KHN Morning Briefing

Summaries of health policy coverage from major news organizations.

Kaiser Health News Original Stories

Political Cartoon: 'Wishful Thinking?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Wishful Thinking?'" by Steve Sack, Minneapolis Star Tribune.

Here's today's health policy haiku:

CMS TO ADJUST SHORT HOSPITAL STAY RULE

Named for two midnights…
It was dicey. But changes
Now are in the works.

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.

Administration News

Obama's Health Law Victory Tour Goes To Tennessee

Fresh from a big Supreme Court win, President Barack Obama talked about the health law's achievements to date and expressed hope that some of the poisoned politics that have surrounded this sweeping overhaul will now be set aside to focus on improvements and refinements. One of his central messages had to do with Medicaid expansion.

The New York Times: Obama Takes Health Care Momentum Into G.O.P. Territory
Days after the Supreme Court delivered a victory for his health care law for the second time, President Obama flew into mostly Republican territory on Wednesday and began an aggressive push to get states that have resisted parts of the law to expand care to more of their poor residents. (Harris and Goodnough, 7/1)

Los Angeles Times: Put Aside Politics And Improve Healthcare, Obama Says
President Obama, fresh from a victory before the U.S. Supreme Court last week that preserved the Affordable Care Act, called for an end to the political fighting over the health law and for more effort to improve it. “This is about people. This is not about politics, it's not about Washington,” Obama said at a town-hall-style meeting at a Nashville elementary school. (Levey, 7/1)

The Associated Press: Obama: ‘Feeling Pretty Good’ About Health Care
Fresh off a Supreme Court victory, President Barack Obama said Wednesday that he’s “feeling pretty good” about the state of his health care law and pleaded for bipartisan cooperation on ways to make it work even better. Obama said he wants to refocus the debate on improving health care quality, expanding access and eliminating waste now that the high court has upheld a key element of the Affordable Care Act. (Superville, 7/1)

The Washington Post: Obama Takes Health-Care Victory Lap In Tennessee
The town hall meeting on health care came one week after the Supreme Court shot down a major challenge to the massive government program that would have denied health-care subsidies to millions of Americans participating in the program through a federal marketplace. ... In Nashville, Obama touted the 166,000 Tennesseans — and 16 million people across the country — who have health care because of the Affordable Care Act. Health-care inflation has been trending down, the president said. (Jaffe, 7/1)

Kaiser Health News: Obama Asks GOP To Work With Him To Improve Health Care
President Barack Obama called on Republicans Wednesday to find a bipartisan way to fix problems in the nation’s health care system rather than continue to fight over the health law. "Part of what I’m hoping is with the Supreme Court case now behind us what we can do is … focus on how we can make it even better because it’s not as if we’ve solved all the problems in our health care system," Obama said in remarks at an elementary school in Nashville, Tenn. "America still spends more on health care than any other advanced nation and our outcomes aren’t particularly better." (Carey, 7/1)

The Hill: President Takes Victory Lap On Supreme Court Obamacare Ruling
The president rattled off “a whole host” of benefits of the law, ranging from free preventative services such as mammograms to the ability of young people to stay on their parents insurance until they are 26. “You don’t always notice that until you need it,” he said of the benefits. He also made the case for the economics of the law, citing lower healthcare inflation. (Ferris, 7/1)

The Wall Street Journal's Washington Wire: Davy Crockett Presses Obama On Health Care
For a brief time on Wednesday, Davy Crockett became the face of President Barack Obama’s push to get more states to expand Medicaid. Mr. Crockett, who described himself as a fifth-generation great-grandson of Davy Crockett, the American folk hero, attended the president’s speech in Nashville, Tenn., and got the opportunity to ask a question. He expressed frustration about denials of his application for Social Security benefits. Mr. Obama promised to look into it. (Armour, 7/1)

Health Law Issues And Implementation

What's Next For The Health Law?

Health and Human Services Secretary Sylvia Burwell talks about educating Americans about the breadth of benefits in the health law, as well as advancing efforts to improve it. A top administration priority will be persuading more states to expand Medicaid.

