KHN Morning Briefing

Summaries of health policy coverage from major news organizations

In This Edition:

From Kaiser Health News - Latest Stories:

Kaiser Health News Original Stories

Political Cartoon: 'Hitch Your Wagon?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Hitch Your Wagon?'" by Lisa Benson.

Here's today's health policy haiku:

WHAT'S JUDICIOUS?

Low cost insurance
Now hangs in the balance of
the will of the Court.

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.

Summaries Of The News:

Health Law

Kansas Legislators Add 'New Twist' To Medicaid Expansion Debate

Some lawmakers are contemplating a plan to eliminate the state's earned income tax credit in favor of expanding the low-income health insurance program. Meanwhile, in Utah, Salt Lake City's police chief casts the expansion as a way to prevent crime.

KCUR: Kansas Lawmakers Talk About Medicaid Expansion But There’s A Catch
Most conservatives in the Legislature favor reducing or eliminating the state’s earned income tax credit but oppose expanded eligibility for Medicaid, which was part of the Affordable Care Act. Kansas is one of 21 states that have not expanded Medicaid coverage to more low-income residents. Conversely, most moderates and liberals favor Medicaid expansion and support the earned income tax credit. Conservatives control the House and Senate leadership offices. (Ranney, 5/19)

Salt Lake Tribune: Utah Police Cite Medicaid Expansion As Crime Prevention Tool
Police Chief John King on Tuesday called for the Utah Legislature to accept federal funds to extend health insurance for thousands more state residents to prevent future crime, as well as save money. King made his plea along with a representative of Fight Crime: Invest in Kids, an anti-crime organization that supports Gov. Gary Herbert's Healthy Utah expansion plan, which includes provisions for treatment of mental health issues. "I'm not here as an expert on health care policy," King said at a news conference. But as a law enforcement officer, the chief — who stressed that he and Fight Crime: Invest in Kids are not equating mental illness with criminality — said he knows the toll that mental illness, behavior disorders and substance abuse can take. (Manson, 5/19)

In related news, Bloomberg reports on the Medicaid managed care rule, for which stakeholders are anxiously awaiting details -

Bloomberg BNA: CMS Set To Release Medicaid Managed Care "Uber Rule"
The CMS is poised to release in the coming weeks what stakeholders and advocates are calling an “uber rule” that will completely overhaul the Medicaid managed care marketplace. Agency officials haven’t offered much specific information about what may be included in the proposal, or even when it will be released—although it’s been under regulatory review at the OMB since March, and the agency has been working on the regulations for over a year. (Weixel, 5/19)

Former CBO Chief Says It Was 'Common Understanding' Subsidies Were For All States

The comments by Doug Elmendorf, who headed the Congressional Budget Office that scored the cost of the health law, go to the heart of the current case before the Supreme Court. In other news about federal funding, a discrepancy between cost estimates threatens a key drug bill, senators set up a funding caucus for NIH and the new head of CBO talks about plans for analyzing health spending.

The Hill: CBO Director: Obamacare Funds Were Assumed To Be For All States
The man who led the Congressional Budget Office when ObamaCare was being constructed said Tuesday it was the “common understanding” at the time that subsidies would be available in all states — a crucial question in a looming Supreme Court case. The challengers in the case of King v. Burwell argue subsidies are only available in states that established their own exchanges, as opposed to a federally-run exchange, citing language in the law referring to an exchange “established by the state.” (Sullivan, 5/19)

In other news from Capitol Hill -

Politico Pro: Funding Breach Is Key Issue For FDA With Cures Bill
The FDA and the House Energy and Commerce Committee have vastly different estimates of what the 21st Century Cures Act would cost the agency — a divide that, if not narrowed significantly, could impact the pace of drug and medical device reviews should the bill become law. ... The agency told Politico on Tuesday that it expects Cures to cost it nearly $900 million through 2020 — and that doesn’t include the cost of implementing the legislation’s proposed biomarkers program, which may be the biggest expense for the agency and add up to an additional $188 million each year. By contrast, Energy and Commerce has pegged the five-year cost of the bill at $115 million for FDA. (Karlin, 5/19)

The Hill: Senators Create New Caucus On NIH Funding
Two top senators are pairing up to bolster support for federal research — and to find a way to fund it. Sens. Lindsey Graham (R-S.C.) and Dick Durbin (D-Ill.) will co-chair the Senate’s newest caucus, dedicated specifically to the National Institutes of Health (NIH). (Ferris, 5/19)

