KHN Morning Briefing

Summaries of health policy coverage from major news organizations

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Kaiser Health News Original Stories

Telemedicine Under Attack As Abortion Rights Supporters Seek More Options For Women

Only two states offer telemed abortions, in which a woman confers with a doctor through an Internet video connection before being prescribed drugs to terminate a pregnancy. Supporters say the practice improves early access to abortion, thus cutting down expenses and complications, but opponents say it is dangerous. (Michelle Andrews, 5/19)

Political Cartoon: 'Won't Hear A Word Of It?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Won't Hear A Word Of It?'" by Hilary Price.

Here's today's health policy haiku:


An emerging frontier in
abortion debates.

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

Medicaid Expansion Has Been Bigger Than Expected And Some States Fear Costs

The federal government is picking up all expenses for the new enrollees now but eventually 10 percent of that cost will fall to the states. Plus, states are on the hook for beneficiaries who have moved into Medicaid and qualified under old rules. Also, get a look at one community health clinic in Missouri, which did not expand Medicaid.

St. Louis Public Radio: A St. Louis Clinic Buckles In For Another Year Without Medicaid Expansion
Despite the efforts of healthcare advocates, hospitals and notable former legislators, the Missouri legislature did not pass Medicaid expansion this year, or even bring it to the debate floor. That means an estimated 147,000 Missourians will have another year without health coverage, and the community health clinics that care for the uninsured will continue trying to bridge the gap. “I don’t know what it will take, I don’t know what more information [lawmakers] need to motivate them to change,” said Dr. Johnetta Craig, Chief Medical Officer at Family Care Health Centers in St. Louis. Craig said that if the past two years are any indication, patients will defer care when they can’t afford it, leading to emergencies and more expensive health care down the road. (Bouscaren, 5/18)

Florida Hospitals Reject Gov. Scott's Plan For Profit Sharing

The governor's proposal was meant to offer a way for some hospitals to withstand the loss of funding that the federal government has said will end soon, as well as the lack of increased revenues since the state has not opted to expand its Medicaid program. That expansion controversy is at the heart of a legislative impasse that has stalled the state budgeting process.

Tampa Bay Times: Hospitals Say No To Scott's Profit-Sharing Plan
Florida hospitals have a response to Gov. Rick Scott’s proposal that lost federal health care funding be offset by profit sharing: No way. On May 8, the governor wrote in a letter that surpluses from profitable hospitals could be used to help keep afloat those that don’t break even as a possible replacement for the federally funded Low-Income Pool, which ends June 30. But the FHA says its hospitals already fund poor Floridians’ health care by way of Medicaid. Pointing to a report commissioned by the state, FHA points out that hospitals contribute roughly $1.3 billion to Medicaid. (Auslen, 5/18)

In Budget Compromise, Minn. Lawmakers Opt Against Changes To State Health Exchange

Republicans had sought to close down the troubled marketplace, called MNsure, and Democrats had hoped to make it a state agency. Also in news about state exchanges, the Kansas legislature is not contemplating any changes to help residents keep subsidies if the Supreme Court strikes them down on the federal health marketplace, and Vermont insurers are seeking a rate increase.

The Minneapolis Star-Tribune: New Task Force Takes Up Potential MNsure Changes
A new task force will take up some of the biggest potential changes to the state’s MNsure exchange after lawmakers this weekend couldn’t reach agreement on several competing proposals. A massive spending bill for health and human services does not include House Republican plans to shift MinnesotaCare enrollees to the health exchange next year, nor does it include a Republican proposal to shut down MNsure in 2017. DFLers in the Senate, meanwhile, didn’t get their wish for MNsure to become more of a traditional state government agency. The MNsure board of directors will retain its authority, including choice of MNsure’s top executive. (Snowbeck, 5/18)

Minnesota Public Radio: MNsure Survives Session Intact Despite Lawmaker Anger
MNsure seemed headed for big changes and possibly closure when the Legislature opened in January. Now, as the session near its end, it appears MNsure won't be changing much at all. State lawmakers over the weekend agreed on a health and human services bill that falls far short of the changes some Democrats and Republicans had hoped to make to the health plan exchange. (Zdechlik, 5/18)

