KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Calming Dementia Patients Without Powerful Drugs

In California nursing homes, just over 15 percent of dementia patients are on antipsychotic drugs. That’s far more than advocates say is necessary. But that number is down from almost 22 percent just three years ago. (Rachel Dornhelm, KQED, 5/29)

Political Cartoon: 'Up To The Courts?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Up To The Courts?'" by Nate Beeler, The Columbus Dispatch.

Here's today's health policy haiku:

A BAD DAY IN THE LAB

Live anthrax spores? Yikes!
Were they not zapped? Sure. Maybe.
But they’re tough to kill.

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

Judge Considers Bid To Dismiss House GOP Case Against Obama Administration And The Health Law

House Republicans filed suit alleging that the Obama administration has overstepped its Constitutional bounds. The administration, in turn, filed a motion to dismiss the case and argued in part that if the lawmakers don't like the law they should work to change it in Congress.

The Wall Street Journal: Judge Considers House GOP’s Case Against Obama’s Health Law
House Republicans filed a lawsuit in November claiming administration officials overstepped their authority by paying back insurers for discounts on health-plan deductibles they are required to offer low-income enrollees. The lawmakers allege that Congress never appropriated money to cover the cost of the discounts. The Obama administration, represented by the Justice Department, filed a motion for the court to dismiss the case on the grounds that the House lacked standing to sue because it hadn’t been harmed. U.S. District Judge Rosemary Collyer heard oral arguments on that motion on Thursday. (Radnofsky, 5/28)

The Washington Post: Judge Weighs Bid To Toss House GOP Suit Against Obama Health-Care Law
The suit was approved by the U.S. House of Representatives on a party-line vote last July and filed in U.S. District Court in Washington. It focuses on the administration’s decisions to pay subsidies to insurance companies that they say were not authorized by Congress and to twice waive the deadline for the so-called “employer mandate” requiring larger employers to provide health insurance to employees. (Hsu, 5/28)

Reuters: Judge Grills Lawyer Defending Obama's Health Care law Changes
A U.S. judge on Thursday blasted the Obama administration's motion to dismiss a lawsuit brought by Republicans in the U.S. House of Representatives over the implementation of the Democratic president's signature healthcare law. Republicans in the House filed a lawsuit in November, saying administration officials unlawfully bypassed Congress. (Dunsmur, 5/28)

The Associated Press: Administration Asks Judge To Toss House Health Care Suit
A skeptical federal judge grilled Obama administration lawyers Thursday over the House GOP's health care lawsuit, sounding unlikely to side with the president and dismiss the case. At issue in the case is some $175 billion the administration is paying health insurance companies over a decade to reimburse them for offering lowered rates for poor people. The House argues that Congress never specifically appropriated that money, and indeed denied an administration request for it, but that the administration is paying it anyway. (Werner, 5/28)

Bloomberg: Obamacare Judge Told Funding Dispute Belongs On Hill, Not Court
U.S. House Republicans suing the Obama administration over the federal health care law should change it if they don’t like it, a Justice Department lawyer told a skeptical judge in a bid to have the lawsuit thrown out. The House “has any number of tools” to settle its differences with the executive branch, without running to the courts, attorney Joel McElvain said. Republicans can negotiate with the administration and “they can pass a new statute,” he said. (Zajac, 5/28)

NBC News: Obama Administration Argues GOP Health Care Suit Should be Tossed
Representing the House was prominent George Washington University law professor Jonathan Turley who argued the Administration is spending money for payments to insurance companies that was not appropriated by Congress and therefore acting unconstitutionally. It is Congress that holds the power of the purse, Turley argued. "We have named an assortment of injuries most obvious is the denial of the power of the purse," Turley told reporters outside the courthouse after the hearing. "If the Administration can claim the authority to take money directly out of the treasury in this fashion, then the power of the purse becomes a decorative element within our system." The administration also tried to make the argument that the House does not have legal standing to challenge how Obamacare is being implemented. (Moe, 5/28)

McClatchy: Health Care Law Supporters Encounter Resistance From Federal Judge
Appointed to the bench by President George W. Bush, Collyer repeatedly, and perhaps tellingly, hammered Justice Department attorney Joel McElvain with sharp comments like “You’re not getting my point,” “You are dodging my question” and “This is the problem with your brief. It’s just not direct.” (Doyle, 5/28)

Fla. Governor Hints At Veto If Lawmakers Pass Senate Compromise To Expand Medicaid

Also, new details on Gov. Rick Scott's plan to find money for hospitals and end the state's budget impasse suggest it would cut overall reimbursements to hospitals. The lobbying on the issue continues to grow in the state.

