First Edition: January 12, 2015
Today's early morning highlights from the major news organizations.
Kaiser Health News:
Congress Seeks To Limit Transfers Between Social Security And Disability Funds
A sweeping rules package the House approved at the start of the 114th Congress includes a provision that has set off a war of words about the future of Social Security and benefits for disabled workers. The measure would stop House lawmakers from transferring money from Social Security’s Old-Age and Survivors Insurance Trust Fund to the program’s Disability Insurance Trust Fund unless lawmakers took steps to “improve the actuarial balance” of both funds. (Carey, 1/12)
Kaiser Health News:
Supreme Court Battle Brewing Over Medicaid Fees
Rita Gorenflo’s 7-year-old son Nathaniel was in severe pain from a sinus infection. But since the boy was covered by Medicaid, she couldn’t immediately find a specialist willing to see him. After days of calling, she was finally able to get Nathaniel an appointment nearly a week later near their South Florida home. That was in 2005. Last month, ruling in a lawsuit brought by the state’s pediatricians and patient advocacy groups, a federal district judge in Miami determined Nathaniel’s wait was “unreasonable” and that Florida’s Medicaid program was failing him and nearly 2 million other children by not paying enough money to doctors and dentists to ensure the kids have adequate access to care. The Florida case is the latest effort to get federal judges to force states to increase Medicaid provider payment rates for the state and federal program that covers about 70 million low-income Americans. (Galewitz, 1/12)
Los Angeles Times:
Obamacare Penalties, Payouts Ahead For Many Tax Filers
Uncle Sam could take a bigger bite at tax time for consumers who received too much government help last year with their Obamacare premiums. That may be just one of several surprises for millions of Americans in advance of the first tax deadline involving the Affordable Care Act. The majority of Americans who get their health insurance at work should see few changes when filing their taxes. Most will just need to check a box on their tax return indicating they had coverage in 2014. (Terhune, 1/9)
The Washington Post:
Treating Chronic Illness With Cough Syrup: Life In The Coverage Gap
[Genesis Matos] Rodriguez was born with asthma and Middle Lobe Syndrome, which causes mucus to build in her lungs. Two years ago, her right lung collapsed; surgeons removed half. Her monthly medical bill to ward off fluids, including Pulmozyme and Albuterol, can hit $4,000. ... Her mother, legally the head of their household, made $9,000 last year working part-time — a few thousand dollars short of qualifying the family for premium subsidies under the Affordable Care Act. Nearly 4 million Americans and 800,000 Floridians live in this limbo of patchwork health care: They are not eligible for Medicaid; they don’t make enough money to afford ACA coverage. Florida, like many states that recently elected (or reelected) Republican governors, has decided not to expand Medicaid eligibility under the Affordable Care Act. (Paquette, 1/9)
The New York Times:
Health-Law Suit Hints At G.O.P. Divide
After President Obama’s Affordable Care Act was enacted in 2010, Republicans at both the state and federal levels seemed to speak with one voice in flatly rejecting it. But in subsequent years, though most Republican governors remained critical of the health care law, nine accepted a central but optional element, expanding Medicaid programs to cover many more low-income residents of their states. At least four others, urged on by hospitals and business groups, will try to do so this year. And now, briefs filed last month in support of a major legal challenge to the law — King v. Burwell, which is now before the Supreme Court — are raising new questions about divisions within the Republican Party over the law. (Goodnough, 1/11)
The Wall Street Journal:
GOP Hopefuls’ 2016 Theme Has A New Pitch
A group of conservative scholars, under the banner of the YG Network, a group affiliated with GOP leaders in the House, published a collection of essays last year to address middle-class concerns, from K-12 education to lower-cost health care. “One of the weaknesses Republicans have had during the Obama years is that they have struggled at times to talk to the middle class, particularly how they can boost low-wage workers,” said Yuval Levin, a fellow at the Ethics and Public Policy Center, a conservative think tank, who outlined a new vision for government in the essays’ introduction. (O'Connor, 1/11)
The New York Times:
New Rules To Limit Tactics On Hospitals’ Fee Collections