The Associated Press: Vermont Health Connect Insurers Seeking Rate Increase
The organization that regulates health care in Vermont says the two providers offering health insurance through the state health exchange are seeking rate increases. The Green Mountain Care Board said Monday that Blue Cross Blue Shield of Vermont has requested an average annual rate increase of 8.4 percent over 2015 rates while MVP Health Care has requested an average annual rate increase of 3 percent. (5/18)

Capitol Hill Watch

Maine Lawmaker Urges Backup Plan If High Court Overturns Health Law Subsidies

Rep. Bruce Poliquin, R-Maine, is warning that, without a plan, consumers will likely face chaos in the insurance marketplace if the Supreme Court justices rule against this provision. Also in news from Congress, the markup of the "Cures" bill is slated to begin today while Sen. Bernie Sanders, I-Vt., introduces legislation aimed at high drug prices.

The Hill: GOP Lawmaker Presses House Leaders For ObamaCare Alternative
Another Republican lawmaker is warning House GOP leaders that they need to come up with a fully fledged plan in case the Supreme Court rules against ObamaCare next month. Without a plan, Rep. Bruce Poliquin (R-Maine) argued consumers would face chaos in the market if the high court rules against subsidies to buy ObamaCare on the federal marketplace. (Ferris, 5/18)

The Hill: Sanders Takes Aim At High Drug Prices
Sen. Bernie Sanders (I-Vt.) and Rep. Elijah Cummings (D-Md.) on Monday introduced a bill aimed at lowering the taxpayer burden for rising generic drug prices. Brand-name drug manufacturers are required by law to pay a rebate to Medicaid when their drug prices rise faster than inflation. Sanders and Cummings’s bill would extend this requirement to generic drug manufacturers. (Sullivan, 5/18)

Public Health And Education

Doctor Group Pushes For 'High Value' Cancer Screening

In an effort to reduce some of the confusion associated with cancer screening, the American College of Physicians reviewed prominent cancer screening guidelines to find less intensive testing strategies that still garner broad expert consensus. The group focused on five specific tests.

The Associated Press: Doctor Group Seeks To Clear Confusion In Cancer Screening
Mammograms at 40 or 50? Every year or every other year? What’s the best colon check? Screening for cancer has gotten more complicated in recent years with evolving guidelines that sometimes conflict. Now a doctors’ group aims to ease some confusion — and encourage more discussion of testing’s pros and cons — with what it calls advice on “high-value screening” for five types of tumors. (Neergaard, 5/18)

Los Angeles Times: Cancer Screening: An Example Of When Less Can Be More, Experts Say
Americans get too many tests to screen for common types of cancer, and the American College of Physicians wants them to stop. New clinical guidelines from the medical group include a litany of statistics that illustrate our obsession with cancer screening. Among them: About 6 in 10 adults submitted to a colonoscopy more often than they needed to. One-third of men who got a PSA test to screen for prostate cancer couldn’t remember being asked by their doctor to do so. And 69% of women who had their cervix removed during a hysterectomy still got tested for cervical cancer. (Kaplan, 5/18)

Reuters: Less Frequent Cancer Screenings Possible For Many People, Docs Say
Many patients could be screened less often for certain cancers to minimize their risk of receiving unnecessary follow-up tests or treatment for tumors that are unlikely to become harmful, U.S. doctors recommend. Less frequent screening for some malignancies, as well as starting tests later in life and ending them earlier in old age, may make sense for some adults without a family history or other risk factors for cancer, according to American College of Physicians (ACP) guidelines published May 18 in the Annals of Internal Medicine. (Rapaport, 5/18)

Meanwhile, mammograms are one of the screening tests that continues to draw study and review -

NPR: Change To Mammogram Guidelines Could Lead To Coverage Shift
Millions of women could lose access to free mammograms under changes to breast cancer screening guidelines that influence insurers, the consulting firm Avalere estimates. The Avalere analysis is based on an update to breast cancer screening recommendations proposed by the U.S. Preventive Services Task Force, a group of medical experts whose work guides health care standards and policy. The public comment period on the proposal expires Monday. (Kelto, 5/18)