Tampa Bay Times: Scott All But Threatens Veto Of Senate FHIX Health Care Plan
Gov. Rick Scott all but threatened a veto Thursday of a Senate plan aimed at expanding health insurance coverage to more than 800,000 uninsured Floridians by drawing down federal money into a privately run insurance exchange. “I’m not doing it,’’ Scott told the Herald/Times after a meeting of the Enterprise Florida board of directors in Tampa. He repeated his claim at the Senate’s Florida Health Insurance Affordability Exchange (FHIX) program is a tax increase but, when asked, he refused to explain how he reaches that conclusion. (Klas & Contoro, 5/28)

The Miami Herald: Miami Groups Petition For Medicaid Expansion At Office Of Florida Rep. Jose Oliva
The Affordable Care Act, also known as Obamacare, includes a provision to expand Medicaid. Florida is among the 18 states that have not chosen to expand it, and a bitter dispute between Republicans in the House and Senate over the issue forced an early end to the regular session. The groups delivered the signatures, collected over several months from around the state, to Oliva’s second-floor office at a shopping center, urging him to listen to his constituents. (Herrera, 5/28)

Here's the latest in Medicaid expansion news from Texas and Utah -

KSL: Utah Medicaid Expansion Negotiations Ongoing
Utah lawmakers continue to work on a plan to cover the state's uninsured but don't anticipate striking any kind of deal before August. Upon failing for a second year to come up with a feasible alternative to the full Medicaid expansion outlined in the Affordable Care Act of 2010, a team of four lawmakers, Utah Gov. Gary Herbert and Lt. Gov. Spencer Cox set out in March to negotiate a deal. "We are working well together," Utah House Speaker Greg Hughes, R-Draper, told a gathering at the Utah Taxes Now Conference in Salt Lake City on Thursday. (Leonard, 5/28)

In related news about Medicaid and other public assistance programs -

The Associated Press: Census: No. Of Americans On Assistance May Be Leveling Off
The once-increasing number of Americans getting some kind of public assistance from the U.S. government may be slowing down, according to new information from the U.S. Census Bureau. ... The programs tracked were Medicaid, Supplemental Nutrition Assistance Program (SNAP), housing assistance, Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF) and general assistance. Medicaid was the most used program in 2012, with an average monthly participation rate of 15.3 percent, followed by SNAP at 13.4 percent, housing assistance at 4.2 percent, SSI at 3 percent and TANF and general assistance at 1 percent. (Holland, 5/28)

And on the topic of health exchanges -

N.C. Man's Saga Shows Continuing Coverage Gaps

The Charlotte Observer looks into the story of a man who quit his job and, therefore, no longer qualified for a federal insurance subsidy in North Carolina -- just before he became ill with a potentially deadly intestinal infection. Meanwhile, Politico Pro reports how some states are seeking to shield mid-size companies from Obamacare requirements and The Financial Times reports on a study about the administrative costs associated with the expansion in insurance coverage.

The Charlotte Observer: After Two Weeks Of Misery, ACA Insurance Brings Man Relief
It’s a sign of how convoluted our health care system is when it’s hard to tell the horror stories from the success stories. When I got an email from Joe Hatley of Conover, a small town about 45 miles northwest of Charlotte, I thought I was reading the former. Hatley said he’d enjoyed my reports on Luis Lang, an uninsured Fort Mill man who needs costly surgery to save his sight. Like Lang, Hatley found himself out of work, sick and uninsured. Both men’s stories highlight gaps in the system in North and South Carolina. But Hatley, who is recovering from a potentially deadly gastrointestinal infection, emphasizes the happy ending to his tale: His hospitalization was covered, even though he waited almost two weeks to see a doctor until his insurance kicked in. (Helms, 5/28)

The Fiscal Times: Obamacare’s $273 Billion Bonanza For Paper Pushers
Since Obamacare took effect, roughly 16.5 million more people have gained health insurance. And while the health care law is objectively succeeding in its key goal of expanding access to coverage to millions of Americans, those gains come with enormous costs to taxpayers — including inordinately steep ongoing administrative costs, according to a new study. (Ehley, 5/28)

Capitol Hill Watch

Congressional Republicans Remain Split Over Plans For King V. Burwell Decision Fallout

Lawmakers differ over whether to extend the health law's insurance tax credits on a temporary basis if the Supreme Court voids them.

The Wall Street Journal: GOP Split On Possible Health-Law Fixes
A month before the Supreme Court is expected to rule on a key component of the Affordable Care Act, congressional Republicans are split over their strategy for handling the possible fallout. Republicans, who control both houses of Congress, are divided over whether to extend temporarily the health law’s tax credits if the court voids them in most of the country. An extension, some lawmakers say, would buy them time to enact a broader overhaul of the 2010 health law they have long opposed. (Peterson and Radnofsky, 5/28)

McClatchy: Proposals To Extend Marketplace Subsidies Would Only Delay Damage
Congressional proposals to temporarily extend federal health insurance subsidies if they’re lost in an upcoming Supreme Court decision would only delay, not avoid premium hikes, insurance market disruptions and potential coverage losses for millions of Americans. That’s the main finding of a new issue brief released Wednesday by the American Academy of Actuaries. (Pugh, 5/28)

Former Congressman Alleges Capitol Physicians Failed To Alert Him To Cancer Threat

Former Rep. Steve LaTourette, R-Ohio, who is battling pancreatic cancer, says the doctors failed to give him important information about a lesion on the pancreas and the need for follow-up appointments. Also in the news, Sen. Roy Blunt, R-Mo., pledges renewed support for community health clinics.

