KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'On The Bright Side?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'On The Bright Side?'" by John Darkow, The Columbia Daily Tribune.

Here's today's health policy haiku:


A new dialogue
Change from repeal to improve…
That’s what the prez wants.

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Health Law Issues And Implementation

On His Victory Lap, Obama Aims To Change The Conversation To Ways To Improve The ACA

News reports note that, although President Barack Obama does not expect GOP opponents to back off of their opposition to the health law, he still plans to attempt to reframe the discussion to ways it can be improved. Meanwhile, other talk focuses on what is necessary to ensure the measure's long-term success and how lobbyists are gearing up to secure changes.

Politico: Barack Obama Takes An Obamacare Victory Lap
White House aides say the president isn’t under any illusions that Republicans will drop their objections to the Affordable Care Act just because the administration won the last Supreme Court fight. So while Obama will “discuss how we can move forward and continue building on the progress made under the Affordable Care Act,” according to the trip announcement, he’s not planning to get confrontational, avoiding the more controversial elements, one official said. In particular, the president intends to praise the efforts of Tennessee’s Republican governor, who has embraced key parts of Obamacare and is working to expand Medicaid in his state, a key part of the health care reforms and a top Obama priority. (Wheaton, 7/1)

The Associated Press: Obama Aims To Change Conversation Around Health Care Law
President Barack Obama is aiming to change the conversation around his health care law from talk about undoing it to talk of how to make it better. Obama was headed to the Nashville, Tennessee-area on Wednesday to discuss ways to improve the Affordable Care Act, including by extending Medicaid coverage to more low-income people. Tennessee is among about 20 states that have rejected Obama's offer of billions of dollars to help pay to expand the federal-state health care program for the poor. (Superville, 7/1)

The Huffington Post: If Obamacare Is Here To Stay, It's Going To Need Some Fixing. Here Are 5 Ways How
Obamacare is here to stay. That’s the message from President Barack Obama and other supporters of the Affordable Care Act after their victory at the Supreme Court last week. But dodging a lethal legal bullet is not the same thing as ensuring long-term success. And if health care reform is going to achieve the latter, it’s going to need reforms of its own. “We’ve got more work to do,” Obama acknowledged after the high court ruled in his favor on Thursday. (Young, 6/30)

The Hill: Obamacare Ruling Paves Way For Lobbying Blitz
Healthcare lobbyists across Washington are hoping to win long-sought changes to ObamaCare now that the Supreme Court has affirmed the law is here to stay. Last week’s ruling in King v. Burwell has unfrozen the field for dozens of healthcare groups that have been stymied in their efforts to tweak the law while it was still fighting for survival in the courts. (Ferris, 7/1)

The Nashville Tennessean: Lawmakers Downplay Obama's Impact On Insure Tennessee
The specific issues, bills or lawmakers might change, but if there's any constant within the Republican caucuses in the Tennessee House and Senate, it's this: They aren't big fans of President Barack Obama. At the same time, Democrats and supporters of Gov. Bill Haslam's controversial Insure Tennessee plan are using the president's visit Wednesday to a Nashville elementary school as their latest rallying cry to push for Haslam's health insurance plan. (Boucher, 6/30)

How The Liberal Justices Steered The Supreme Court In Its Recent Health Law Decision

News outlets analyze the high court dynamics that led to this term's blockbuster decisions, including King v. Burwell.

The New York Times: Right Divided, A Disciplined Left Steered The Supreme Court
The stunning series of liberal decisions delivered by the Supreme Court this term was the product of discipline on the left side of the court and disarray on the right. In case after case, including blockbusters on same-sex marriage and President Obama’s health care law, the court’s four-member liberal wing, all appointed by Democratic presidents, managed to pick off one or more votes from the court’s five conservative justices, all appointed by Republicans. ... For example, in King v. Burwell, the case brought by groups hostile to the Affordable Care Act, Chief Justice John G. Roberts Jr. and Justice Anthony M. Kennedy joined the court’s four liberals in rejecting the challenge to health insurance subsidies provided through federal exchanges. Justices Antonin Scalia, Clarence Thomas and Samuel A. Alito Jr. dissented. (Liptak, 7/1)