Bloomberg: With Obamacare Here To Stay, U.S. Wants To Tout Its Benefits
After the Supreme Court declined to gut the law in a decision last week, there’s an opportunity to build on gains in health coverage and also rectify some missteps in the Affordable Care Act’s marketing, Sylvia Mathews Burwell, the U.S. health secretary, told Bloomberg’s Al Hunt in an interview for PBS’s “Charlie Rose” program. “We as an administration haven’t done as much as we could to make sure people understand the breadth of the benefits,” she said. “The ACA became about a very narrow thing. Even narrower than the uninsured, it became about the marketplace. It is about so much more.” (Wayne, 7/1)

Marketplace: The Obamacare Sales Pitch
It’s been almost a week since the Supreme Court’s momentous ruling that further cements the Affordable Care Act as the law of the land, and Wednesday President Barack Obama flew to Nashville, Tennessee, to talk about health care. While some consider this a bit of a victory lap, the president’s choice of Tennessee suggests it’s much more of an overture. (Gorenstein, 7/1)

In addition, the health law's data release requirements could shape marketplace developments -

The Wall Street Journal: New Data Could Affect Health-Insurer Deals
The federal government’s release of new data on health-insurer payments under the Affordable Care Act is roiling the industry, including potentially affecting the timing of any deal for Humana Inc., as suitors pore over the detailed information disclosed late Tuesday. (Wilde Mathews and Mattioli, 7/1)

Modern Healthcare: ACA Risk-Adjustment Winners And Losers Shouldn't Be Surprised
Insurers are sizing up their reimbursements under CMS' reinsurance program and some plans appear to be off on their estimates. As part of the Affordable Care Act's plan to protect against adverse selection and protect insurers from excessive losses that could come from a disproportionate share of consumers with high medical costs, money is transferred between plans with relatively lower risk enrollees to plans with relatively higher risk enrollees. (Dickson, 7/1)

In other news on mergers and aquisitions -

The New York Times: Centene To Acquire Its Managed Care Rival Health Net For $6.8 Billion
The Centene Corporation, a managed health care company, said on Thursday that it had agreed to acquire its rival Health Net in a cash-and-stock deal valued at $6.8 billion, including the assumption of debt. The deal would combine two providers of managed care in the United States, creating a company with more than 10 million members and an estimated $37 billion in revenue this year, the companies said. It would also expand Centene’s scale and give it a larger market presence in the western United States.

And a new study shows that Massachusetts' residents filing for bankruptcy after that state's health reform law took effect had less medical debt -

The Wall Street Journal's Bankruptcy Beat: The Future Of Personal Bankruptcy In A Post-Obamacare World
In his 2014 study, Northeastern University law professor Daniel Austin dug into personal bankruptcy filings to figure out what happened after Massachusetts lawmakers made health insurance mandatory in 2005. His findings? Massachusetts residents who file for bankruptcy protection these days have way less medical debt compared to the rest of the country. The typical Massachusetts person or couple who filed in 2013 had $3,041 in medical debt, while people everywhere else had an average of $8,594 in medical debt. (Stech, 7/1)

Americans Approve Of The High Court's Health Law Decision, Poll Finds

Twice as many people surveyed support the Supreme Court's decision as are opposed to it, but divisions continue regarding overall views on the Affordable Care Act.

The Washington Post: Poll: 62 Percent Of Public Supports Supreme Court Ruling On Obamacare
Twice as many Americans support the Supreme Court’s decision last week to uphold a key provision of the health-care law as are opposed, according to a poll released Wednesday. When told that the court ruled to allow Americans to continue receiving subsidies to afford health insurance in all states, about 6 in 10 surveyed said they approve of the decision while about one-third disapprove, according to the latest tracking poll by the Kaiser Family Foundation. (Sun, 7/1)

Meanwhile, some experts handicap the chances for future health law legal challenges -

Politico Pro: Experts Agree: No More Big ACA Lawsuits
The monumental lawsuits that threaten the core of Obamacare might be a thing of a past, but the same can’t be said about Americans’ enduringly negative perceptions of the law, several health experts said Wednesday. (Pradhan, 7/1)

And USA Today analyzes how the justices reached their decision in King v. Burwell -

USA Today: Liberal Unity, Conservative Disarray Led Supreme Court To The Left
It may have been fitting that the two marquee decisions — declaring a constitutional right to same-sex marriage and saving the Affordable Care Act from a potentially fatal challenge — came last week. That meant the court's liberal wing didn't lose a major case until Monday, the last day of the term. (Wolf, 7/1)

Oregon Approves Premium Rate Increases For 2016 Marketplace Plans

Oregon is the first state to announce its rates for the marketplace. In other news about state insurance markets, a report about Minnesota insurers' business on that state's online exchange, and Washington state's marketplace does not get as much funding as officials had sought.