The Associated Press: Former Rep. LaTourette Files Claim Over Missed Cancer
Former Rep. Steve LaTourette, gravely ill with pancreatic cancer, has filed a claim against the government over the treatment he received from his Capitol doctors, claiming they failed to pass along critical information about a lesion on the organ and the need for follow-up monitoring. LaTourette, R-Ohio, filed administrative claims against the government earlier this month in anticipation of filing a lawsuit later. But papers filed with a federal court in Washington last week say LaTourette “is likely to succumb to rapid physical and cognitive deterioration” and urge that he be allowed to testify now since he may not be able to when any lawsuit is filed. (Taylor, 5/28)

St. Louis Public Radio: Blunt Expresses Support For Community Health Centers In St. Louis
Missouri Republican Senator Roy Blunt visited a community health clinic in north St. Louis Thursday and pledged support for the model, which uses federal funds to provide basic healthcare services for people who are uninsured or living in poverty. The Affordable Care Act included an increase in funding to community health centers over the past five years. Congress has extended the funding for another two years. (Bouscaren, 5/28)

Marketplace

Congressional Proposal To Streamline FDA Approvals Worries Consumer Advocates

As the House moves forward with the "21st Century Cures" bill, some warn that its provision allowing “clinical experience" over randomized controlled trials could lead to lower standards when approving new uses for existing drugs. Other outlets report on more pharma news, including lessons learned from an international drug pricing study and examples of insurers and drug companies teaming up to reduce sticker shock on new speciality drugs.

The Wall Street Journal: Speeding Up Drug-Approval Process Could Have Downside
Would a congressional bill designed to jump-start medical innovation end up lowering standards for approving new uses of existing medicines? Consumer advocates are raising this concern about the 21st Century Cures legislation, which passed the House Energy and Commerce Committee unanimously last week and, in part, is designed to reform the approval process for drugs. Supporters say the bill is a long overdue move that, among other things, will give the FDA the tools to ensure treatments reach patients faster. (Silverman, 5/28)

Bloomberg: Big Pharma And Insurers Play Nice
In the summer of 2014, biotechnology company Amgen seemed to be on the verge of a breakthrough with an injectable anti-cholesterol drug. ... As positive results came out of Amgen’s labs, the price of another drug shocked the health insurance industry: Sovaldi, a hepatitis C cure that its manufacturer, Gilead Sciences, initially priced at $84,000 for a 12-week course. Express Scripts, the biggest pharmacy benefit manager (PBM) in the country, balked at the cost. It eventually refused to include Sovaldi in its 2015 formulary .... That taught Amgen and other drugmakers a lesson. Avoiding hostility with insurers and PBMs is now a paramount industry goal. (Weintraub, 5/28)

Meanwhile, Fred Inc. reports losses due to lower Medicare reimbursements and the U.K.'s Smith & Nephew cuts prices to disrupt the U.S. orthopedics market -

The Wall Street Journal: Fred’s Swings To Loss Amid Pressure In Pharmacy Business
Fred’s Inc. swung to a loss in its first quarter as the discount retailer’s pharmacy business struggled with lower Medicare reimbursements and higher generic drug costs. The Memphis, Tenn.-based company said slow reimbursements, reimbursement rate reductions associated with preferred Medicare Part D networks, and inflation in generic drugs pressured its pharmacy segment during the quarter. (Beilfuss, 5/28)

The Wall Street Journal: Smith & Nephew’s Cut-Price Solo Strategy
When prices are falling, apply a little pressure. Tougher pricing for hip and knee replacements helped prompt cost-cutting consolidation in the medical-equipment arena. Zimmer last year agreed to buy Biomet. Stryker also cast an eye over the U.K.’s Smith & Nephew . (Thomas, 5/28)

Teva To Pay $1.2B To Settle Charges That A Subsidiary Blocked Lower-Cost Generics

The Federal Trade Commission alleged Cephalon paid four competitors to delay marketing generic versions of its money-making sleeping pill, Provigil. The settlement is a victory in the federal government's efforts against a drug industry practice known as "pay-for-delay."