Los Angeles Times: A Liberal But Restrained Supreme Court Term
The Supreme Court in the just-completed term passed up a number of opportunities to upend existing law, including the Affordable Care Act. ... The court’s hesitation to strike down existing laws was evident in several cases. ... Justice Kennedy’s votes with the court’s liberals are a major factor in their success. But another conservative justice, Chief Justice Roberts, wrote the majority opinion rejecting a conservative-backed lawsuit that would have gutted the Affordable Care Act. He was joined by the liberal bloc and Justice Kennedy. (Braven, 6/30)

And here's a breakdown of how the ruling will play out in Florida -

The Tampa Tribune: What King V. Burwell Ruling Means For Floridians
Now that the ruling has been made, it’s important for Floridians to understand what it means for them. One of the predictions was that after taking advantage of the insurance subsidies to buy coverage, over 1 million Floridians would owe thousands of dollars to the IRS at tax time. With the subsidies upheld, this is an obstacle averted for 1.3 million Floridians who would have collectively owed more than $4 billion for the 2015 tax year. (Naff, 7/1)

Coverage And Access

Negotiations Between Employers, Unions Could Feel The Impact Of Health Law Requirements

These developments are occurring, according to the Wall Street Journal, amidst other cost- and risk-shifting trends.

The Wall Street Journal's CFO Journal: Unions Face Battle-Tested Executives In Talks
While wrangling over benefits is a cornerstone of union negotiations, looming threats facing several big companies—including coping with the requirements of The Affordable Care Act– exacerbate the conflicts, as we reported today in CFO Journal. ... With major tenets of the health law in place for the long haul, labor and management will have to figure out the “subtle, million-and-one smaller points of the bigger package,” he said, such as the excise tax on high-cost plans, or Cadillac tax. Companies could terminate their health care plans, or move employees to higher deductible plans. (Johnson, 6/30)

The Wall Street Journal: Bosses Reclassify Workers To Cut Costs
As courts and regulators increase their scrutiny of the relationship between businesses and independent contractors, employers are turning to a range of tactics to classify workers, taking them off the formal payroll and lowering costs. ... All this is happening against the backdrop of a broader shifting of risk from employers to workers, who shoulder an increasing share of responsibility for everything from health-insurance premiums to retirement income to job security. Alleged misclassification of workers has been one of the primary battlegrounds of this shift. (Weber,6/30)

And what about that expected overtime rule -

Modern Healthcare: Healthcare Workers Wonder How Expected Overtime Rule Affects Them
The home-care sector is keeping an eye out for an expected move by the White House to make up to 5 million more people eligible for overtime pay. Some say it could benefit fee-based employees while others believe it could cause employers to scale back on hiring specialized workers. A new rule from the Labor Department would more than double the threshold at which employers can avoid paying overtime, to $970 a week, by next year. (Sandler, 6/30)

Same-Sex Marriage Ruling Has Huge Impact On Private, Public Employers

The Wall Street Journal examines the implications for companies that offer spousal health benefits and fund those through a separate insurance company, as well as for those that are self-insured. The Texas Tribune reports that starting Wednesday, employees of Texas government agencies, universities and schools can enroll a same-sex spouse in their benefit program. And Modern Healthcare delves into the implications for Medicaid programs.