The Oregonian: More Than 220,000 Oregonians Face Higher Prices For 2016 Health Coverage
More than 220,000 Oregonians who buy their own health insurance will face higher premiums next year, and Portlanders could see some of the biggest hikes in the country. Oregon is the first state to announce 2016 rates for people who aren't covered by their employers or government programs. Overall, the news is not good for consumers. ... the least expensive "silver" plan premium available to a 40-year-old next year will run $271 per month under the new rates. That's up $49 per month over this year's low rate. (Budnick, 7/1)

The Minneapolis Star-Tribune: Government Programs Drove Insurer Earnings
Doing business with the government was a key source of income last year for Minnesota health insurers, but some of the money could be coming back to the state of Minnesota. Operating income from state health care programs including Medicaid and MinnesotaCare jumped by about two-thirds to about $195 million last year, up from $117.4 million in 2013, according to a report Wednesday from Allan Baumgarten, an independent health care analyst in St. Louis Park. ... Due in part to uncertainty about the health care needs of those gaining coverage under the law, contracts between the state and private insurers in the programs included provisions for retrospective severity adjustments. (Snowbeck, 7/1)

The Seattle Times: Health-Exchange Budget Takes Hit, But Still ‘Sufficient’ For 2015-17
Washington’s health-insurance exchange will have to figure out how to get by on less money from the state than it hoped for over the next two years, but officials Wednesday said the budget is “sufficient.” Over the 2015-17 biennium, the Washington Health Benefit Exchange will have a $110 million budget to operate Healthplanfinder, the online exchange selling individual insurance coverage and plans for small businesses. The website is also where people enroll in Medicaid. (Stiffler, 7/1)

A new report finds that the newest people to enroll in the marketplace plans were younger and healthier than those who came in on the first year.

The Hill: New Obamacare Enrollees Are Healthier, Report Finds
New ObamaCare enrollees are healthier and spent less on drugs than enrollees last year, according to a new analysis. The report from Express Scripts, the country’s largest pharmacy benefits manager, is a positive sign for the law, given the need to maintain a mix of healthy and sick enrollees to keep costs down. Still, ObamaCare exchange enrollees tended to be sicker than those in other health plans. Costs were 16 percent higher per member per month compared to non-ObamaCare plans, the report finds, largely due to higher spending on costly drugs for complex conditions. (Sullivan, 7/1)

In Kentucky, officials award contracts for the state's Medicaid managed care plans.

Louisville Courier-Journal: 5 Medicaid Providers Get New Ky. Contracts
Kentucky has awarded new contracts to the five private companies that manage its rapidly expanding Medicaid program, its growth fueled by hundreds of thousands of new members under the Affordable Care Act. The growth has been a windfall for some of the companies over the past year, but the new contracts are designed to limit potential profits and address complaints about slow payments and excessively complicated forms and procedures. (Yetter, 7/1)

Medicare

Medicare Proposes To Ease Coverage Rules On Short Hospital Stays

The Centers for Medicare & Medicaid Services proposed Wednesday a number of changes that would make it easier for patients to get an exception to the controversial "two-midnight" rule.

The Associated Press: Medicare Proposes Coverage Change On Short Hospital Stays
Medicare proposed Wednesday to ease a coverage policy on short hospital stays that has been criticized because it can result in higher costs for seniors. Under Medicare, coverage for inpatient and outpatient care is determined under very different payment rules. In some cases, a hospital admission classified as inpatient can result in lower bills for beneficiaries. (Alonso-Zaldivar, 7/1)

Politico Pro: CMS Proposes Two-Midnight Modifications
CMS wants to revise a controversial Medicare policy for determining how hospitals are paid for patients who have shorter stays. The agency on Wednesday proposed several major changes that would make it easier to get an exception to the “two-midnight” rule, which defines “inpatients” as individuals who doctors believe will need to spend at least two nights in the hospital. The designation of “inpatient” and “outpatient” determines the level of payment that hospitals receive under Medicare. (Mershon, 7/1)