The Obama administration has adopted sweeping new rules to discourage nonprofit hospitals from using aggressive tactics to collect payments from low-income patients. Under the rules, nonprofit hospitals must now offer discounts, free care or other financial assistance to certain needy patients. Additionally, hospitals must try to determine whether a patient is eligible for assistance before they refer a case to a debt collector, send negative information to a credit agency, place a lien on a patient’s home, file a lawsuit or seek a court order to seize a patient’s earnings. (Pear, 1/11)
The Associated Press:
Medicare Pays Doctors To Coordinate Seniors' Chronic Care
Adjusting medications before someone gets sick enough to visit the doctor. Updating outside specialists so one doctor's prescription doesn't interfere with another's. Starting this month, Medicare will pay primary care doctors a monthly fee to better coordinate care for the most vulnerable seniors — those with multiple chronic illnesses — even if they don't have a face-to-face exam. The goal is to help patients stay healthier between doctor visits, and avoid pricey hospitals and nursing homes. (Neergaard, 1/10)
The Wall Street Journal:
Lab Under Federal Investigation Cuts Ties With Sales Contractor
A cardiac-biomarker laboratory under federal investigation cut ties with its sales-and-marketing contractor, ending a joint enterprise that has collected hundreds of millions of dollars from Medicare. The lab, Health Diagnostic Laboratory Inc., and the sales contractor, BlueWave Healthcare Consultants Inc., are the focus of a Justice Department civil probe into whether they paid kickbacks to doctors to induce them to prescribe HDL’s advanced blood tests. (Carreyrou, 1/11)
USA Today:
Doctors Engulfed In Spine Surgeon Saga
More than a dozen physicians representing two hospitals have been named as defendants in federal lawsuits that allege they acted in bad faith by allowing a spine surgeon to perform surgery at the hospitals. The doctors in question served on the committees that approved surgical privileges at Avera Sacred Heart and Lewis & Clark Specialty Hospital, both in Yankton, according to the lawsuits. The doctors are accused of extending Dr. Allen Sossan privileges to perform complex spine surgeries, despite knowing that Sossan had a history of performing unnecessary surgeries and unprofessional conduct. Both Avera Sacred Heart and Lewis & Clark also are defendants. (Ellis, 1/11)
The Wall Street Journal:
HCA Holdings Says 2014 Results To Top Guidance
HCA Holdings Inc. said it would report better-than-expected 2014 results, bolstered by an increase in admissions and emergency room visits along with a one-time adjustment from Medicaid payments in Texas. The hospital operator said it now expects Ebitda for the year of $7.4 billion, topping its previous projection of $7.25 billion to $7.35 billion. (Armental, 1/9)
The Wall Street Journal:
Roche Holding To Pay $1.03 Billion For Diagnostics-Firm Stake
Roche Holding AG agreed to pay $1.03 billion for up to a 56.3% stake in Foundation Medicine Inc. in a collaboration that underscores the growing importance of genetic diagnostics in the treatment and development of drugs for cancer. (Winslow, 1/12)
The New York Times' Dealbook:
Roche To Buy Majority Stake In Foundation Medicine, Leader In Tumor Testing
The Swiss pharmaceutical giant Roche said on Monday that it would acquire a majority of the tumor-testing company Foundation Medicine for more than $1 billion, in a deal aimed at improving both cancer treatment and drug development. (Pollack, 1/12)
The Associated Press:
Wearable Sensors Gather Lots Of Data -- Now To Make It Useful
It's not just about how many steps you've taken or how many calories you've burned in a day. Wearable fitness trackers and health monitors are becoming more commonplace and diverse, but just what do you do with all of that data? ... Health monitors aren't just for fitness buffs. Startups and big tech companies at the gadget show promoted all kinds of uses for the data generated by wearable sensors — from mindfulness exercises to figuring out the best time to get pregnant. Other companies aim to offer value by aggregating data from different sources, so it can be viewed and interpreted together. That could be useful, but it also raises a host of privacy concerns. (Bailey, 1/11)
The Wall Street Journal:
Fit for Motivation, If Not Precision
Electronic wristbands that count footsteps and calories produce imprecise data. But that’s beside the point. The devices are motivational tools to promote fitness, and the numbers they generate are good enough for that. Initially embraced by fitness fanatics, activity trackers, such as the Fitbit, Jawbone and FuelBand, have become popular among mainstream users, many of whom are wearing the accouterments as part of New Year’s resolutions to get in shape. How well do they work? (McGinty, 1/9)
The Wall Street Journal:
The Future Of Medicine Is In Your Smartphone