The Wall Street Journal: What Employers Need To Know About Court’s Gay-Marriage Ruling
The Supreme Court on Friday ruled that same-sex couples have a constitutional right to marry, meaning that same-sex marriages must be recognized nationwide. The ruling will have vast implications for employers, which until now have been operating under a patchwork of different state and federal laws governing the legal and tax treatment of same-sex unions. ... Companies that offer spousal health benefits and use a separate insurance company to fund their benefits will now be required to cover both gay and straight spouses. ... But companies that are self-insured, which means they assume the insurance risks for their own employees, a common practice among large companies, aren’t under the same legal constraints. (Silverman, 6/30)

Modern Healthcare: Marriage Ruling Brings Medicaid Costs And Benefits For Same-Sex Spouses
The U.S. Supreme Court's decision last week to legalize same-sex marriage across the country will have mixed effects for same-sex couples when it comes to Medicaid. In Obergefell v. Hodges, the court ruled 5-4 that same-sex marriage is a fundamental right guaranteed by the 14th Amendment. Prior to the ruling, same-sex marriage only was allowed in 37 states and the District of Columbia. Experts say the ruling will affect coverage rules for both Medicaid medical and long-term-care benefits. (Dickson, 6/30)


Drug And Device Makers Paid $6.5B To Doctors, Hospitals In 2014

About 80 percent of the dollars went to doctors for consulting, speeches, research and other activities. Nearly 610,000 doctors received payments, as well as some 1,100 teaching hospitals, according to government data. The effort to highlight potential conflicts of interest is mandated by the Affordable Care Act.

The Wall Street Journal: Drug And Medical-Device Makers Paid $6.49 Billion To Doctors, Hospitals In 2014
Drug and medical-device makers paid $6.49 billion to U.S. doctors and teaching hospitals during 2014, according to the federal government’s first full-year accounting of the breadth of industry financial ties with medical providers. The tally comprises company payments to more than 600,000 doctors and 1,100 hospitals for services such as consulting, research and promotional speeches about drugs, as well as the value of free meals provided to doctors by sales reps pitching products. (Loftus and Walker, 6/30)

The Associated Press: Drug And Device Firms Paid $6.5B To Care Providers
From research dollars to free lunches and junkets, drug and medical device companies paid doctors and leading hospitals nearly $6.5 billion last year, according to government data posted Tuesday. The latest update to the Open Payments database is part of an ongoing effort to highlight potential conflicts of interest in medicine. Unlike last year's initial version of the database, this one is much easier to use for consumers interested in looking up their own doctors. (6/30)

The Hill: Medical Companies Paid Doctors $6.49B In 2014
Holly Campbell, a spokeswoman for PhRMA, the nation's top drug lobby, defended the payments, saying they include funding of important clinical trials and facilitate feedback from doctors to companies about their products. “Collaboration between physicians and biopharmaceutical professionals is critical to improving the health and quality of life of patients,” she said in a statement. (Sullivan, 6/30)

Here's an up-close look at the payments directed to Maryland hospitals and physicians -

The Baltimore Sun: Hospitals Receive Funding From Drug And Device Makers
Maryland's hospitals and doctors took in more than $7.6 million in payments for research, speeches and other work from drug and device manufacturers in 2014, according to federal authorities who have been releasing payment data periodically. The money is a share of about $6.5 billion in funds paid to U.S. hospitals from 1,444 companies, data supplied by the Centers for Medicare and Medicaid Services shows. (Cohn, 6/30)

In other drug industry news -

High Costs Of Life-Saving Drugs Are Piling Financial Pressure On People With Serious Illnesses

Meanwhile, Politico Pro reports that some states are attempting to tackle the growing cost of medications.

The Washington Post's Wonkblog: How New Drugs Helping Millions Of Americans Live Longer Are Also Making Them Go Broke
Around the U.S., people with serious diseases like Agar’s are falling through the cracks, unable to afford the medication they need even if they have good jobs and good insurance. Patients with HIV, cancer, lupus, leukemia, hepatitis C and other serious conditions are paying huge out-of-pocket sums for necessary medication. These costs are putting heavy mental and financial stress on some of America’s most vulnerable people. (Swanson, 6/30)

Politico Pro: States Starting To Tackle High Drug Costs
The battle over drug prices is playing out in states across the country, with at least four states capping consumers’ out-of-pocket costs and others considering transparency requirements to force drug companies to explain their high prices. (Norman, 6/30)