Modern Healthcare: CMS Will Modify—Not Scrap—'Two-Midnight' Rule
The CMS plans to soften but keep the controversial "two-midnight" rule governing short hospital stays in spite of aggressive calls from providers and policy experts to abandon the policy. In a proposed payment rule posted Wednesday, the Obama administration said it plans to allow physicians to exercise judgment to admit patients for short hospital stays on a case-by-case basis. The CMS also said it would remove oversight of those decisions from its administrative contractors and instead ask quality improvement organizations to enforce the policy. Recovery audit contractors, meanwhile, would be directed to focus only on hospitals with unusually high rates of denied claims. (Dickson, 7/1)

Marketplace

Drug, Device Makers Pay Doctors Regularly And Well, Data Show

A ProPublica analysis of drug and device makers' payments found that 768 doctors received payments on more than half of the days in 2014. More than 14,600 doctors received payments on at least 100 days in 2014. The payments must be reported as part of the Affordable Care Act.

NPR/ProPublica: Industry Payments To Doctors Are Ingrained, Federal Data Show
Few days went by last year when New Hampshire nephrologist Ana Stankovic didn't receive a payment from a drug company. All told, 29 different pharmaceutical companies paid her $594,363 in 2014, mostly for promotional speaking and consulting, but also for travel expenses and meals, according to data released Tuesday detailing payments by drug and device companies to U.S. doctors and teaching hospitals. ... What is being seen for the first time now is how ingrained pharmaceutical companies and their sales reps are in the lives of those who write prescriptions for their products. A ProPublica analysis found that 768 doctors received payments on more than half of the days in 2014. More than 14,600 doctors received payments on at least 100 days in 2014.(Ornstein and Grochowski Jones, 7/1)

State Watch

State Highlights: Drones Deliver Supplies To Rural Va. Field Hospital; N.C. Autism Bill Nears Finish Line

News outlets report on health care developments in Virginia, North Carolina, California, Massachusetts and New York.

The Washington Post: Drones To Deliver Medicine To Rural Virginia Field Hospital
The sprawling field hospital that springs up in rural southwest Virginia every summer has been called the largest health-care outreach operation of its kind. This year, the event will host another first. Unmanned aerial vehicles — drones — will deliver medicine to the Wise County Fairgrounds in part to study how the emerging technology could be used in humanitarian crises around the world. (Portnoy, 7/1)

North Carolina Health News: Finish Line In Sight For Autism Insurance Bill
After years of waiting, families of kids with autism may finally get insurance coverage for treatment. A bill that would have North Carolina insurers reimburse for some evidence-based treatment is finally looking like it may pass both chambers of the General Assembly – but not before withstanding significant opposition and leaving advocates angry. (Editor in Childrens Health, 7/1)

WBUR: Having A Baby? Big Differences In Hospital Quality Across Massachusetts
If you’re one of the roughly 70,000 women who will give birth in Massachusetts this year, you may be planning to deliver at a hospital close to home or where your OB practices. But what you might not realize is that when it comes to childbirth, there are big differences in hospital quality across the state. (Bebinger, 7/2)

The Sacramento Bee: Tim Donnelly Files Referendum To Overturn California Vaccine Bill
A former state assemblyman known for his defiant conservatism is seeking to reverse California’s newly passed vaccination mandate. The day after Gov. Jerry Brown signed Senate Bill 277, an intensely controversial bill requiring all California schoolchildren to be fully vaccinated, former Assemblyman Tim Donnelly submitted paperwork to overturn the law. Opponents of the bill have also predicted a legal challenge, arguing the law will unconstitutionally block unvaccinated children from receiving an education. (White, 7/1)

Los Angeles Times: Jim Carrey Calls Gov. Brown A 'Fascist' For Signing New Vaccination Law
Jim Carrey has come out swinging against Gov. Jerry Brown for signing one of the nation’s toughest vaccination laws this week, barring religious and other personal-belief exemptions for schoolchildren. The Golden Globe-winning actor slammed Brown on Twitter, calling him a “corporate fascist” who was poisoning children by signing into law the vaccination requirements. (Rocha, 7/1)

Weekend Reading

Longer Looks: When A Doctor's Wife Is Ill; Vaccinating Calif.; Does Food Processing Matter?

Each week, KHN's Alana Pockros finds interesting reads from around the Web.

