storage has to be refrigerated. We hit some walls and we realized, ‘Oh, maybe this is why it’s taken so long to fix it.’”

Detritus at hackathon’s end includes junk food, coffee, diagrams and squeezable stress balls in the shape of breasts. (Carey Goldberg/WBUR)

But the hackathon represents progress, she and others said, at the very least because it united and amplified the voices of women dissatisfied with the current state of pumping.

Women tend to think it’s a personal, private problem if they have trouble pumping at work or elsewhere, she said. And “Probably the reason it hasn’t changed by now is that we’ve sort of just….sucked it up.”

Readers, thoughts? Pumping experiences? Dreams of a better pump?

More on the breast pump hackathon:
The Media Lab “Make The Breast Pump Not Suck” Hackathon
FAQ on the Hackathon
Boston.com video on breast pump hackathon

Categories: Health Care

Soule & Bugbee’s Legal Bibliography (1881-1890)

In Custodia Legis - Mon, 09/22/2014 - 2:00pm

This is a guest post by Anne Guha, who was an intern with the Law Library’s Public Services Division this spring and is now working in Public Services.

We recently received a fascinating inquiry from a fellow law librarian through our Ask a Librarian system, and with her permission, would like to share the results with you.  This patron hailed from the George Mason University Law Library in Arlington, Virginia, and she was looking to learn about our collection of Soule & Bugbee’s Legal Bibliography (1881-1883) and its continuing title, Legal Bibliography (1884-1890), which took over starting with issue number 5.  This periodical, published by Boston legal publishers Soule & Bugbee (and later just by Charles C. Soule), was “published and distributed gratuitously at irregular intervals,” mailed out to judges, lawyers, and law students, who were in turn encouraged to pass the issues around to other legal practitioners (“Show this paper to other Lawyers” it declares on several of its covers):

The Law Library of Congress is fortunate to have issue numbers 3-11 of this fascinating periodical, which included advertisements for a wide variety of recently released or forthcoming legal publications by various publishers, in addition to a number of other interesting features.  Soule & Bugbee’s printed book notes, descriptions, publication dates, excerpts – and, of course, prices! – for various types of materials, such as legal reference manuals, treatises, books for law students, reporters, “odd reports, “rare old law books, “old civil-law books,” and “special lists of bargains:”

The various sales pitches are quite fun and interesting to read.  In issue number 4, they write: “We ask your subscription for the Fourth Edition of Chitty’s (English) Equity Index”, a digest of equity reports, which could be ordered “in sheep or in half calf,” and which “every library needs”: In number 3 we learn that Green Brice’s Ultra Vires is, “in many respects, the most serviceable book on Corporation Law,” and that Baylies on Sureties and Guarantors is “more satisfactory than any other work on these subjects”:

Number 4 also contains “Reading for leisure hours,” a “list of publications [...] which are intended for the amusement and recreation of lawyers,” including titles such as Browne’s Law and Lawyers in Literature and Heard’s Oddities of the Law.

Other issues contain additional notable items.

Several, for example, include illustrations and engravings:

Issue 5 included a loose illustration of Sir Matthew Hale, declaring on page 4: “What is a coif? — Can any reader tell whether the head-gear of Chief Justice Hale, as represented in the engraving accompanying this paper, is a coif or not?”  

This periodical also occasionally printed short articles and features, such as pronunciation tables for names of English and American reporters and legal authors, which, according to issue number 4, “seem to be liable to mispronunciation,” or, in issue 3, an update on “the famous bug case”:

A few of the issues have advertisements for law schools, such as issue number 8, which places their illustrious names alongside a full-column-length advertisement for Horsford’s Acid Phosphate (“For Dyspepsia, Mental and Physical Exhaustion, Nervousness, Diminished Vitality, etc. [...] Beware of Imitations!”):

What spurred our patron’s interest in this publication?  It turns out that this periodical is something of a predecessor to George Mason University Law School’s own law journal, The Green Bag: An Entertaining Journal of Law.  George Mason’s Green Bag was inspired by a legal magazine of the same name, published by Charles C. Soule, which is announced here in issue number 11 of Legal Bibliography:

In a nod to its forebearer publication, George Mason’s modern Green Bag is planning to publish a scholarly edition of the whole Legal Bibliography series.

Categories: Research & Litigation

Viewpoints: CHIP Funding Needed; GOP's Flawed Plan To Make 'The Pill' OTC; Millenials' Health Issues

Kaiser Health News - Mon, 09/22/2014 - 9:29am

The New York Times: Children's Health Insurance At A Crossroads
Federal financing for a beneficial health insurance program for low-income children, known as the Children's Health Insurance Program or CHIP, will run out next year unless Congress agrees to extend it. Bills are pending in both the House and the Senate to extend financing for four years, to 2019. Congress should approve the extension in the lame-duck session after the midterm elections so that families and state officials will know what the future holds. The program needs to be maintained amid uncertainty as to whether other good coverage will be available for these children (9/21).  