The New York Times: Teva Settles Cephalon Generics Case With F.T.C. For $1.2 Billion
The pharmaceutical company Cephalon had a cash cow on its hands. In the United States alone, its prescription drug Provigil, which treats sleep disorders, generated over $475 million in sales in 2005 and almost double that in 2007. It made up about half of Cephalon’s business. When the company was faced with an expiring patent and the prospect of generic drug makers selling far cheaper versions of Provigil, it chose to buy off the competition, according to federal regulators. (Ruiz and Thomas, 5/28)

Meanwhile, scope maker Olympus Corp. is under investigation by the Justice Department -

Los Angeles Times: Justice Department Investigates Scope Maker Olympus Over Superbug Outbreaks
The Justice Department is investigating embattled scope maker Olympus Corp. and its role in recent superbug outbreaks at UCLA and other U.S. hospitals. The Japanese company said it received a subpoena in March from federal investigators that “seeks information relating to duodenoscopes that Olympus manufactures and sells.” The company disclosed the inquiry in a financial filing this month. (Terhune and Petersen, 5/28)

Public Health And Education

Shipments Of Live Anthrax Probed

The Centers for Disease Control and Prevention has a team looking into how the military shipped the spores to more than a dozen labs around the country. Meanwhile, USA Today reports that many of the country's high containment biological research labs are secretive about what they are doing.

NPR: CDC Investigates Live Anthrax Shipments
The Centers for Disease Control and Prevention is still trying to figure out how the military managed to ship anthrax spores that were apparently live from one of its facilities to more than a dozen labs across the United States. "We have a team at the [military] lab to determine what may have led to this incident," says CDC spokesman Jason McDonald. In addition, he says, the agency is working with health officials in nine states to make sure the potentially live samples are safely disposed of and the labs affected are decontaminated. (Brumfiel, 9/28)

USA Today: Universities, Feds Fight To Keep Lab Failings Secret
Transparency is an important cornerstone in maintaining public trust in biological research, says the National Institutes of Health, which has issued guidance to laboratories that receive federal funding. While many research organizations answered USA TODAY's questions and provided basic records about their biosafety committees' work, dozens of others were not so forthcoming. (Young and Penzenstadler, 5/28)

Study Tracks Patients After Prolonged Mechanical Ventilation

The often poor outcomes raise questions about who should be a candidate for such care and what their families should be told. Meanwhile, researchers are using video games to target issues ranging from cancer to teen pregnancy and electronic health records become a prime target for hackers.

The Philadelphia Inquirer: Life After Mechanical Ventilation: Searching For Answers
Emily Damuth and Stephen Trzeciak, critical-care specialists at Cooper University Hospital, would like to be able to tell patients what their lives will be like if they choose to stay on a breathing machine for more than a couple of weeks. There's just one problem: The doctors don't know. Trzeciak said intensive-care unit physicians like him rarely see their patients again once they leave the hospital. What happens after the ICU heroics is a "black box" for them, he said. He and Damuth found that frustrating enough that they led a study that looked at what happens to patients in the United States and other countries who get mechanical ventilation for more than two weeks. (Burling, 5/28)

U.S. News & World Report: Gaming The System
The objective of the Internet-based "Re-Mission 2" games is simple: Kill cancer. The games – six in all – arm players with weapons like "chemo bombs" and antibiotics to fight the leukemia monster, destroy bacteria, rescue healthy cells and annihilate tumors, all while collecting points and conquering levels. And for players who are battling cancer themselves, winning in the virtual world could have profound implications for their health in the real one. Researchers at HopeLab, the California nonprofit that created the game, say teens and kids who play it understand their disease better and show improved adherence to their medications as a result. (Leonard, 5/29)

NBC News: Electronic Medical Records Are Latest Target For Identity Thieves
Despite high-profile hacks that have targeted high-profile retailers like Target and entertainment giant Sony Pictures, security experts are warning of a more prized target for identity thieves: medical records. ... Anthem, one of the nation's largest health insurance companies, said in February that hackers accessed a database containing 80 million records, and that Social Security numbers, names, dates of birth and medical insurance identification numbers were at risk. It was followed by Premera Blue Cross, which announced a month later that it, too, was hacked, and health data for as many as 11 million people may have been compromised. (Gosk, 5/28)

State Watch

Children's Mental Health Services Get Attention In New York, Minnesota

Also in Minnesota, the legislature has stepped up funding for a number of mental health programs.