The Washington Post: His Wife Is Ill. He’s A Doctor. Isn’t He Supposed To Know What To Do?
Two weeks after my wife has a hysterectomy, she begins experiencing fevers that rise and spike each evening: 99.2, then 100.7, then 101.5. I am an infectious-disease doctor and a consultant for Medicare. And I am puzzled and a bit frightened. “What do we do?” asks my wife — also a physician. She is lying on the sofa, covered with a blanket, color drained from her face, a drop of sweat rolling down her neck. It is Friday night. “Do we call the surgeon, go to the emergency room or wait until Monday?” Shouldn’t I know what to do? (Manoj Jain, 6/29)

Vox: California Gov. Jerry Brown Just Approved One Of The Toughest Mandatory Vaccine Laws In The Country
The story of SB277 started last February: Following the Disneyland measles outbreak, California lawmakers introduced legislation that would require children to receive mandatory vaccines before starting school. Under the law, the only people who can opt out are those who have a medical reason, such as an allergy or a disease that would make them unfit for the shots. And unvaccinated kids can only be homeschooled. In April, the bill passed the state Senate health committee by a 6-2 vote. "I've personally witnessed the suffering caused by vaccine-preventable diseases, and all children deserve to be safe at school," Democratic Sen. Richard Pan, the bill's co-author and a pediatrician, said in a statement. (Julia Belluz, 6/30)

The Atlantic: Don’t Worry So Much About Whether Your Food Is ‘Processed’
“To say all processed food is bad is a mistake,” said Dariush Mozaffarian, the dean of Tufts University’s Friedman School of Nutrition Science and Policy, at a session before the Aspen Ideas Festival. “I think it’s interesting, even the question ‘fresh versus processed’… as though they were opposites,” he said. “You can have something that’s fresh and processed and something that’s fresh and not processed.” (Julie Beck, 6/28)

The Atlantic: Colonial Americans Drank Roughly Three Times As Much As Americans Do Now
Go ahead, have a small beer; it will bring “Serenity of Mind, Reputation, Long Life, & Happiness.” Even a strong beer would be fine, for that brings “Cheerfulness, Strength, and Nourishment,” as long as it’s only sipped at meals. So declared Benjamin Rush, one of the signers of the Declaration of Independence and the early republic’s most prominent physician. In his loquaciously named pamphlet, An Inquiry Into the Effects of Ardent Spirits on the Human Mind and Body, first published in 1784, Rush describes the “usual” downward spiral of drink. (Emma Green, 6/29)

Des Moines Register: Grieving Father: Stop Jailing People For Mental Illness
No one believes Jeff Cornick was thinking straight when he drunkenly carried up to a dozen gas cans into his Des Moines house, stalked around rooms with a lit candle and ranted to police that he was going to blow himself up. "Shoot me!" he yelled to an officer, a police report shows. The question is: Did this bizarre behavior make him a serious criminal? Or just a person who needed serious psychiatric treatment? (Tony Leys, 6/27)

Health Policy Research

Research Roundup: Medicare Part D's Effect; Attitudes On Indoor Tanning; Premium Changes

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

Annals of Internal Medicine: Did Medicare Part D Affect National Trends In Health Outcomes Or Hospitalizations?
Medicare Part D increased economic access to medications, but its effect on ... health outcomes and use of other medical services remains unclear. ... [Researchers analyzed a] nationally representative sample of Medicare beneficiaries ... from 2000 to 2010 [to see] changes in self-reported health status, limitations in activities of daily living (ADLs) ..., emergency department visits and hospital admissions (prevalence, counts, and spending), and mortality. Medicare claims data were used for confirmatory analyses. ... Five years after Part D implementation, no clinically or statistically significant reductions in the prevalence of fair or poor health status or limitations in ADLs ... were detected. Compared with trends before Part D, no changes in emergency department visits, hospital admissions or days, inpatient costs, or mortality after Part D were seen. (Briesacher et al., 6/16)

Health Affairs: Despite High Cost, Improved Pneumococcal Vaccine Expected To Return 10-Year Net Savings Of $12 Billion
In 2010 the US Advisory Committee on Immunization Practices recommended that the seven-valent pneumococcal conjugate vaccine (PCV7) be replaced by the thirteen-valent version (PCV13), which provides protection against six additional serotypes of the bacterium Streptococcus pneumoniae. The higher price ... may be a concern for funding agencies and payers .... This study estimated the budgetary impact ... from 2010 to 2019. Implementing the PCV13 vaccine is projected to cost public and private payers $3.5 billion and $2.6 billion, respectively, more than PCV7. However, PCV13 is expected to provide net cost savings of $6.1 billion and $4.2 billion, respectively, to those payers during the ten-year period by preventing pneumococcal disease and its associated costs. An additional $1.7 billion in cost savings would be realized for uninsured patients. (Kohli et al., 7/1)

