First Edition: May 19, 2014

Today's headlines include a report about federal health care subsidies and an update on states small business health exchanges.   

Kaiser Health News: Gaps In Kids' Dental Coverage A Trouble Spot
Kaiser Health News staff writer Marissa Evans, working in collaboration with USA Today, reports: "No one wants to go to the dentist, but kids need to. A small cavity left to fester can grow into a big health problem. That's why the government made pediatric dental care one of the health law's 'essential benefits.' But new data suggest the law is failing to fully deliver on its promise: A lot of parents didn't buy dental coverage during the recent online enrollment period. That spells trouble, according to health experts (Evans, 5/19). Read the story.

The Washington Post: Federal Health-Care Subsidies May Be Too High Or Too Low For More Than 1 Million Americans
The government may be paying incorrect subsidies to more than 1 million Americans for their health plans in the new federal insurance marketplace and has been unable so far to fix the errors, according to internal documents and three people familiar with the situation. The problem means that potentially hundreds of thousands of people are receiving bigger subsidies than they deserve. They are part of a large group of Americans who listed incomes on their insurance applications that differ significantly -; either too low or too high -; from those on file with the Internal Revenue Service, documents show (Goldstein and Somashekhar, 5/16).

The Wall Street Journal: States To Decide On Key Part Of Small-Business Health Exchanges
The Obama administration said Friday it would let states decide whether to implement a key part of the health law's small-business exchanges next year, extending an earlier delay. The Department of Health and Human Services said in rules released Friday that it would be up to state insurance commissioners to decide whether employees at small businesses using the health-insurance exchanges could choose from a range of plans or be limited to just one selected by their employer (Radnofsky, 5/16).

The Associated Press: $250K Fine For Lying On Health Insurance Forms
Lying to the federal health insurance man could cost you dearly. The Obama administration Friday spelled out civil fines of up to $250,000 for knowingly and willfully providing false information to get taxpayer-subsidized coverage under the new health care law (5/16).

The New York Times: Poorer Health Of Surgery Patients On Medicaid May Alter Law's Bottom Line
Surgery patients covered by Medicaid arrive at the hospital in worse health, experience more complications, stay longer and cost more than patients with private insurance, a new study has found. The study, by researchers at the University of Michigan, may offer a preview of what to expect as millions of uninsured people qualify for Medicaid under the Affordable Care Act (Pear, 5/17).

The Washington Post: White House Aide Named By Obama To Oversee Health-Care Law, Other Priorities
President Obama on Friday appointed longtime White House aide Kristie Canegallo as deputy chief of staff for policy implementation, to oversee issues that include the continuing rollout of the Affordable Care Act and better integration of technology in classrooms. The move, which comes three days before senior White House health-care adviser Phil Schiliro will step down, aims to institutionalize some of the changes chief of staff Denis McDonough made in the wake of the health-care law's botched debut last fall (Eilperin, 5/16).

The Associated Press: Study: Political TV Ads On Health Law Total $445M
The report, released Friday by nonpartisan analysts Kantar Media CMAG, estimates that $445 million was spent on political TV ads mentioning the law since the enactment of the Affordable Care Act in 2010. Spending on negative ads outpaced positive ones by more than 15 to 1 (5/16).

The New York Times' Sunday Review: Medicine's Top Earners Are Not The M.D.s
Though the recent release of Medicare's physician payments cast a spotlight on the millions of dollars paid to some specialists, there is a startling secret behind America's health care hierarchy: Physicians, the most highly trained members in the industry's work force, are on average right in the middle of the compensation pack. That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine (Rosenthal, 5/17).

Los Angeles Times: Growing Evidence Points To Systemic Troubles In VA Healthcare System
The Phoenix VA Health Care System is under a federal Justice Department investigation for reports that it maintained a secret waiting list to conceal the extent of its patient delays, in part because of complaints such as Laird's. But there are now clear signs that veterans' health centers across the U.S. are juggling appointments and sometimes manipulating wait lists to disguise long delays for primary and follow-up appointments, according to federal reports, congressional investigators and interviews with VA employees and patients (Zucchino, Carcamo and Zarembo, 5/18).

The New York Times: Obama Angry Over Falsification Of Veterans Affairs Data, Chief Of Staff Says
President Obama is "madder than hell" about reports that some medical facilities run by the Department of Veterans Affairs have falsified data to hide substantial delays for veterans to see doctors, and he has demanded that the department's leaders "fix these things," the White House chief of staff said in an interview aired Sunday. "The president is madder than hell, and I've got the scars to prove it, given the briefings that I've given the president" on the subject, the chief of staff, Denis R. McDonough, said on the CBS News program "Face the Nation." He said that the White House had "deployed additional staff over to the Veterans administration to dig into this" (Knowlton, 5/18).

Politico: McDonough: Obama 'Madder Than Hell' On VA Scandal
President Barack Obama is "madder than hell" about the Veterans Affairs scandal, White House chief of staff Denis McDonough says. "The president is madder than hell, and I've got the scars to prove it, given the briefings I've given the president," he said in an interview with CBS News Chief White House Correspondent Major Garrett that aired Sunday on "Face the Nation." "Nobody is more outraged about this problem, right now, Major, than the president of the United States," McDonough added (Topaz, 5/18).