Over the past decade, smartphones have radically changed many aspects of our everyday lives, from banking to shopping to entertainment. Medicine is next. With innovative digital technologies, cloud computing and machine learning, the medicalized smartphone is going to upend every aspect of health care. And the end result will be that you, the patient, are about to take center stage for the first time. (Topol, 1/9)
The New York Times:
G.O.P. Governors Face Test In Shift On Ideological Agendas
Yet that pragmatism is likely to be tested in the 24 states where Republicans also control the legislature and where bills are expected that would further restrict abortion, roll back the Common Core education standards and ensure that the president’s health care law does not gain a foothold in any more states. Many conservative lawmakers in these states see a turn toward moderation by Republican leaders as being at odds with the public mood, particularly after such a decisive electoral sweep. (Robertson and Gabriel, 1/11)
The Washington Post:
McAuliffe Begins Second Year As Virginia Governor With Revamped Priorities
McAuliffe (D) bagged big economic development wins in his freshman year, resulting in $5.5 billion in private economic investments in the state — more than double, he says, what any previous Virginia governor pulled off in his first year. But he also lost a bitter fight with the Republican-controlled General Assembly to expand Medicaid under the Affordable Care Act, his marquee campaign issue and chief legislative priority. As the legislature prepares to return to Richmond on Wednesday as resolute as ever about opposing Medicaid expansion, McAuliffe’s renewed call for such a change is widely seen as symbolic. He has promised to try a more hands-on approach with lawmakers who bucked him last year, but he has decided that jobs, an issue with broad bipartisan appeal, will be his chief cause in the session. (Vozzella and Portnoy, 1/10)
The Washington Post:
Issues To Watch During Virginia’s 2015 Legislative Session
After losing a bruising battle over his top campaign promise of expanding Medicaid to 400,000 Virginians last year, the governor again included the issue in the amended budget proposal he unveiled in December. At the same time, he seemed to acknowledge how little chance the proposal has of passing by failing to factor the financial savings into his overall spending plan. (Portnoy, 1/10)
Los Angeles Times:
Brown Offers $164.7-Billion Budget Plan
Taking advantage of a growing economy, Gov. Jerry Brown proposed a $164.7-billion budget Friday that would boost funding for schools, community colleges, courts and home care for the elderly and disabled. ... The governor is also grappling with higher costs as more Californians sign up for Medi-Cal, which provides healthcare to the poor, under President Obama's signature law. But Brown did not propose higher payments for doctors who participate in the program or set aside money to provide coverage for immigrants who are in the country illegally — two priorities for activists and some top lawmakers. Nor did he include money for the long-term expense of providing healthcare to retired public workers, although he said he would work with unions to address the issue. (Megerian, 1/9)
The Washington Post:
California Gov. Brown’s Budget Holds Back On Social Spending, Angering Some On The Left
Brown warned of rising health care obligations that, without proper funding, could leave the state hundreds of billions of dollars in the red. Medicaid expansion under the Affordable Care Act has added more than 4 million new low-income residents to California’s program, and Brown said he would begin negotiating with state public employee unions over the amount of money they contribute to their own health-care costs, a significant and rising portion of the budget. (Reid, 1/9)
The New York Times:
Patients Seek ‘Right To Try’ New Drugs
Since May, a string of states have passed laws that give critically ill patients the right to try medications that have not been approved by the Food and Drug Administration. Deemed “Right to Try” laws, they have passed quickly and often unanimously in Colorado, Michigan, Missouri, Louisiana and Arizona .... The laws do not seem to have helped anyone obtain experimental medicine, as the drug companies are not interested in supplying unapproved medications outside the supervision of the F.D.A. But that seems almost beside the point to the Goldwater Institute, the libertarian group behind legislative efforts to pass Right to Try laws. (Turkewitz, 1/10)
NPR:
In Oregon, Medicaid Now Covers Transgender Medical Care
Oregon began covering the cost of reassignment surgery for transgender people on Medicaid in January. It also covers things like hormone therapy and puberty suppression. (Foden-Vencil, 1/10)