JAMA Dermatology: Recent Changes In The Prevalence Of And Factors Associated With Frequency Of Indoor Tanning Among US Adults
We examined changes in the ... frequency of indoor tanning among US adults [using] ... the 2010 and 2013 National Health Interview Survey .... We observed significant reductions in indoor tanning from 2010 to 2013: from 5.5% to 4.2% ... among all adults, from 8.6% to 6.5% ... among women, and from 2.2% to 1.7% ... among men .... The decrease in indoor tanning may be partly attributable to the increased awareness of its harms. Indoor tanning devices have been classified as carcinogenic to humans, their use has consistently been shown to increase skin cancer risk, and laws restricting access among minors may have changed public perceptions of their safety. In addition, a 10% excise tax on indoor tanning was implemented in 2010, which may have contributed to the decrease in indoor tanning. (Guy, Berkowitz, Holman and Hartman, 7/1)

AMA Journal of Ethics/Urban Institute: Consumer Satisfaction With Health Insurance Coverage In Massachusetts
This paper examines Massachusetts residents’ satisfaction with their health insurance coverage using the 2013 Massachusetts Health Reform Survey (MHRS). We find that nonelderly adults in Massachusetts are generally quite satisfied with their coverage, their network of health care practitioners, and the quality of care available with their plans. However, they are less satisfied with the financial protections afforded by their health insurance coverage and often report financial barriers to care and problems paying medical bills. Health care affordability continues to be a challenge for Massachusetts residents, despite near-universal coverage. (Long and Dimmock, 7/1)

Urban Institute: Marketplace Price Competition In 2014 And 2015: Does Insurer Type Matter In Early Performance?
We analyze how price competition in the ACA’s nongroup insurance marketplaces varies by insurer type: national, regional, Blue Cross Blue Shield, previously Medicaid-only, provider-sponsored, and co-ops. National insurers are expanding their presence, but are not yet pricing aggressively. Regional insurers have increased participation but seem to be losing price competitive ground. Blue Cross Blue Shield insurers have widespread participation but pursue very different pricing strategies. Previously Medicaid-Only insurers are a growing presence that is getting increasingly price competitive. Provider-sponsored insurers have a limited presence and an inconsistent competitive footing. Finally, co-ops are expanding and improving their competitive pricing position. (Blumberg, Holahan and Wengle, 6/25)

The Kaiser Family Foundation: Analysis Of 2016 Premium Changes And Insurer Participation In The Affordable Care Act’s Health Insurance Marketplaces
This brief presents an early analysis of changes in the premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 10 states plus the District of Columbia, where we were able to find complete data on rates for all insurers. ... In most of these 11 major cities, we find that the costs for the lowest and second-lowest cost silver plans – where the bulk of enrollees tend to migrate – are changing relatively modestly in 2016, although increases are generally bigger than in 2015. The cost of a benchmark silver plan in these cities is on average 4.4% higher in 2016 than in 2015. These premiums are still preliminary in some cases and could be raised or lowered through these states’ rate review processes .... We also find that the number of insurers participating has stayed the same or increased in 9 states. (Cox, Ma, Claxton and Levitt, 6/24)

The Kaiser Family Foundation: Year Two Of The ACA Coverage Expansions: On-The-Ground Experiences From Five States
This brief provides insight into ... questions [about the Affordable Care Act enrollment] through an on-the-ground view of ACA implementation in five states. ... Key findings from stakeholders ... show that, as of the second year, most major enrollment systems issues had been resolved. The states that expanded Medicaid continued to experience enrollment growth, and Marketplace enrollment goals were met or surpassed in four of the five states, although affordability remains a key enrollment challenge. ... Per enrollee costs of care for expansion enrollees have been lower than anticipated in the three states that expanded Medicaid. Expansion enrollees generally are able to access needed care, although there are access challenges for some services. (Artiga, Tolbert and Rudowitz, 6/22)