NPR: Doctors' Ignorance Stands In The Way Of Care For The Disabled
Though nearly 20 percent Americans have physical or mental disabilities, studies show that less than 20 percent of medical schools teach their students how to talk with disabled patients about their needs. More than half of medical school deans report that their students aren't competent to treat people with disabilities, and a similar percentage of graduates agree. Accreditation and licensing boards don't require clinicians to demonstrate knowledge or skills in treating patients with disabilities (Wen, 5/17).

The New York Times: Drug Found To Aid Breathing In A Fatal Lung Disease
For the first time, researchers have found drugs that can slow the decline of people with a fatal lung disease, idiopathic pulmonary fibrosis. Studies of two experimental drugs were published in The New England Journal of Medicine and presented on Sunday in San Diego at a meeting of the American Thoracic Society. ... InterMune announced on Friday that it would make pirfenidone available for free to some patients in the United States through an "expanded access program," designed to help patients obtain experimental drugs that have not yet been approved (Grady, 5/18).

The Associated Press: Poll: More Stressful To Care For Spouse Than Mom
Americans 40 and older say they count on their families to care for them as they age, with good reason: Half of them already have been caregivers to relatives or friends, the poll found. But neither the graying population nor the loved ones who expect to help them are doing much planning for long-term care. In fact, people are far more likely to disclose their funeral plans to friends and family than reveal their preferences for assistance with day-to-day living as they get older, according to the poll by The Associated Press-NORC Center for Public Affairs Research (5/19). 

The Wall Street Journal: AstraZeneca Rejects Pfizer's New Higher Offer
While the rejection is a major setback in any potential deal between the two drug giants, U.K. takeover rules give Pfizer and AstraZeneca until May 26-;a month from the confirmation of Pfizer's earlier approach-;to enter takeover discussions. That allows time for any investors dismayed with AstraZeneca's 12% share-price fall Monday to push the board to engage in talks (Plumridge, 5/19).

USA Today: Britain's AstraZeneca Rejects 'Final' Pfizer Bid
British drug maker AstraZeneca rejected Monday what its New York-based rival Pfizer called over the weekend its "final" takeover offer. In a statement, AstraZeneca's board cited the "uncertainty and risks" for shareholders as a reason for the rejection, which came just hours after the maker of the erectile-dysfunction drug Viagra had upped the value of its bid to 55 pounds (around $93) a share in a deal that would have led to the world's largest drugs company (Hjelmgaard, 5/19).

The Associated Press: AstraZeneca Rejects $119-Billion Offer From Pfizer
In a statement released Monday, AstraZeneca's board said it "reiterates its confidence in AstraZeneca's ability to deliver on its prospects as an independent, science led business" (5/19). 

The Washington Post's The Switch: Privacy Advocates Warn Of 'Nightmare' Scenario As Tech Giants Consider Fitness Tracking
Fitness tracking apps and devices have gone from an early adopter novelty to a staple of many users' exercise routines during the past few years -- helping users set goals and measure progress over time. Some employers even offer incentives, including insurance discounts, when workers sign up. … But as several major tech companies appear poised to disrupt that landscape, privacy advocates warn that consumers aren't always aware of how sensitive the data the apps collect can be or what privacy protections exist. And changes in the privacy policy of Moves, a fitness tracking app recently acquired by Facebook, have only amplified those fears (Peterson, 5/19). 

The Texas Tribune/New York Times: Caregivers Struggle To Untie A Confining Knot
Nurse practitioners have long fought against Texas regulations that link them financially and professionally to supervising physicians, a construct they say limits their ability to treat patients in a state with a looming shortage of primary care doctors. Texas lawmakers loosened some supervision requirements during the last legislative session after a compromise with physician groups, which argue that nurse practitioners do not have the training or experience to be entirely independent. But nurse practitioners are still battling for increased autonomy in the state Medicaid program (Ura, 5/17).

The Wall Street Journal: States Open To Drug Options
A push to widen access to experimental drugs for people with terminal illness is gaining traction among lawmakers in several states, highlighting a growing clamor from patients for promising therapies that haven't been approved for sale. The so-called right-to-try bills, the first of which was signed into law in Colorado on Saturday by Gov. John W. Hickenlooper, may not make a big difference in practice because they generally don't require companies to provide access to the unapproved drugs outside of clinical trials (Loftus and Frosch, 5/18). 

The New York Times: North Carolina Governor Tested By Own G.O.P. As Legislators Return
Just as significant as what Mr. McCrory put in his budget proposal, delivered at a news conference, was what he left out. There was scant mention of his top policy initiative of the last two years, a Medicaid overhaul, which he had to set aside after members of the Republican leadership said they would not take it up (Gabriel, 5/17).

The Washington Post: Boston Hospital Pilot Gives Patients Access To Their Therapists' Notes
For years, the woman went to a Boston hospital to talk to a therapist about being depressed and overweight. The therapist, listening closely, asked questions and jotted down notes on a memo pad. Until recently, the 54-year-old woman didn't know what her therapist was writing. Then, last month, her therapist offered to share his notes with her regularly (Sun, 5/18).

USA Today: Texas Abortion Law Creates Obstacles For Valley Women
The women who visit Lucy Felix at her advocacy center are lately faced with a slate of difficult choices: risk deportation to drive to a clinic, cross the nearby border into Mexico for a risky abortion or keep an unwanted, unplanned pregnancy to term. Since Texas lawmakers passed new restrictions on abortion clinics last year, the number of clinics in the Rio Grande Valley that perform the service has dropped from two to zero, forcing women to drive more than 300 miles roundtrip to other cities for services or attempt riskier procedures across the border (Jervis, 5/17). 

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