Modern Healthcare: CBO's New Scoring Policy Could Affect Federal Health Care Programs
The Congressional Budget Office is under new leadership, and the agency made it clear Tuesday that a different type of economic analysis will be used to study the effects of federal spending policies, particularly those in healthcare. Most analyses from the CBO use “static scoring,” which looks at the direct economic effects of a law without factoring in how the economy will react longer term. Conversely, “dynamic scoring” incorporates macroeconomic elements. The agency uses dynamic scoring for some, but not all, analyses. (Herman, 5/19)

Dispute Over Federal Hospital Funding Threatens Safety-Net Hospitals In Texas

In states such as Texas and Florida, that have not expanded Medicaid and are facing a cut in federal hospital funds, the future is uncertain for many hospitals. The Texas Tribune examines which hospitals are at risk, while Florida news outlets report that a plan by the governor is not gaining traction among hospital executives. Also, elsewhere hospital officials in North Carolina seek Medicaid changes.

The Texas Tribune: With Hospital Funds In Question, Who's At Risk?
As Texas negotiates with Washington over how to pay for health care for the poor and uninsured — a tricky dance given the state's opposition to expanding Medicaid coverage under President Obama's signature health law — billions of dollars in federal funding are on the line. And the state's safety-net hospitals and clinics are steeling themselves for an uncertain future. Currently, Texas providers rely on a five-year, federally approved program called the "1115 waiver" that reimburses them for the care they provide to people who cannot afford health insurance. But the feds have indicated that "uncompensated care" money could be discontinued if Texas doesn't expand Medicaid, the joint state-federal insurer of last resort, to include the poorest adults. (Aaronson and Walters, 5/20)

Health News Florida: Florida Hospitals Hesitant To Give Commission Data
Gov. Rick Scott, who last week asked the state's hospitals to provide a large amount of financial data by Monday, will not get all that he asked for that quickly. He may not get some of it at all. Hospital executives and lawyers say they want to cooperate with Scott and his newly appointed Commission on Healthcare and Hospital Funding, which seeks data on services, profits, costs and patient outcomes. (Gentry, 5/18)

The Associated Press: Gov. Rick Scott's Hospital Commission To Meet For First Time
Gov. Rick Scott's new hospital commission consists of Republican donors and business leaders who will likely help him go after some of the state's hospitals as the standoff over Medicaid expansion intensifies. The panel, which will meet for the first time Wednesday, is beginning its work as the governor has become increasingly antagonistic toward hospitals that receive taxpayer funds in the face of a $1 billion hole in his budget. (Kennedy, 5/19)

In other hospital news -

The Wall Street Journal: Major Donations Bolster Hospital, Medical Research
A stretch of the Upper East Side of Manhattan will be transformed into even more of an international hub for hospitals and medical research with a total of $250 million in separate donations from the industrialist David H. Koch and the financier Henry R. Kravis and his wife, Marie-Josée Kravis. (Grayce West, 5/20)

Georgia Health News: WellStar Expanding Reach In LaGrange Hospital Deal
Marietta-based WellStar is planning to add another hospital system to its fold, one that’s outside its current geographical sweet spot. West Georgia Health in LaGrange announced Tuesday that it has signed a letter of intent to join WellStar Health System, which dominates the northwest Atlanta suburbs. The CEO of West Georgia, Jerry Fulks, cited the changes rampant in health care payments — many of which were ignited by the Affordable Care Act — for his system’s yearlong pursuit of a partner. (Miller, 5/19)

Coverage And Access

Number Of 'Underinsured' Rising, With 1 In 4 At Financial Risk From Medical Bills: Study

A report warns that an estimated 31 million people are insured by health plans that would not protect them enough from high medical bills. Rising deductibles were cited as the biggest problem.

The Hill: Study: 'Underinsured' Population Has Doubled To 31M
One-quarter of people with healthcare coverage are paying so much for deductibles and out-of-pocket expenses that they are considered underinsured, according to a new study. An estimated 31 million insured people are not adequately protected against high medical costs, a figure that has doubled since 2003, according to the 2014 national health insurance survey by the Commonwealth Fund. (Ferris, 5/20)

New Data Rate Hospital Performance On Popular Elective Surgeries

U.S. News and World Report released the data on coronary artery bypass grafts and hip and knee replacements, which 1.4 million patients get every year. Elsewhere, a new program allows patients to borrow money to pay their medical bills.