The Associated Press: NY Lawmakers Reviewing Mental Health Services For Children
Legislators in New York are taking a look at the state of mental health care for children. The state Assembly plans to hold a public hearing in Buffalo on Friday focusing on the availability of services specifically in western New York. Lawmakers on the panel conducting the hearing plan to examine an ongoing effort to consolidate and merge state mental health programs. They'll also look at the impact of the potential closure of the Western New York Children's Psychiatric Center. (5/29)

MinnPost: $46M In New Funding: NAMI-MN Leader Summarizes Legislature's Mental Health Initiatives
Suicide prevention programs: $449,000. Mental health crisis services: $8.57 million. Text for Life: $1 million. Respite care for families of children with mental illness: $847,0000. It’s been a banner year for mental health advocates at the Minnesota Legislature, with lawmakers on both sides of the aisle voting to support mental health initiatives with over $46 million in new funding. (Steiner, 5/27)

Meanwhile, in other related news -

The Washington Post: Women Of All Ages More Likely To Have Serious Mental Health Problems Than Men, Report Says
Women in every age group in the United States were more likely than men to have serious mental health problems, according to federal health statistics released Thursday. The report from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention, also found that more than one-fourth of people age 65 or older who are afflicted with these mental health problems have difficulty feeding, bathing and dressing themselves. (Sun, 5/28)

The Associated Press: Demi Lovato Is The New Face Of Mental Health Campaign
When Demi Lovato was diagnosed with bipolar disorder, she was actually relieved. “Growing up, I felt very, very depressed,” she said. “Even though I was playing concerts and living out my dream, I couldn’t tell you why I was upset.” Lovato is sharing her story and encouraging others to do the same through Be Vocal: Speak Up For Mental Health, an initiative launched Thursday by a pharmaceutical company, the National Alliance on Mental Illness and other mental-health advocacy groups. Its aim is to improve treatment options at all levels and erase the stigma around mental illnesses. (Cohen, 5/28)

State Highlights: Calif. Immigrant Health Bill Clears Key Fiscal Panel; Ala. House OKs Measure To Create Medicaid Long-Term Care Networks

News outlets report on health issues from California, Alabama, Texas, Indiana, North Carolina, Maryland, D.C., Ohio, Kansas and Florida.

Los Angeles Times: Scaled-Back Immigrant Healthcare Bill Clears Key Fiscal Panel
A sweeping measure to offer state-subsidized healthcare coverage to people in the country illegally was significantly pared back Thursday in an effort to rein in costs as it cleared a key legislative hurdle. Rather than extend Medi-Cal--California's healthcare coverage for the poor--to all eligible adults regardless of immigration status, as originally proposed, the amended bill by state Sen. Ricardo Lara would set up a limited enrollment healthcare program. (Mason, 5/28)

The Associated Press: Alabama House Passes Bill To Create Long-term Care Networks
The Alabama House on Thursday passed a bill that would establish integrated care networks to allow more Medicaid recipients to stay in their homes instead of nursing homes. Senate Majority Leader Greg Reed, R-Jasper, said the legislation could cut Medicaid costs by $1.5 billion from 2018 to 2028 while also allowing more Medicaid recipients to receive home-based care. (Swant, 5/28)

Times Union: Therapists Say Rate Cut Would Hurt Kids
A proposed rate cut for physical, occupational and speech therapy in the Medicaid program is being decried by providers who warn that it could particularly affect children who need care [In Texas]. The $209.4 billion state budget proposed for the next two years includes a cut of about $350 million in state and federal funds for the therapy program serving children and elderly Texans. (Fikac, 5/28)

Columbus Dispatch: Medicaid Cuts Could Put Ohio Babies At Risk, Advocates Say
Health-care advocates say a state plan to scale back Medicaid coverage for low-income pregnant women will push Ohio’s already dismal rate of infants dying before their first birthday even higher. “If this budget does not change, our state legislature is in the process of enacting legislation that will increase the number of babies that die on the South Side. It is absolutely obscene,” said the Rev. John Edgar of the United Methodist Community Development for All People on Parsons Avenue. (Candisky, 5/29)

Politico: Welcome To The Red State HIV Epidemic
It t wasn’t supposed to happen here. Not in Austin, a one-doctor-and-an-ice-cream-shop town of 4,200 in southeastern Indiana, nestled off Interstate 65 on the road from Indianapolis to Louisville, where dusty storefronts sit vacant and many residents, lacking cars, walk to the local market. Not in rural, impoverished Scott County, which had reported fewer than five new cases of HIV infection each year, and just three cases in the past six years. Not in a state where, of the 500 new cases reported annually, only 3 percent are linked to injection drug use. But it did. And it could happen in many more backwoods towns just as unprepared as Austin. (Wren, 5/28)

North Carolina Heath News: Eugenics Compensation Amendment Continues To Leave Some Victims Out
An amendment to the House budget would speed compensation to eugenics victims. Nonetheless, some victims have been left out in the cold. According to the North Carolina Department of Administration, which is processing claims from people who were sterilized, close to 800 claims were filed, but only 220 were found to be “qualified” to receive compensation from the fund. (Hoban, 5/29)