Reuters: Extra Radiology Exams May Only Benefit Some Women With Dense Breasts
While it's often suggested that women with dense breasts get ultrasound or other extra screenings after a mammogram, a new study suggests those added tests may only help certain women. Breast density increases breast cancer risk and can mask tumors during mammograms, the researchers explain in the Annals of Internal Medicine. (Doyle, 5/18)

Campaign 2016

Sen. Lindsey Graham To Join Crowded Field Vying For Republican Nomination

As Sen. Lindsey Graham, R-S.C., takes steps to launch his presidential bid, The Associated Press outlines his positions on the health law, abortion, Medicare spending and other issues. Also from the Republican campaign trail, Louisiana Gov. Bobby Jindal forms an exploratory committee and Texas Sen. Ted Cruz's health insurance status again makes the news.

The Associated Press: Where They Stand: Lindsey Graham On Issues Of 2016 Campaign
South Carolina Sen. Lindsey Graham will announce his campaign for president next month, after saying Monday he is running for the Republican nomination. Here’s a snapshot of where Graham stands on issues likely to be debated in the Republican presidential primaries. ... He voted against the Affordable Care Act and supports the GOP’s “Ryan Budget” that would curtail Social Security and Medicare spending and benefits over time. ... On abortion, Graham receives high marks from state and national organizations that oppose a woman’s right to terminate a pregnancy. But he’s also tried to bridge the gap between conservatives who support absolute bans on abortion and those who support exceptions for rape, incest and health of the mother. Graham argues absolute bans aren’t politically feasible. (Barrow, 5/19)

The New York Times: Bobby Jindal Forms Exploratory Committee
In an email sent to reporters, Mr. Jindal was harshly critical of President Obama and said the country was ready “to try a dramatically different path.” “While other Republican leaders are talking about change, I’ve published detailed plans to repeal and replace Obamacare, rebuild America’s defenses, make America energy independent, and reform education for our nation’s children,” Mr. Jindal wrote in the statement. (Corasaniti, 5/18)

McClatchy: Jindal Takes Big Step Towards Presidential Bid
[Bobby] Jindal, 43, now in his second term as governor, has been far down in most Republican presidential polls. He’s positioned himself as friendly to the party’s religious right. He’s also regarded as an expert on health care issues. (Lightman, 5/18)

McClatchy: Cruz Foregoes Obamacare After All
Sen. Ted Cruz, R-Texas, one of the federal health law’s fiercest critics, will not participate in Obamacare after all. Cruz and his family have bought coverage in the private market instead of going through Cruz’s employer, Congress, which offers plans for federal workers under the Affordable Care Act. The Texas senator said in March after he announced his presidential candidacy that he was considering plans offered through the federal health care law, triggering stories and commentary about the irony of Cruz signing up for Obamacare. (Recio, 5/18)

In Virginia, labor and minority groups team up to influence local races -

The Washington Post: Coalition Of Labor, Immigrant Groups Flexing Muscles In Va. Local Races
A coalition of labor and minority groups is launching an effort to support progressive Democrats running in Virginia’s June 9 primary election and has promised five candidates a last-minute infusion of cash and a small army of door-knocking volunteers. Coalition leaders said they will try to mobilize young and minority residents who have not voted in large numbers in the past and urge them to back local candidates who want to boost the minimum wage, expand health-care coverage for the poor, and create new protections and opportunities for immigrants. (Sullivan, 5/18)


In Push For Better Market Position, Endo To Buy Par Pharmaceutical For $8 Billion

Dublin-based Endo is steadily consolidating its market share amid a wave of mergers of generic drug businesses.