Kaiser Health News: Study Predicts Huge Toll Of Hepatitis C Drugs On California Budget
California taxpayers could be on the hook for billions of dollars to treat hepatitis C patients in various state-funded programs, according to a report released Tuesday by an insurers’ trade group. The analysis commissioned by the California Association of Health Plans estimates that paying for the patients’ high-priced hepatitis C medications in prisons and state hospitals, or through Medi-Cal and other state programs, could range from $512 million to $5.1 billion. The wide-ranging estimates depend on how many patients are treated and how much the drugs are discounted by manufacturers. (Gorman, 7/1)

Campaign 2016

Health Sector Profits Contributed To Jeb Bush's Post-Gubernatorial Wealth

Republican presidential hopeful Jeb Bush's tax filings show his net worth soared after he left the office of Florida governor in 2007. The New York Times reports that this financial boost included his earnings as a paid director to Tenet Healthcare, a hospital company which supported the health law.

The New York Times' First Draft: Jeb Bush’s Wealth Soared When He Left Governor’s Office, Tax Returns Show
One of his endeavors included serving as a paid director to the hospital company Tenet Healthcare, which backed President Obama’s Affordable Care Act. The position invited questions for Mr. Bush, who as a candidate opposes the health care law. Mr. Bush profited handsomely from his Tenet shares. According to the newly released tax returns, Mr. Bush acquired $441,203 worth of stock in Tenet Healthcare in May 2011. The stock doubled in value by the time he sold it in October 2013, earning him a profit of $462,013 in just 29 months. Like other hospital stocks, Tenet rose sharply from October 2012 through March 2013, when President Obama’s re-election made it likely that the health care law would be carried out. (Eder, 6/30)

Politico Pro: Bush Tax Returns Show Big Health Care Company Profits
Jeb Bush has raked in hundreds of thousands of dollars from health care company stocks since leaving office in 2007, according to tax returns released Tuesday. The former Florida governor, in a transparency effort meant to sharply distinguish himself from Democratic presidential front-runner Hillary Clinton, released 33 years of tax returns that showed an average effective tax rate of 36 percent. The returns, which span 1981 to 2013, indicate he’s had at least $29 million in income after he led the Sunshine State. (Pradhan, 6/30)

Public Health And Education

FDA Considering New Restrictions On Liquid Nicotine Products

Meanwhile, on the tobacco front, the New York Times continues its reporting on the U.S. Chamber of Commerce and its global work against anti-smoking laws, highlighting how some of the organization's members don't agree with these efforts.

The Associated Press: FDA Weighs New Restrictions On Liquid Nicotine Products
The Food and Drug Administration said Tuesday it is responding to an uptick in nicotine poisonings reported by emergency rooms and poison centers nationwide, many involving infants and children. The agency said in an online posting it is considering whether "it would be appropriate for the protection of the public health to warn the public about the dangers or nicotine exposure" and "require that some tobacco products be sold in child-resistant packaging." (6/30)

The New York Times: Many Board Members Fight Smoking Even As Chamber Opposes Tobacco Laws
Anthem, one of the nation’s largest health insurers, wants its members to stop smoking. ... But Anthem’s executive vice president, Wayne S. DeVeydt, serves on the board of the U.S. Chamber of Commerce, which is engaged in a worldwide campaign to block antismoking laws. These include taxes on cigarettes in the Philippines, graphic health warnings on cigarette packs in Jamaica and Nepal, a plan to prohibit the display of cigarettes by retailers in Uruguay and restrictions on smoking in public spaces in Moldova. The chamber’s global opposition to antismoking measures, reported by The New York Times on Tuesday, poses a challenge for many of the members of the organization, particularly hospitals and health insurers. (Hakim, 7/1)

State Watch

California's Vaccine Measure Signed Into Law By Gov. Jerry Brown

The new law represents one of the nation's most far-reaching vaccine mandates, barring religious and other personal-belief exemptions for school children. Only two other states, West Virginia and Mississippi, bar such exemptions. Some predict opponents will challenge the measure in court.