The Associated Press: US Alleges Pain Clinics Operated As ‘Pill Mills’
The U.S. Attorney’s Office said Thursday that the indictments were returned on May 20 and unsealed Wednesday. They allege that the owners, operators and other associated with four clinics plotted to distribute oxycodone. The indictments name four pain clinics: PG Wellness Center of Oxon Hill, Maryland; A Plus Pain Clinic of Washington; First Priority Health Care of Elkridge, Maryland; and MPC Wellness Center of Greenbelt, Maryland. (5/28)

Health News Florida: Florida Getting First Breast Milk Bank
Baby Serenity lay on her tummy in a tiny white crib at Winnie Palmer Hospital for Women & Babies’ neonatal intensive care unit in Orlando. A nurse rubs her back as her chest heaves up and down with her little breaths. When Serenity was born three months early, in February, she weighed just one pound. Like many preemies, Serenity is dealing with a chronic lung disease and a heart condition. She’s also at high risk of necrotizing enterocolitis, a life threatening disease of the intestines. Doctors said breast milk could help build her immune system and fight infection. But Jenkins – like many mothers of premature babies -- said she couldn’t produce her own milk. Some moms can’t supply their own breast milk because they themselves are ill, stressed or on medications. (Chavez, 5/28)

The Kansas City Star: As Vaping Culture Gets Hot, Some Drop Cigarettes, But Maybe Not All the Risks
Like many a hardcore smoker, Candi McCann found it a bear to quit. Nothing worked. Not the patch. Not those blue smoking cessation pills her doctor prescribed. Then she tried those electronic cigarettes that produce a steamy vapor instead of smoke. Click, just like that, she went from more than a pack of smokes a day to becoming the Kansas City area's leading vaping evangelist. “I'm not going to tell you this is healthy,” said McCann. “But I can tell you that it is 99 percent better for you than smoking.” Whether that stat is true or not, that's one selling point that keeps customers coming back to the more than three dozen vape shops that have set up in the metro area since 2013. Before, there were few or none. (Hendricks, 5/28)

Health Policy Research

Research Roundup: RUC And Medicare Pay; Rx For Marketplace Patients; Who's Homebound?

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

Government Accountability Office: Medicare Physician Payment Rates: Better Data and Greater Transparency Could Improve Accuracy
The American Medical Association/Specialty Society Relative Value Scale Update Committee (RUC) has a process in place to regularly review Medicare physicians' services' work relative values .... Its recommendations to the Centers for Medicare & Medicaid Services (CMS) ... though, may not be accurate .... First, the RUC's process for developing relative value recommendations relies on the input of physicians who may have potential conflicts of interest .... Second, GAO found weaknesses with the RUC's survey data .... [CMS] does not maintain a database to track when a service was last valued or have a documented standardized process for prioritizing its reviews. ... CMS's process is not fully transparent because the agency does not publish the potentially misvalued services identified by the RUC in its rulemaking. (5/21)

Health Affairs: Early Marketplace Enrollees Were Older And Used More Medication Than Later Enrollees; Marketplaces Pooled Risk
Medication use may provide an early indicator of the health needs and access to care among Marketplace enrollees. We used data from January–September 2014 on more than one million Marketplace enrollees from Express Scripts, the largest pharmacy benefit management company in the United States. ... Among Marketplace enrollees, we found that those who enrolled earlier (October 2013–February 2014) were older and used more medication than later enrollees. Marketplace enrollees, as a whole, had lower average drug spending and were less likely to use most medication classes than the employer-sponsored comparison group. However, Marketplace enrollees were more likely to use medicines for hepatitis C and particularly for HIV. (Donohoe et al., 5/27)

JAMA Internal Medicine: Epidemiology Of The Homebound Population In The United States
It is uncertain how many people who live in the United States are homebound. [Researchers used] cross-sectional data [of Medicare beneficiaries] from the National Health and Aging Trends Study collected in 2011 .... We defined homebound persons as those who never (completely homebound) or rarely (mostly homebound) left the home .... We defined semihomebound persons as those who only left the home with assistance or had difficulty ... leaving the home. ... the prevalence of homebound individuals was 5.6%, including an estimated 395 ,422 people who were completely homebound and 1 ,578, 984 people who were mostly homebound. Among semihomebound individuals, the prevalence of those who never left home without personal assistance was 3.3%, and the prevalence of those who required help or had difficulty was 11.7%. ... Only 11.9% of completely homebound individuals reported receiving primary care services at home. (Ornstein et al., 5/26)

JAMA Internal Medicine/Rand Corp.: Antibiotic Prescribing For Acute Respiratory Infections In Direct-To-Consumer Telemedicine Visits
Direct-to-consumer (DTC) telemedicine companies provide consumers with around-the-clock access to care for common nonemergent conditions through telephone and live video visits via personal computers and mobile phone apps. DTC telemedicine is often more convenient and less expensive than in-person visits. However, concerns about the quality of these services have been expressed .... Using health plan claims, we compared antibiotic prescribing rates for acute respiratory infection (ARI) between Teledoc, a large DTC telemedicine company, and physician offices. ... the fraction of ARI visits at which an antibiotic was prescribed was similar for Teledoc and physician offices. ... For cases in which an antibiotic was prescribed, the adjusted broad-spectrum antibiotic prescribing rate for all ARI visits was 86% for Teladoc vs 56% at physician offices. (Uscher-Pines, 5/26)