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

MedPage Today: Report: Most Hospitals Stand Aloof In Their Neighborhoods
Outside of direct patient care, hospitals spend relatively little to foster health in their communities, a new study found. A report published online Thursday by Health Affairs revealed that for the $62 billion that not-for-profit hospitals allocated in 2011 for "charity care and community benefit," only $4 billion -- less than 1% of hospital spending across the board -- went toward improving health in surrounding geographic areas. ... One effect of this trend is a big spike in the value of the tax exemptions that not-for-profit hospitals receive. From 2002 to 2011, that value rose from $12.6 billion to $24.6 billion, according to the study, which based its findings on Internal Revenue Service data. (Harris, 6/26)

Reuters: For Post-Op Complications, Go Back To The Same Hospital: Study
Patients who need to be rehospitalized within a month after major surgery have a lower risk of death over the next two months if they return to the hospital where they had the surgery rather than going to a different facility, according to a new study. “Most clinicians or surgeons feel like if you take the time to do a big operation on someone, you know the area operated on, how the operations went, if there were complications,” lead author Dr. Benjamin S. Brooke of the University of Utah School of Medicine in Salt Lake City told Reuters Health by phone. Doctors who did not perform the surgery won’t have that context, which may explain part of the survival benefit of returning to the original hospital, he said. (Doyle, 6/29)

The Associated Press: Report Urges Major Steps To Help Victims Of Cardiac Arrest
Every year, about 395,000 people suffer cardiac arrest in their homes or other non-hospital settings — and less than 6 percent of them survive, the Institute of Medicine estimated Tuesday. ... An additional 200,000 cardiac arrests occur in hospitals every year, and even there only a quarter of patients survive, the report found. ... the IOM committee said fear, not understanding what cardiac arrest is, lack of first-aid training and concern about legal liability can hamper response and cost precious time. ... Moreover, there are wide disparities in outcomes: One study found that survival ranged from about 8 percent to 40 percent across 10 different communities. On Tuesday, the IOM called for a major public education effort to teach people how to recognize and react to cardiac arrest. (Neergaard, 6/30)

Reuters: Nearly Four Of 10 U.S. Kids Exposed To Violence
Phone-based surveys show that nearly four of every 10 kids and teens in the U.S. were exposed to violence or abuse over the previous year, researchers have found. “Children are the most victimized segment of the population,” said study leader David Finkelhor of the Crimes Against Children Research Center at the University of New Hampshire in Durham. ... Compared to 2011, the violence rates appear to be stable, and certain kinds of violence exposure may be decreasing, he said. While the rates are not going up, “the problem is that there is still way too much,” he said. (Doyle, 6/29)

Reuters: Elder Abuse May Be More Common Than People Think
Elder abuse may be more common than is recognized, particularly among adults with dementia or other cognitive impairments, a research review suggests. In North and South America, elder abuse prevalence ranges from 10 percent of lucid older adults to almost half of those with dementia, the review of previous studies found. In Europe, prevalence ranges from about 2 percent in Ireland to about 61 percent in Croatia and in Asia, exposure to elder abuse ranges from 14 percent in India to 36 percent in China. (Rapaport, 6/25)

Reuters: Few People Heading Toward Diabetes Know It
Only about one in eight people with so-called pre-diabetes, often a precursor to full-blown disease, know they have a problem, a U.S. study found. Lacking awareness, people with the elevated blood sugar levels were also less likely to make lifestyle changes such as getting more exercise or eating less sugary food that might prevent them from ultimately becoming diabetic. (Rapaport, 6/29)

Editorials And Opinions

Viewpoints: GOP Needs Plans For Health Care; Kill IPAB; Selling Oil To Pay For Drug Cures

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

The Wall Street Journal: An ObamaCare-Inspired Rebellion
The long battle over ObamaCare’s subsidies that culminated at the Supreme Court last week has overshadowed a consequential shift in health insurance: toward high-deductible plans that will help put market forces back into medicine. (David Goldhill and Paul Howard, 7/1)

The Wall Street Journal: Tell Us Your Health-Care Plans, GOP Hopefuls
Now more than ever, it is imperative for every Republican presidential candidate to present a concrete plan to replace ObamaCare. The Affordable Care Act remains unpopular: Wednesday’s RealClearPolitics average of polls showed 51.4% disapprove while only 43.6% approve. Voters are more likely to be opposed than are adults overall, and opponents are more fervent than supporters. (Karl Rove, 7/1)