USA Today: California Governor Signs Strict Law Requiring Vaccinations For Most Kids
While all 50 states require school children to be vaccinated, 48 currently allow exemptions for families with religious objections and 20 exempt children based on parents' personal beliefs, according to the National Conference of State Legislatures. Twelve states this year considered legislation addressing vaccine exemptions. In May, Vermont became the first state to repeal its personal belief exemption, although the law still permits exemptions for religious reasons. (Szabo, 6/30)

The Associated Press: What's Next For California's Contentious Vaccine Law
Gov. Jerry Brown has signed a hotly contested California bill to impose one of the strictest school vaccination laws in the country in the wake of an outbreak of measles at Disneyland late last year. The following is a look at what the new law signed Tuesday means for the nation's most populous state. (7/1)

The Washington Post: Jim Carrey Denounces New Calif. Vaccine Law In Twitter Rant
A celebrity critic of vaccines and former partner of another star with an autistic child has taken to social media to denounce a new California law requiring most children be vaccinated. Jim Carrey dated Jenny McCarthy for about five years before they split in 2010. In 2005, McCarthy’s son Evan was diagnosed with autism; during their relationship and after their breakup, Carrey and McCarthy were vocal proponents of the discredited theory that vaccines and autism are linked. (Moyer,7/1)

State Highlights: L.A. OKs Pact To Boost Nursing Home Inspections; Mass. AG Focuses On Barriers To Mental Health Care

News outlets report on health care developments in California, Massachusetts, North Carolina, New Hampshire and Tennessee,

Los Angeles Times: L.A. County Approves New Pact For Troubled Nursing Home Inspection Program
Amid criticism of past oversight efforts, Los Angeles County supervisors approved a new contract Tuesday that redefines state and local responsibilities for inspecting nursing homes and other health facilities and investigating complaints of abuse, neglect or inadequate care of patients. The new contract will give the county more money and scale back its duties. Los Angeles County is the only local government in the state that is contracted to inspect health facilities. Elsewhere, the state handles licensing duties and investigates complaints. (Sewell, 6/30)

WBUR: Mass. AG Shifts Health Care Costs Conversation To Behavioral Health
If you or someone you are close to has ever tried to get more than a doctor’s appointment for deep depression, alcoholism or a drug addiction, you already know that figuring out where to get care and who will help cover the cost is messy. Now that struggle is spelled out in the first health care cost trends report from Attorney General Maura Healey. (Bebinger, 6/30)

The Boston Globe: Small Health Insurers Decry ‘Risk Adjustment’ Payments
The winners and losers have been announced in a federally mandated program that will redistribute $61 million among the state’s health insurers. The big winner, as expected, is Blue Cross Blue Shield of Massachusetts, the state’s largest insurer, which stands to rake in $51.6 million in payments from smaller rivals. (Freyer, 7/1)

North Carolina Health News: Federal Grant Will Help Thousands Recover From Substance Abuse
More than 4,000 people who are working to recovery from substance abuse disorders will have some extra help, thanks to a $7.8 million federal grant that’s coming to North Carolina. The Department of Health and Human Services announced late Monday that the grant, from the federal Substance Abuse and Mental Health Services Administration, will be targeted at helping people get sober and back on their feet. (Hoban, 6/30)

New Hampshire Union Leader: North Country Hospitals Link Up
The CEOs of four small, rural hospitals announced an agreement Tuesday to form a nonprofit organization known as North Country Healthcare. It all began a year ago in July, when CEOs Russell Keene of Androscoggin Valley Hospital, Warren West of Littleton Regional Healthcare, Peter Gosline of Upper Connecticut Valley Hospital and Scott Howe of Weeks Medical Center gathered at the Omni Mount Washington Hotel, where each said the best way for all to survive was to unite. (Koziol, 6/30)