The New England Journal of Medicine: Medicaid At 50 — From Welfare Program To Nation’s Largest Health Insurer
Over its 50-year history, the federal–state Medicaid program has evolved from a neglected stepchild of Medicare to the nation’s largest health care program, providing coverage to tens of millions of persons and families of limited means. ... the Affordable Care Act (ACA) essentially completed Medicaid’s transformation from a welfare-style program that served certain categories of low-income persons — namely, those with disabilities, the elderly, pregnant women, parents of dependent children, and children 18 years of age or younger — to one in which any American with a family income at or below 138% of the federal poverty level (just under $28,000 for a family of three) is eligible to enroll. ... In this article, ... we will cover key developments in the program’s history and its current, if unsettled, state as the ACA is implemented. (Iglehart and Sommers, 5/28)

The Kaiser Family Foundation: Medicaid Financing: How Does It Work And What Are The Implications?
Medicaid represents $1 out of every $6 spent on health care in the US and is the major source of financing for states to provide coverage to meet the health and long-term needs of their low-income residents. The Medicaid program is jointly funded by states and the federal government. ... This brief reviews how the Medicaid program is financed as well as the implications for budgets, responsiveness to state policy choices and need, the links between Medicaid spending and state economies. Key conclusions include: ... The federal government guarantees matching funds to states for qualifying Medicaid expenditures .... In some instances, Medicaid provides a higher matching rate for select services or populations, the most notable being the ACA Medicaid expansion enhanced match rate. (Snyder and Rudowitz, 5/20)

The Urban Institute/Robert Wood Johnson Foundation: Medicaid Expansion, The Private Option And Personal Responsibility Requirements
Ever since the Supreme Court effectively ruled in June 2012 that states could choose whether or not to expand Medicaid to nonelderly adults under the Affordable Care, that choice has been one of the most prominent and often one of the most contentious issues for states. In this report, we describe the six states (Arkansas, New Hampshire, Indiana, Iowa, Michigan and Pennsylvania) that requested and received approval from the federal government to experiment with coverage approaches that are modelled on private insurance concepts .... The bottom line is that some state initiatives under [Medicaid's waiver] Section 1115 may be effective, while others are unlikely to achieve their stated objectives. But regardless of their ultimate effectiveness, all of them have extended health coverage to large numbers of people. (Wishner et al., 5/27)

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

MedPage Today: Docs 'Missing The Mark' On Shared Medical Decisions
Patients trying to decide between two surgical options for the treatment of ulcerative colitis found information supplied by doctors to be "believable" but not very "useful," according to a small pilot study at the University of California San Francisco. The study was based on responses from 25 patients who were questioned about the research they did before meeting with a surgeon and the sources of information they considered most useful. An abstract of the study was presented at Digestive Disease Week in Washington. (Ready, 5/24)

Reuters: Gender And Family Relationships Affect Caregiver Strain
For both men and women, caring for a sick or disabled spouse or child is more stressful than caring for a parent, according to a new study from Canada. Caregiving can be difficult, but little is known about whether it's harder on women or men, or depends on the nature of the relationship between the recipient and the giver of care, the researchers wrote in The Gerontologist, online April 17. (Doyle, 5/26)

Reuters Health: To Promote Breastfeeding, Fewer Hospitals Hand Out Formula
Fewer U.S. hospitals are giving away free infant formula, a new study finds, a shift that may help encourage more new mothers to breastfeed. Pediatricians recommend that mothers exclusively breastfeed infants until at least six months of age because it can reduce babies’ risk of ear and respiratory infections, sudden infant death syndrome, allergies, childhood obesity and diabetes. Formula provides nutrients needed for growth and development, but doesn’t offer added protection against illness or infection. (Rapaport, 5/26)

The Associated Press: Study Reveals Flaws In Gene Testing; Results Often Conflict
The first report from a big public-private project to improve genetic testing reveals it is not as rock solid as many people believe, with flaws that result in some people wrongly advised to worry about a disease risk and others wrongly told they can relax. Researchers say the study shows the need for consumers to be careful about choosing where to have a gene test done and acting on the results, such as having or forgoing a preventive surgery. (Marchione, 5/28)

Reuters: Fitness In Middle Age Linked To Healthier Brain In Later Years
People who have better aerobic fitness in middle age may ward off decreases in brain volume later in life, potentially preserving memory and other functions, a U.S. study suggests. “The current findings suggest that maintaining high fitness in midlife may boost brain health on average 20 years later in adults who have not yet experienced cognitive impairment,” lead study author Qu Tian, a gerontology researcher at the U.S. National Institute on Aging, said by email. (Rapaport, 5/28)

Editorials And Opinions

Viewpoints: Doctors' Frustrations With EHRs; The Blame Game On Subsidies

A selection of opinions on health care from around the country.