The Wall Street Journal: Killing ObamaCare’s Rationing Board
The Supreme Court has left the ObamaCare demolition job to Republicans, who at least until 2017 will have to chip away at its architecture piecemeal. Last week the House made a good start by voting to kill the Independent Payment Advisory Board (IPAB), aka ObamaCare’s rationing board. Eleven Democrats joined 233 Republicans to abolish IPAB, a 15-member jury of high priests appointed by the President that’s charged with making cost-cutting recommendations for Medicare. (7/1)

Fortune: Obamacare: The Business World's Biggest Disruptor
While the U.S. Supreme Court has removed much of the uncertainty surrounding the future of the Affordable Care Act (ACA), the impact of this far-reaching change in U.S. health care financing and delivery will be a complex story unfolding gradually for years to come. The ACA is a huge “disruptive innovation,” to borrow a popular term from the business school literature. Like other disruptive innovations, it will generate winners and losers and have a slew of unforeseen consequences. (Alice M. Rivlin, 6/30)

The Wall Street Journal: Amid Merger Talk, A Look At Health Insurers’ Medicare Business
Discussion is growing about what rumored mergers between health insurance companies could mean for shareholders and the public. Initially, it was Humana exploring acquisitions by Cigna and Aetna. Then UnitedHealthcare approached Aetna. More recently, Aetna made a takeover proposal to Humana and Anthem announced a takeover bid for Cigna that seems to have been rejected. When the Justice Department grapples with these mergers, it can be expected to take into account these companies’ growing Medicare business. (Drew Altman, 7/1)

Politico: Congress’ Bizarre Idea To Pay For Health Care
Now that the Supreme Court has settled the latest challenge to Obamacare, the next big health care news in Washington will likely be the 21st Century Cures Act, a $106.4 billion health care research bill that could come to the House floor in July. How will Congress pay for it? If you haven’t been watching, you’ve missed one of the stranger decisions of the year: the Energy and Commerce committee proposes to sell off 64 million barrels of crude oil from the Strategic Petroleum Reserve. (Larry Goldstein and Lucian Pugliaresi, 7/1)

Los Angeles Times: Supreme Court Should Strike Down Texas' Unnecessary Abortion Law
The Supreme Court's decision Tuesday to allow nearly a dozen Texas abortion clinics to stay open while it considers whether to review an an onerous new antiabortion law was not just a welcome course of action for women in that state. It was also a promising indication that the court is concerned about the burdensome and unnecessary law, which requires clinics to be outfitted as ambulatory surgical centers and doctors to have admitting privileges at nearby hospitals. (7/1)

The Washington Post: California’s Vaccination Bill May Go A Bit Too Far
The right to swing one’s fist ends at the next person’s nose, and — at least according to California legislators — the right not to get vaccinated ends at a statewide measles outbreak. That’s what lawmakers decided last week when they passed a bill mandating vaccinations for schoolchildren, regardless of personal or religious objections. California’s move to increase vaccination rates is welcome, though it may go slightly too far. (7/1)

The New York Times' Opinionator: How To Talk About Dying
Too many people we love had not died in the way they would choose. Too many survivors were left feeling depressed, guilty, uncertain whether they’d done the right thing. The difference between a good death and a hard death often seemed to hinge essentially on whether someone’s wishes were expressed and respected. Whether they’d had a conversation about how they wanted to live toward the end. (Ellen Goodman, 7/1)

Forbes: What Many 65-Year Olds Don't Know About Medicare
You know the old mantra: When you turn 65 you are eligible for Medicare and Social Security. But matters are no longer that simple. And because growing numbers of older Americans are not taking Social Security benefits until past 65, they may be making poor Medicare choices or missing out on some benefits entirely–simply because the government is not telling them they need to actively enroll for health coverage. (Howard Gleckman, 7/1)

JAMA: Strategies To Improve Survival From Cardiac Arrest
Maximizing survival and minimizing disability are fundamental goals of patient care, but a new Institute of Medicine (IOM) report released this month, “Strategies to Improve Cardiac Arrest Survival: A Time to Act,” suggests that the United States is falling short in efforts to improve outcomes from cardiac arrest during the next decade. ... cardiac arrest is not a futile situation: it is a treatable event. Most survivors of cardiac arrest are not neurologically devastated but have long-term health-related quality of life. If advances achieved within some US communities could be implemented nationally, the rate of favorably functional survival from cardiac arrest could substantially improve. (Lance B. Becker, Tom P. Aufderheide and Robert Graham, 7/1)