Modern Healthcare: Hospitals Turn To Friendlier Tools To Collect Unpaid Bills
In one of the bigger ironies of the Affordable Care Act era, when millions of people have gained access to insurance, many providers are reporting an increase in bad debt. The reason: More individuals and families are finding themselves in high-deductible plans as employers shift their benefit packages, and individuals and families buy plans on the federal or state-run exchanges, where the most popular options involve significant copays and deductibles. (Kutscher, 5/16)

Public Health And Education

'Sham' Cancer Charities Accused Of Misusing $187 Million In Donations

Money donors gave to pay for pain medications, hospice services and other cancer care was instead spent by a family on personal items like meals and dating websites, according to a civil complaint filed by federal officials.

The Washington Post: Cancer Charities Bilked Donors Out Of $187 Million, Government Says
A group of four cancer philanthropies bilked donors across the country out of $187 million, the Federal Trade Commission charged Tuesday in what the agency called one of the largest government actions against charity fraud. The four groups named in the civil complaint are the Cancer Fund of America, Cancer Support Services, the Children’s Cancer Fund of America and the Breast Cancer Society. Their operations from 2008 to 2012, which were called a “sham” by the FTC, relied on emotional appeals to help women and children with cancer. (Whoriskey, Dennis and Cha, 5/19)

The New York Times: 4 Cancer Charities Are Accused Of Fraud
There were subscriptions to dating websites, meals at Hooters and purchases at Victoria’s Secret — not to mention jet ski joy rides and couples’ cruises to the Caribbean. All of it was paid for with the nearly $200 million donated to cancer charities, and was enjoyed by the healthy friends and family members of those running the groups, in what government officials said Tuesday was one of the largest charity fraud cases ever. (Ruiz, 5/19)

The Wall Street Journal: Cancer Charities Called $187 Million ‘Sham’
A group of family members whose charities claimed to be raising millions of dollars for cancer victims bilked donors to the tune of $187 million over five years, spending some of that money on fancy cars and trips for themselves and their friends, according to a civil suit. The alleged fraud, which would be one of the largest-ever involving a charity, was detailed in a complaint filed by the Federal Trade Commission, all 50 states and the District of Columbia. (McWhirter, 5/19)

The Associated Press: FTC: Family Raised $187M For Cancer, Spent It On Themselves
A Tennessee man and his family used much of the $187 million it collected for cancer patients to buy themselves cars, gym memberships and take luxury cruise vacations, pay for college tuition and employ family members with six-figure salaries, federal officials alleged Tuesday in one of the largest charity fraud cases ever, involving all 50 states. The joint action by the Federal Trade Commission and the states says James T. Reynolds Sr., his ex-wife and son raised the money through their various charities: The Cancer Fund of America in Knoxville, Tennessee, and its affiliated Cancer Support Services; The Breast Cancer Society in Mesa, Arizona; and the Children’s Cancer Fund of America in Powell, Tennessee. (Flaherty, 5/19)

Global Activists To Challenge Patents On Breakthrough Hep C Drugs Due to Price

Other health reporters examine the cancer risks related to dense breasts, improper gluten-free labeling on probiotics and its risks to those with celiac disease, stablizing metabolic syndrome rates and the possible overuse of an asthma drug.

The New York Times: High Cost Of Hepatitis C Drug Prompts A Call To Void Its Patents
Activists in several countries are seeking to void patents on the blockbuster hepatitis C drug Sovaldi, saying that the price being sought by the manufacturer, Gilead Sciences, was prohibitive. ... The actions are a sign that the controversy over Sovaldi is spreading beyond the United States, where the $84,000 charge for a course of treatment has strained Medicaid budgets, to middle-income countries. (Pollack, 5/19)

NPR: Dense Breasts Are Just One Part Of The Cancer Risk Calculus
Almost half the states now require doctors to tell women if they have dense breasts because they're at higher risk of breast cancer, and those cancers are harder to find. But not all women with dense breasts have the same risks, a study says. Those differences need to be taken into account when figuring out each woman's risk of breast cancer, the study says, and also weighed against other factors, including family history, age and ethnicity. (Shute, 5/19)