The Washington Post: Why Doctors Quit
The newly elected Barack Obama told the nation in 2009 that “[electronic health records] just won’t save billions of dollars” — $77 billion a year, promised the administration — “and thousands of jobs, it will save lives.” He then threw a cool $27 billion at going paperless by 2015. It’s 2015 and what have we achieved? The $27 billion is gone, of course. The $77 billion in savings became a joke. Indeed, reported the Health and Human Services inspector general in 2014, “EHR technology can make it easier to commit fraud,” as in Medicare fraud, the copy-and-paste function allowing the instant filling of vast data fields, facilitating billing inflation. That’s just the beginning of the losses. Consider the myriad small practices that, facing ruinous transition costs in equipment, software, training and time, have closed shop, gone bankrupt or been swallowed by some larger entity. (Charles Krauthammer, 5/28)

The Washington Post's Plum Line: GOP Plans Would Destroy Obamacare To Save It, New Study Finds
If the Supreme Court guts subsidies for millions, Republicans will probably try to pass some form of “contingency fix” plan that would keep those subsidies going — at least, until after the 2016 elections. But that would likely be packaged with repeal of the individual mandate, which suggests the real GOP game plan may be to draw a presidential veto — allowing Republicans to claim they tried to save all those people’s health insurance, but mandate-crazed Barack Obama wouldn’t let them. (Greg Sargent, 5/28)

Bloomberg View: The Next Obamacare Fight: Who To Blame
The more significant impact of the debate over intent, if the [Supreme Court] rules for King, comes in two parts. The first involves the Republican Party's image: If a consensus forms that conservatives stripped 8 million people of health insurance because they insisted on litigating a typo, that plays into the Democratic narrative of a party that's poorly attuned to the financial concerns of middle-class voters. On the other hand, if Obamacare's opponents can convince the public that Democrats brought this on themselves (by trying to coerce state governments and then changing their story when that approach didn't work), those opponents can try to avoid taking the blame for people losing their insurance. ... That fight could also influence the way Americans view the legitimacy, and limits, of Democrats' efforts to expand the social safety net. (Christopher Flavelle, 5/29)

Bloomberg View: FTC'S Drug Settlement A Win For The Lawyers
Is Thursday's $1.2 billion antitrust settlement between the Federal Trade Commission and Teva Pharmaceutical Industries a victory for consumers? Or is it a sign of government enforcement run amok? The answer to that question, it turns out, goes back to a 2013 U.S. Supreme Court case, FTC v. Actavis, in which five justices allowed the FTC to pursue a new kind of antitrust litigation. And the issue at the heart of that case was fascinating: What happens when the good kind of monopoly created by a patent runs headlong into the bad kind of monopoly created by collusion between merchants? (Noah Feldman, 5/29)

The New England Journal of Medicine: Screening For Lung Cancer With Low-Dose CT — Translating Science Into Medicare Coverage Policy
The [National Lung Screening Trial ] provided the initial evidence to support lung-cancer screening with low-dose CT. The next step is to address the challenges ahead to ensure that population screening confers similar benefits over time and minimizes risk. By creating a new preventive benefit with specific evidence-based coverage criteria, CMS has established a mechanism to provide responsible access to high-quality lung-cancer screening with low-dose CT in the Medicare population while trials continue .... However, the primary responsibility for ensuring appropriate integrated screening in which benefits outweigh harms ultimately rests with practicing physicians, informed patients, and the multidisciplinary stakeholders involved in screening efforts. (Joseph Chin, Tamara Syrek Jensen, Lori Ashby, Jamie Hermansen, Joseph D. Hutter and Patrick H. Conway, 5/28)

JAMA: Paying For Prevention: A Novel Test Of Medicare Value-Based Payment For Cardiovascular Risk Reduction
Traditionally, federal strategies to enhance uptake of preventive care, such as screening mammography, have relied on improved access by expanding insurance coverage for services, reducing or eliminating patient co-payments, and investing in public media campaigns. ... Designing payment incentives that properly encourage prevention is more complex .... the Center for Medicare & Medicaid Innovation recently announced a large, novel model test to determine whether financially rewarding reductions in 10-year predicted risk for atherosclerotic heart disease (defined as initial myocardial infarction or stroke) across a physician’s patient population is an effective model for value-based prevention. ... Termed the Million Hearts Cardiovascular Risk Reduction Model, this model will represent the largest test of value-based prevention payment ever conducted by CMS. (Darshak M. Sanghavi and Patrick H. Conway, 5/28)