The Wall Street Journal: Endo To Buy Par Pharma For About $8 Billion
Endo International PLC agreed to buy rival drug maker Par Pharmaceutical Holdings Inc. for $8 billion, the latest in a string of cross-border mergers steering tax revenue away from the U.S., despite Washington’s efforts. Endo, which relocated from Pennsylvania to Ireland last year, is one of several drug companies lately using their lower-tax foreign addresses as springboards for acquisitions in the U.S., which has one of the world’s highest corporate tax rates. (Hoffman, 5/18)

The Associated Press: Endo Buying Par For $8B In Push For Generics, Higher Profit
Drugmaker Endo International PLC is climbing toward the top of the steadily consolidating generic medicine business with a deal to buy Par Pharmaceutical Holdings Inc. for about $8.05 billion. The deal would enable Dublin-based Endo to leapfrog from No. 10 to No. 5 in U.S. generic drug sales barely five years after its first foray into generics. (Johnson, 5/18)

The Philadelphia Inquirer: Endo, Lannett, Teva All Part Of Mergers Wave In Generic Drugs
Endo Pharmaceutical P.L.C. said Monday that it will pay $8.05 billion for privately held Par Pharmaceutical Holdings L.L.C., to strengthen its position on the shifting landscape of generic drugmakers. The stock-and-cash sale comes amid consolidation in the market for generic drugs, as companies strive for greater leverage and profit, while patients and payers complain of rising prices. Some of the large generic drugmakers also sell so-called branded drugs, which usually carry higher prices because they are protected from market competition by patents. (Sell, 5/19)

State Watch

State Highlights: Calif. Woman Sues Anthem Over Hep C Drug Coverage; State Pressed To Explain Why It Revoked Blue Shield Of Calif.'s Tax Exemption

News outlets examine health care issues in California, Florida, Texas, Alabama, Oregon, Pennsylvania, Vermont, Arizona, New Hampshire and Massachusetts.

Los Angeles Times: Woman Sues Anthem Blue Cross For Refusing To Cover Hepatitis C Drug
A West Hollywood woman sued insurer Anthem Blue Cross for refusing to cover the cost of an expensive drug that she says would cure her hepatitis C infection. Shima Andre said in the lawsuit that Anthem has refused to pay the estimated $99,000 it would cost to be treated with the controversial drug Harvoni, which has been shown to destroy the deadly virus in most patients. In a denial letter, Anthem explained that the drug was “not medically necessary” because Andre does not have advanced liver damage, the lawsuit said. (Pfeifer, 5/18)

The Miami Herald: Jackson Says Florida State Health Dept. 'Invented' Requirements In Trauma Center Application
After the Florida Department of Health denied Jackson Health System its bid for a trauma unit in South Miami-Dade April 30, Jackson is fighting back, saying that the department changed the requirements of the application beyond what is outlined in state law, leaving the hospital in a “guessing game.” In a petition to the department on Monday, Jackson fought back against the department’s claims that its application for a license to operate a trauma unit at Jackson South Community Hospital was denied because it was missing documentation and some of the information was not up to state standards. (Herrera and Chang, 5/18) House Black Caucus Proposes Budget Plan To Boost Medicaid, Corrections
The Black Caucus in the Alabama House of Representatives today proposed a budget plan that shifts money to cover what it says are critical services without raising taxes. The plan proposes changes to a budget bill approved by the House Ways and Means General Fund Committee last week. ... Compared to the committee plan, the Black Caucus plan would add $34 million for Medicaid, $19.7 million for Corrections, $4.8 million for Public Health and $1 million each for Law Enforcement and Finance. It would offset those increases by skipping a $15 million repayment to the Alabama Trust Fund due next year and making other reductions from the committee approved plan. (Cason, 5/18)

Kaiser Health News: Telemedicine Under Attack As Abortion Rights Supporters Seek More Options For Women
Abortion rights supporters say more than a dozen states have banned one option that could improve early access: telemedicine. Iowa and Minnesota are the only states that offer so-called "telemed" abortions. Women who choose this option confer with a doctor through an Internet video connection and can then be prescribed two drugs, mifepristone and misoprostol, which when taken in sequence induce an abortion. Women who opt for a medication abortion can be no more than nine weeks into their pregnancy. (Andrews, 5/19)