The New York Times: Many Probiotics Taken For Celiac Disease Contain Gluten
More than half of the top-selling probiotic supplements they analyzed contained gluten, a protein found in wheat, barley and rye that is harmful to people with celiac disease. The authors of the study found gluten in probiotic supplements that carried “gluten-free” claims on their labels, and they discovered that the most expensive supplements were just as likely to contain gluten as the cheapest products. ... The new findings are a symptom of what experts say is a larger problem in the $33-billion-a-year supplement industry. Several large studies and law enforcement investigations in the last two years have suggested that supplements often do not contain what their labels claim. The industry is loosely regulated, and the Food and Drug Administration has said that two thirds of companies do not comply with a basic set of good manufacturing practices. (O'Connor, 5/19)

Reuters: Metabolic Syndrome Common But Rates Stable Among U.S. Adults
About a third of U.S. adults have a collection of risk factors that increases their risk of heart disease and strokes, according to new research. While previous studies found an increasing prevalence of so-called metabolic syndrome among U.S. adults, researchers report in JAMA that rates remained mostly stable between 2008 and 2012. (Doyle, 5/19)

Meningitis Outbreak Victims To Get Compensation From $200 Million Fund

A federal bankruptcy judge approved the compensation pool for victims and creditors impacted by tainted steroid shots produced at a Massachusetts compounding pharmacy. In other court news, a synthetic marijuana prosecution hangs in the balance as Iowa struggles to define Schedule I chemicals.

The Associated Press: Judge Approves $200M Settlement In 2012 Meningitis Outbreak
Victims of a 2012 meningitis outbreak caused by a now-closed Massachusetts compounding pharmacy will have access to a $200 million compensation fund, following approval Tuesday by a federal bankruptcy judge. The new fund will be available to compensate creditors and victims who became ill or died as the result of receiving tainted steroid injections from the New England Compounding Center. It is part of a plan to liquidate the assets of the Framingham-based center approved by U.S. Bankruptcy Court Judge Henry Boroff. (Marcelo, 5/19)

The Des Moines Register: Missed Deadline Puts Synthetic Drug Prosecution At Standstill
Spice, White Tiger, Mr. Nice Guy, Purple Diesel, K2. Synthetic marijuana goes by a dozen different names, with dozens of different ingredients — all of them man-made and some of them deadly. In Iowa and across the United States, lawmakers and law enforcement have struggled to pass bills that keep up with the constantly changing chemicals used in fake pot. Out of that struggle comes a Polk County court battle that will decide whether felony charges stick against a Des Moines woman accused of selling synthetic marijuana for a drug ring operating out of convenience stores. (Rodgers, 5/19)

Women’s Health

Congress Advances Measures Giving Women In The Military Greater Access To Contraceptives

The House's defense policy bill says military clinics and hospitals must offer any method of contraception approved by the Food and Drug Administration. Similar efforts are moving in the Senate too. Also on the issue of contraception, a federal court has denied for the second time Notre Dame's challenge to the contraception-coverage requirements in the health law.

The New York Times: Lawmakers Back Broader Access To Contraceptives For Women In The Military
Both houses of Congress are moving to guarantee greater access to contraceptives for women in the military, actions that lawmakers say are prompted in part by concern about unplanned pregnancies in the armed forces. The annual defense policy bill, passed on Friday by the House, says military clinics and hospitals must be able to dispense any method of contraception approved by the Food and Drug Administration. Women have complained that they are sometimes unable to obtain contraceptives prescribed by their doctors, especially when they are deployed overseas. (Pear, 5/19)

The Wall Street Journal: Appeals Court Denies Notre Dame’s Challenge To Health Law’s Contraception Mandate
A federal court again denied the University of Notre Dame’s challenge to the health law’s contraception provision, saying a compromise arrangement offered by the Obama administration appears adequate to meet the Catholic institution’s religious objections to covering birth control for students and staff. Notre Dame has been fighting the Affordable Care Act’s requirement that most employers include contraception in health plans with no out-of-pocket costs, arguing that the federal government is forcing it to violate its beliefs. (Radnofsky and Kendall, 5/19)

And in Florida, two college students have filed a lawsuit over an invasive vaginal procedure they were required to undergo as part of their training -