The Nashville Tennessean: Lifetime Health Benefits For Council Targeted Again
With time running out before a new Metro Council is elected, a generous but controversial perk for council members is under fire again. Metro Councilman Phil Claiborne, term-limited from his Donelson-area seat, has revived legislation that would reduce Metro government’s financial obligation in covering lifetime health insurance for former two-term council members. (Garrison, 6/30)

Editorials And Opinions

Viewpoints: Bush's Health Law Profits; Calif. Leads On Vaccination; Burgess' Medicare Crusade

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

The New York Times' The Upshot: How Jeb Bush Made A Profit On Obamacare
Jeb Bush the candidate is not a fan of Obamacare. But Jeb Bush the investor made a big bet on the Affordable Care Act, and it paid off. According to tax returns released by Mr. Bush’s campaign on Tuesday, he sold $1,103,424 worth of stock in Tenet Healthcare in September and October of 2013, yielding a capital gain of $556,283. It hadn’t taken Mr. Bush long to double his money — he was selling shares he had acquired in 2010 and 2011. (Josh Barro, 6/30)

Los Angeles Times: A Court Of One: Anthony Kennedy
Forget the debate over whether the Supreme Court has taken a liberal turn. It is not a liberal court or a conservative court. It's a Kennedy court. On major constitutional and statutory questions, Justice Anthony M. Kennedy's views matter more than anything else. Liberals do have more to celebrate this term than in the recent past, from the same-sex marriage and Obamacare decisions, to a major housing discrimination case, to a surprising win for minority plaintiffs in a voting rights lawsuit. In all of those cases, Kennedy was in the majority, and all but one — Obamacare — were decided 5-4. (Richard L. Hasen, 6/30)

The Denver Post: Obama's Lonely Road To The Finish Line
Americans were perilously close to losing their right to health care when the Supreme Court offered a reprieve. Few were more grateful than the conservative politicians who had been railing against the Affordable Care Act while praying they would not have to face the political consequences of its collapse. (Froma Harrop, 6/30)

Los Angeles Times: California Settles The Vaccination Question
Congratulations, California. With Gov. Jerry Brown's swift signature Tuesday on a tough new mandatory vaccination bill, the state has established itself as a national leader on public health. Of course, it will take some years for reality to catch up with the bill's mandates. First there will be the inevitable lawsuits. And even if those don't delay implementation, it will still take a few years before all California students are immunized, because those currently in seventh grade and higher are not required under the law to be vaccinated. (6/30)

The Washington Post: Behind The Momentum For Paid Sick Leave
Last week, the Supreme Court upheld a core provision of the Affordable Care Act, quashing the Republican Party’s latest attempt to gut the law through the judicial system. At issue in the case, King v. Burwell, was the government’s ability to provide subsidies to help millions of working Americans purchase health insurance through the federal exchange. Yet, as too many middle-class families know, health insurance is only one of the costs associated with getting sick. For more than 40 million workers who currently lack paid sick leave, another pressing concern is how to afford taking time off. (Katrina vanden Heuvel , 6/30)

Dallas Morning News: My 10-Year Fight To Stabilize Medicare Payments
The SGR was instituted to prevent Medicare fee hikes from exceeding growth of the economy. The effect was to cut Medicare payments to doctors. ... Let me, for a moment, ignore the unpleasant thought that this problem was one Congress itself created — some 17 years ago — and allow me some self-indulgence for having solved a federally imposed conundrum. ... Most congressional offices didn’t even realize SGR was a culprit at that time and, despite the systemic flaw, they weren’t willing to attach their name to a costly repeal vote. To my frustration, Congress opted for one-year funding “patches” to extend the problem rather than confront it. (Rep. Michael Burgess, R-Texas, 6/30)

The New York Times: The Real Problem With Medical Internships
Approximately 26,000 newly minted doctors across the United States will begin their internships today. For many, this legendarily grueling year will be the most trying time of their professional lives. Most will spend it in a state of perpetual exhaustion, as near ascetics with regard to family, friends and other pleasures. I was an intern nearly 20 years ago, but I still remember it the way soldiers remember war. (Sandeep Jauhar, 7/1)