The Pittsburgh Post-Gazette: Are Health Plans With High Deductibles Becoming More Popular?
Employers struggling to pay for workers' health coverage can slow annual spending by about 5 percent by switching to high-deductible health plans, but the burden likely will fall on patients and health care professionals who'll be expected to pick up the slack. The costs might drive patients to delay care or struggle to come up with a $5,000 deductible, while hospitals ultimately might have to write off any balance due. One Western Pennsylvania hospital has even begun requiring patients having elective surgery to meet first with a finance counselor. (Twedt, 5/18)

New Hampshire Public Radio: Can Fixing A Child's Environment Help Fix Her Teeth?
You probably never would have guessed it, but one of the front lines of public health in New Hampshire is on the second floor of an elementary school in Claremont - in a storage closet. Here a dental hygienist meets with a second grade girl to talk teeth. ... Looking into a child’s mouth can tell you a lot about her health. In fact, oral hygiene is a sort of canary in a coal mine for not just a child’s health, but also the environment she grows up in. In New Hampshire, some are tackling oral hygiene through both caring for children’s teeth and the environment the child grows up in. (Rodolico, 5/19)

New Hampshire Public Radio: Mental Health Initiatives Target New Hampshire's Youngest and Poorest
What happens during the first months and years of a child’s life matters - a lot. Researchers know, for example, that middle- and upper-income children are more likely to have positive, nurturing relationships with the adults who care for them and, as a result, they do better in school, form healthier relationships and are less likely to suffer from mental illness. Meanwhile, children who grow up poor are often subjected to abuse and neglect that creates unrelenting “toxic” stress that damages their developing brain, increasing the likelihood they will be diagnosed with developmental delays and emotional disorders. ... Over the past several years, as attention was focused on the collapse of New Hampshire’s adult mental-health system, advocates and community-health workers have launched programs aimed at young children and families in two of the state’s poorest areas. (Wallstin, 5/19)

The Associated Press: Facing $1 Billion Deficit, Arizona Sharply Limits Welfare
Facing a $1 billion budget deficit, Arizona's Republican-led Legislature has reduced the lifetime limit for welfare recipients to the shortest window in the nation. ... The cuts of at least $4 million reflect a prevailing mood among the lawmakers in control in Arizona that welfare, Medicaid and other public assistance programs are crutches that keep the poor from getting back on their feet and achieving their potential. (5/18)

The Associated Press: N.H. Highlights Drug-Exposed Newborn Legislation
Medical providers and first responders on Monday urged Sen. Kelly Ayotte to consider further incorporating mental health treatment into her efforts to address New Hampshire's heroin and prescription drug crisis. Ayotte, a Republican, is co-sponsoring several pieces of legislation related to drug addiction treatment, including one that would direct the federal government to develop a strategy to help infants diagnosed with newborn withdrawal. At a discussion she led at Catholic Medical Center, hospital officials told her that the number of infants born at the hospital after being exposed to drugs in the womb has more than doubled to 7 percent in the last year. (Ramer, 5/18)

The Associated Press: Mass. Alleges Cape Cod Doc Improperly Prescribed Opiates
A Cape Cod doctor has been charged with illegally prescribing opiates and overbilling the state's low-income health program. Attorney General Maura Healy said Dr. Mohammed Nassery was indicted Friday on 11 counts of illegal prescribing, nine counts of Medicaid false claims and one count of larceny. Healy said Nassery has agreed not to practice medicine in Massachusetts. (5/18)

Editorials And Opinions

Viewpoints: Concerns About Medicaid Successes; Raiding Medicare

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

Los Angeles Times: State Governments Lament That Citizens Are Actually Getting Health Coverage
One of the more bizarre spectacles of U.S. government in the modern age is the sight of political leaders complaining that a public program is actually working. On Monday, Politico delivered a striking case in point. The subject was Obamacare, or more specifically the expansion of Medicaid through which millions of low-income families receive health coverage. According to author Rachana Pradhan, in many states that expanded Medicaid and even some that rejected expansion under the Affordable Care Act, enrollment has significantly exceeded projections. To some political leaders, for some reason, this is supposed to be a bad thing. (Michael Hiltzik, 5/18)