The Associated Press: Lawsuit: Ultrasound Students Pressured Into Procedure
Two former students in a Florida community college ultrasound program say they were punished for objecting to a policy that encouraged students to undergo an invasive vaginal procedure to become better technicians. The two unnamed female students filed a federal lawsuit last week against Valencia State College in Orlando, claiming the policy violated their civil rights under the First and Fourth amendments. (Schneider, 5/19)

Marketplace

Health Sector Business Climate Good For Deal-Making, Acquisitions And Spin-Offs

Anthem's CFO said the potential for a "meaningful" merger within the insurance industry would shrink the field of major players. Johnson & Johnson is entering a development and marketing deal with Achillion Pharmaceuticals on one or more of the drugmaker's hepatitis C drugs. And Walgreens is relaunching its home-infusion division as a separate company.

Reuters: Anthem CFO Says Insurer Could Make 'Meaningful' Acquisition
The financial chief of Anthem Inc, the second-largest U.S. health insurer, said on Tuesday that low interest rates and other conditions make it a good time for an acquisition, adding to speculation about merger activity in the sector. DeVeydt's comments came against a backdrop of renewed speculation about the potential for a major insurance deal that would shrink the field of large U.S. players from five to four. (5/19)

Bloomberg: J&J Deal Heats Up One Of The Most Competitive Drug Markets
Johnson & Johnson agreed to develop and market Achillion Pharmaceuticals Inc.’s drug for hepatitis C, thrusting the world’s biggest maker of health-care products back into the growing competition for patients of the liver disease. J&J will work with Achillion on one or more of its top hepatitis C treatments, which may include ACH-3102, ACH-3422 and sovaprevir, in exchange for royalty payments, the companies said Tuesday in a statement. In a separate deal, J&J will pay $225 million for a stake in Achillion. (Harrison, 5/19)

The Chicago Tribune: Walgreens Spins Infusion Business Into Separate Company
Walgreens Boots Alliance's home-infusion division has been relaunched as an independent company called Option Care, after the drugstore chain sold a majority stake in the business to a Chicago private equity firm. Home-infusion therapy is a big and growing business. Paul Mastrapa, Option Care's CEO, estimates that infusion therapy is a $14 billion industry in the U.S., expanding 10 percent a year. (Sachdev, 5/19)

In other news, the Center for Public Integrity examines Medicare Advantage's lucrative move into the intersection of policy and Wall Street -

Center for Public Integrity: How Medicare Advantage Investors Made Billions Off Loose Government Lips
The third of February 2011 was mostly a ho-hum day on Wall Street­ — but not for companies offering Medicare Advantage plans. Several of those firms hit the jackpot, tacking on billions of dollars in new value after federal officials signaled they might go easy on health plans suspected of overcharging the government. ... A CMS spokesman said the two-paragraph memo was routine and that officials did nothing wrong in sending it out. But the advisory appears to contradict CMS regulations that urge officials to wait until after markets close to disclose information that could move stocks. The episode also raises fresh questions about the security and timing of “market-sensitive” disclosures – and just who gains access to the information. (Schulte, 5/19)

And the Food and Drug Administration -- as part of its effort to combat antibiotic resistance -- is seeking data from drugmakers on antimicrobials sold for use in animals such as cows and chickens -

The Washington Post: To Fight Superbugs, FDA Seeks Detailed Data On Animal Antimicrobials
The U.S Food and Drug Administration said it is asking drugmakers for data on antimicrobials sold for use in each food animal, such as cows and chickens, as part of efforts to combat antibiotic­resistant bacteria. ... Details on the use of medically important antimicrobials — a group of drugs that includes antibiotics, antifungals and antivirals — will help the agency discern patterns of resistance and identify disease trends, the FDA said in a statement Tuesday. (5/19)

Campaign 2016

The Health Law's Impact On Small Business Part Of Campaign Trail Buzz

Small business issues -- including policies related to Obamacare -- are becoming important talking points among presidential hopefuls from both parties.