The Washington Post: Two Ideas That Could Overcome Political Gridlock
There is a credible case that a Republican-controlled Senate could prove more productive. The new, tenuous majority, with an eye on 2016, would want to prove itself and would have more leverage over recalcitrant House Republicans. ... What could get done that Obama might sign? On two pressing issues — paying for badly needed infrastructure and further controlling the rise in health-care costs — two leading Democratic think tanks have proposed intriguing, bipartisan ways forward (Ruth Marcus, 9/20).

The Washington Post: Over-The-Counter Availability Of 'The Pill' Wouldn't Be A Panacea
You know it's a weird political season when several Republican senatorial candidates are trumpeting their support for making oral contraceptives available without a prescription — and Planned Parenthood's political arm is running TV attack ads against them. Obviously, the GOP is trying to deflect the Democratic charge that it is waging a "war on women," while Democrats and their allies are determined to make it stick (9/21).

Los Angeles Times: New Study Shows That The Savings From 'Tort Reform' Are Mythical
"Tort reform," which is usually billed as the answer to "frivolous malpractice lawsuits," has been a central plank in the Republican program for healthcare reform for decades. The notion has lived on despite copious evidence that that the so-called defensive medicine practiced by doctors merely to stave off lawsuits accounts for, at best, 2% to 3% of U.S. healthcare costs. As for "frivolous lawsuits," they're a problem that exists mostly in the minds of conservatives and the medical establishment (Michael Hiltzik, 9/20).

The New York Times: In Context, Health Premium Increases Don't Actually Look Like Increases
Based on data available so far, we reported last week that the average premiums for last year's most popular plans would rise 8.4 percent, but that people willing to switch plans could get much better deals — an average 1 percent increase, and even decreases in some markets. But is 8.4 percent an alarming increase or a good deal for a plan you like? Is a 1 percent increase a disappointment or a terrific bargain? To put both increases in context, we've assembled some historical data on insurance markets that existed before the Affordable Care Act (Margot Sanger-Katz, 9/22).

The Washington Post: Virginia Republicans Reject Any And All Suggestions To Expand Health Coverage
The opposition of Virginia's GOP lawmakers to any form of Medicaid expansion — under any conditions or timetable or permutation — has assumed its own convoluted logic. They are against using federal funds to insure poor Virginians mainly because the other side — namely, President Obama — is for it. The blatant bankruptcy of the Republican position was on display in Richmond this week, where legislators met in special session to debate the Medicaid expansion — despite the fact that the GOP-controlled House of Delegates had dug in its heels .... They have advanced no legislation, nor even the seed of an idea, that would provide a basic safety net for their low-income constituents who must deal with their health problems by visiting emergency rooms. That is a costly and inefficient means of providing health care (9/19).

The New York Times: Can a Computer Replace Your Doctor?
Silicon Valley is bringing a host of new data-driven technologies to health care, many of them with enormous potential. But before we rush to measure every human attribute in real time, it would be a good idea to ask: When is more data actually useful to promote and ensure better health? And when does technology add true value to health care? The results have been mixed (Elisabeth Rosenthal, 9/20).

The Wall Street Journal: What Health Issues Will Millennials Face That Their Parents Didn't?
New technologies, economic shifts and demographic trends have changed the way millennials manage work and play. What about health? To get some perspective, we asked a group of health-care professionals this question: What health issue will millennials have to deal with that their parents didn't? (9/19).

The Washington Post: The Challenge Of Fighting Antibiotic-Resistant Superbugs
When some of the best science minds in the United States say a problem has become "dire," requires "urgent attention," is growing at an "alarming rate" and has become "a crisis" that threatens medicine, economic growth, public health, agriculture and national security, it might be wise to listen. That is what President Obama's outside science advisers told him Thursday about the rise of antibiotic resistance, the growing tendency of bacteria to overcome the antibiotics that are a bedrock of modern medicine (9/20).

The New York Times: A Cancer Battle We Can Win
The war against cancer can be confusing, with providers, insurers and policy makers debating the effectiveness of treatments, prevention programs and research. But there is one significant victory within our grasp. There is, increasingly, a consensus that CT screening for lung cancer can save thousands of lives each year (Andrea McKee and Andrew Salner, 9/21).

Health Affairs: Different Parts Of The Same Elephant: Medicaid Research And State Expansion Decisions
Debates about Medicaid expansion betray an underlying fundamental disagreement not only about the Affordable Care Act (ACA) but about the Medicaid program itself. Medicaid, unlike Medicare, lacks the near-universal buy-in to the fundamental value of the program to beneficiaries' health and well-being. As a means-tested (read welfare-related) program, Medicaid raises concerns and disagreements regarding work (dis)incentives, labor market effects, the "deserving" poor, and how this relates to the construct of health care as a right and a public good (Donna Friedsam, 9/19).

Categories: Health Care

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