The Associated Press: Small Business Is Key In Presidential Campaign Playbook
Small businesses aren't in the dire straits they were four years ago, but presidential candidates aren't letting go of an issue they think will get them votes. Democrat Hillary Rodham Clinton has made small business one of the top items on her campaign agenda. Republican Ted Cruz says the primary problems hurting small companies are the health care law, taxes and government regulations. Republican Rand Paul says the tax law is burdening small business and slowing the economy. (5/20)

And a more immediate electoral contest -- the Kentucky GOP primary -- appeared too close to call on election night. Both front-runner candidates have pledged to undo the state-run insurance exchange -

The Associated Press: GOP Primary For Governor In Kentucky Too Close To Call
Kentucky's volatile Republican primary for governor ended in a virtual tie Tuesday night as less than 100 votes separated Matt Bevin and James Comer. ... Bevin and Comer agree on most major policy issues, including passing laws to ban companies from forcing its employees to join a labor union and vowing to dismantle the state-run health insurance exchange authorized by the federal Affordable Care Act. (5/20)

State Watch

Rhode Island Medicaid Overhaul Triggers Opposition

News outlets also report on Medicaid news from North Carolina and Missouri.

Providence Journal: R.I. Medicaid Overhaul Would Hurt The Poor, Opponents Say
Speakers at a Senate Finance Committee hearing on Tuesday night were all for the long-term innovations at the heart of Governor Raimondo's Reinventing Medicaid initiative, but some said they were concerned that its immediate cuts would cause significant harm to the hospitals and nursing homes that care for Rhode Island's poor. (Salit and Gregg, 5/19)

WRAL: House Medicaid Budget Provision Draws Fire
The proposed House budget would give Health and Human Services Secretary Aldona Wos sweeping authority to run North Carolina's Medicaid program, allowing her to push forward with changes to the program's details and overall structure with relatively little intervention from the General Assembly. "This is audacious," Rep. Verla Insko, D-Orange, said of the provision during the House Appropriations Committee's vetting of the budget Tuesday morning. (BInker, 5/19)

The St. Louis Post-Dispatch: Missouri Officials: State Shouldn't Owe Feds For Medicaid Rebates
Responding to a critical federal audit, Missouri Medicaid officials say the state will soon begin collecting required prescription drug rebates and shouldn’t face financial penalties for failing to collect those rebates years ago. In a letter dated May 13 and obtained by the Post-Dispatch late Monday, Missouri Department of Social Services Director Brian Kinkade told federal officials the state would begin to collect the rebates on Medicaid drug claims made after July 1. (Shapiro, 5/19)

Cities And Counties Try To Reduce Number Of Imprisoned Mentally Ill Through Training, Support Centers

A scathing report highlights the tough conditions for Illinois inmates who suffer from mental illnesses. At a Chicago jail, those problems will have to be tackled by a clinical psychologist who was appointed to lead the facility. Meanwhile, an Arizona jail where half the prisoners are Native American is taking a cultural approach to treating drug addictions.

Stateline: New Efforts To Keep The Mentally Ill Out Of Jail
In many places, police, judges and elected officials increasingly are pointing out that a high proportion of people in jail are mentally ill, and that in many cases they shouldn’t be there. In recent years, many cities and counties have tried to reduce those numbers by training police to deal with mental health crises, creating mobile mental health units to assist officers, and establishing mental health support centers as an alternative to jail, among other measures. ... Earlier this month, a coalition including the Council of State Governments Justice Center, the American Psychiatric Foundation and the National Association of Counties kicked off a national campaign to encourage local jurisdictions to collect data on the jailed mentally ill and adopt strategies to avoid incarceration. In February, the MacArthur Foundation announced it would send a total of $75 million to jurisdictions interested in reducing unnecessary incarceration of people, including the mentally ill. (Ollove, 5/19)

NPR: Clinical Psychologist To Head Chicago's Cook County Jail
Now a sign of just how entwined the criminal justice system is with mental illness. Next week, a clinical psychologist will take over as head of one of the country's largest jails - Cook County Jail in Chicago. On any given day, it houses some 9,000 inmates. Prison officials estimate that a third of them are mentally ill. (Block, 5/19)

NPR: Many Native American Communities Struggle With Effects Of Heroin Use
[Akimel O'odham tribe member Shannon] Rivers is a former addict. He says the reasons why Native Americans have such high rates of incarceration and substance abuse are complex. ... And there's a new problem: a recent FBI report shows the Mexican drug cartels are specifically targeting Indian Country. High unemployment on the reservations means many turn to trafficking and dealing. The cartels know the tribes lack law enforcement resources. (Morales, 5/20)

Tennessee Enacts Abortion Waiting Period; Texas Considers Abortion Restrictions On Minors

And in Missouri, Aetna will pay a $4.5 million fine for covering some elective abortions for ineligible women who didn't buy an optional policy, as required by state law.

The Tennessean: 48-Hour Abortion Waiting Period Signed Into Tennessee Law
Women seeking an abortion in Tennessee will now have to make two trips to a clinic, waiting 48 hours after getting in-person counseling from a doctor before being able to return for the procedure, under a new measure signed into law by Gov. Bill Haslam on Monday. Physicians who do not follow new rules on what to tell their patients during the in-person counseling could face either misdemeanor or felony charges, or risk having their medical licenses revoked. (Wadhwani, 5/19)

The Texas Tribune: Texas Senate Panel OKs Restrictions On Minors Seeking Abortions
Minors seeking abortions in Texas without parental consent will face a tougher set of legal hurdles under legislation already approved by the House and now headed for the Senate floor. The Senate Health and Human Services Committee Tuesday approved House Bill 3994 by state Rep. Geanie Morrison, R-Victoria, on a 5-2 vote. Morrison's bill would tighten the requirements on “judicial bypass,” the legal process that allows minors to get court approval for an abortion if seeking permission from their parents could endanger them. (Ura, 5/19)

The Associated Press: Missouri Fines Aetna For Paying For Uninsured Abortions
Missouri Gov. Jay Nixon announced Tuesday that insurer Aetna has agreed to pay $4.5 million for violations of state law that included paying for elective abortions when the women were not eligible under their policies, marking the largest insurance penalty in state history. In documents outlining the agreement, the insurance company said it covered elective abortions for women who did not pay for additional insurance for those abortions. A 1983 Missouri law requires that women buy optional insurance for elective abortion coverage. (Ballentine, 5/19)

State Highlights: Tenn. Right-To-Die Battle Hits Courts; Audit Of Health Centers Raises Questions In N.J.

News outlets examine health care issues in Tennessee, New Jersey, Georgia, Connecticut, Louisiana, Vermont, Colorado, California and Texas.

The Tennessean: Battle Over Right To Die Headed To Nashville Courts
A civil rights activist who pledged to make right-to-die legislation his final fight filed a lawsuit Tuesday challenging state law that prohibits assisted suicide. Attorney, businessman and political candidate John Jay Hooker, who is facing his own terminal diagnosis, is undeterred by the Tennessee General Assembly's choice to send the issue to summer study and is now asking a Davidson County Chancery Court judge to weigh the issue. He says the state law, which makes it a felony for a doctor or another person to assist in someone's death, violates the state constitution. (Barchenger, 5/19)

NJ Spotlight: State Auditor Raises Questions About Payments To Community Health Centers
Many millions of dollars in state payments for services provided by community health centers in New Jersey may not have been documented correctly, according to the state auditor. But a lawyer for the centers, which are known as federally qualified health centers (FQHCs), said the auditor was merely pointing out concerns that had been previously raised and were later rejected by federal judges.The Office of the State Auditor, which is part of the nonpartisan Office of Legislative Services, issued a report last week finding that the FQHCs had billed for services under the Medicaid program using other healthcare providers’ information, and that they had received $9 million in payments that weren’t approved by the insurers who are paid by the state to manage healthcare for Medicaid recipients. (Kitchenman, 5/19)

Connecticut Mirror: The Doctor Is Online, And Lawmakers Are Prescribing Some Rules
Telemedicine — also referred to as telehealth — is expected to become a larger part of medical care as technology evolves, the emphasis on reducing health care costs grows and the demand for care outstrips the supply of medical providers, particularly in primary care. But regulation of the practice has lagged. (Levin Becker, 5/20)

St. Louis Public Radio: Seven Years In The Making, Missouri Bill To Cover Eating Disorders Await Signature
A bill awaiting the Missouri governor’s signature would add an extra layer of protection for people battling eating disorders: SB 145. The Affordable Care Act already requires insurance companies to cover treatment for eating disorders under a mental health parity law, but some patients reported they are still denied coverage because their Body Mass Index measurements were above a predetermined level. (Bouscaren, 5/19)

California Healthline: Scope Of Practice Bill Sent To Senate Floor
Optometrists could perform more medical duties than currently allowed in California under legislation passed on Monday by the Senate Appropriations Committee. ... The bill is designed to help address the dearth of primary care providers in California by allowing some of their duties to be taken up by optometrists who undergo special training for the tasks. (Gorn, 5/19)

The Texas Tribune: Texas House Backs Senate Bill Making Execution Drug Providers Secret
Legislation that would keep the names of execution drug providers secret is headed to the governor’s office after the Texas House gave final approval on Tuesday to a Senate measure. Senate Bill 1697, authored by state Sen. Joan Huffman, R-Houston, and sponsored in the House by state Rep. John Smithee, R-Amarillo, would make information about anyone who participates in the execution procedure – including those who manufacture, supply, transport and administer execution drugs – confidential and unavailable through public records requests. (Hershaw, 5/19)

Editorials And Opinions

Viewpoints: Too Many Consumers Underinsured; Getting A Grip On Performance Measures

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

Huffington Post: It's Not Just You -- Those Health Insurance Deductibles Are Getting Scary
Debates about health care frequently focus on the number of people with and without insurance, because it’s a relatively straightforward thing to measure. ... But an equally important question is what kind of insurance you have -- and that includes whether your policy leaves you exposed to large, potentially crippling out-of-pocket expenses. ... If you get sick and end up in the hospital, a high deductible could leave you owing many thousands of dollars, forcing you into financial distress. You wouldn’t be uninsured, but you would be underinsured. You’d also have lots of company. (Jonathan Cohn, 5/20)

The New York Times' The Upshot: Why Insurance Doesn’t Always Prevent Giant Medical Bills
Health insurance is supposed to help you pay for your health care, but it’s also supposed to protect you from financial ruin. A large new survey finds that, for nearly a quarter of insured adults, insurance has provided flimsy protection against huge medical bills. The survey, from the health research group the Commonwealth Fund, looked at around 3,000 adults who had been insured all year, and found that in 2014, 23 percent of them were “underinsured,” according to a definition of financial exposure developed by the researchers. (Margot Sanger-Katz, 5/20)

The Washington Post: Yet Another Example Of The IRS Disregarding The Plain Text Of The PPACA
The Internal Revenue Service (IRS) is charged with administering many key provisions of the Patient Protection and Affordable Care Act (PPACA). One might expect the IRS to follow the law when doing so. In drafting regulations to implement the PPACA’s tax credit provisions, however, the IRS seems to have a habit of ignoring the statutory text where the IRS does not like the result. (Jonathan H. Adler, 5/19)

The Wall Street Journal's Washington Wire: Are More Americans Benefiting From Obamacare Than Realize It?
One reason the Affordable Care Act gets mixed reviews is the persistent and sharp partisan divide in public opinion on the law. But a less appreciated reason for this is simply that many more people benefit from the ACA than may realize it. More than half of Americans say the health reform law has had no impact on them or their family, Kaiser Family Foundation Health Tracking Polls have found. As the chart above shows, that’s true of Democrats (60%), independents (54%), and Republicans (55%). But the ACA benefits more people than say it has affected them and far more than the approximately 23 million more people who have signed up for a marketplace plan or Medicaid as a result of the law. (Drew Altman, 5/20)

JAMA: Measuring Vital Signs
The budding enthusiasm for performance measurement ... has begun to create serious problems for public health and for health care. Not only are many measures imperfect, but they are proliferating at an astonishing rate, increasing the burden and blurring the ability to focus on issues most important to better health and health care. Measures of the same phenomenon also vary in specification and application, leading to confusion and inefficiency that make health care more expensive and undermine the very purpose of measurement, namely, to facilitate improvement. ... In response to these issues, a new report from the Institute of Medicine (IOM), Vital Signs: Core Metrics for Health and Health Care Progress, addresses the major opportunities and current problems in the health care measurement enterprise. (David Blumenthal and J. Michael McGinnis, 5/19)

Health Affairs Blog: Bridging The Gap Between Behavioral And Primary Health Care For Low-Income Patients
A traditionally marginalized component of the health care system, mental health and substance use issues have long been treated separately from physical health—despite the fact that we know they can have an impact on our physical well-being. Bridging the divide between behavioral and primary health care not only makes sense, it’s what patients want. Recent Blue Shield of California Foundation research reveals that low-income patients prefer to receive behavioral health services in the same setting as they receive their primary care. It also shows that a broad gap still exists between need and available treatment. (Rachel Wick, 5/16)