First Edition: June 2, 2014

Today's headlines include reports about state health law implementation activities as well as the next steps regarding the difficulties at the VA health system.

Politico: GOP's Obamacare Fears Come True 
Liberals wanted a national enrollment system under Obamacare. They might just get it. Right now, 36 states rely on HealthCare.gov, the federal exchange, to enroll people in health coverage. At least two more states are opting in next year, with a few others likely to follow. ... The federal option was supposed to be a limited and temporary fallback. But a shift to a bigger, more permanent Washington-controlled system is instead underway -; without preparation, funding or even public discussion about what a national exchange covering millions of Americans means for the future of U.S. health care. It's coming about because intransigent Republicans shunned state exchanges, and ambitious Democrats bungled them (Cheney and Haberkorn, 6/1). 

The Associated Press: US Law Prods States To Revisit Health Care Rules
Prompted by the health care overhaul law, several states are updating their rules for insurance networks to better reflect who is covered and how people shop for and use their benefits. ... For example, nurse practitioners and physician's assistants now provide a significant share of primary care, and many consumers head to urgent care clinics instead of scheduling office visits, he said. And the current focus on hospitals ignores the reality that virtually every service provided during a short-term hospital stay is now available in other settings, including ambulatory surgical centers (Ramer, 5/31).

The Washington Post: Maryland Looks To Connecticut For Health Exchange Answers
The Access Health CT Web site is everything that the Maryland Health Connection site had hoped to be. The format is simple and easy to navigate, allowing Connecticut residents to browse health insurance plans before creating an account. More importantly, the system properly relays enrollment information to insurance companies and the federal government, making real the Affordable Care Act's vision of quickly insuring tens of thousands of previously uninsured people (Johnson, 5/31).

The Associated Press: Board Oks $43.5M In Contacts On Health Exchange
The Maryland Health Benefit Exchange Board voted Friday for a five-year contract with Xerox totaling $29.3 million to host new technology used in the more successful health exchange website used in Connecticut. The board also voted for a three-year contract with Deloitte totaling $14.2 million. That contract is for software licenses, both for development and production (5/30).

The Washington Post: Va. Attorney General Hires Law Expert As Possible Shutdown Looms
At issue is whether to expand health coverage for the poor as allowed under President Obama's Affordable Care Act; McAuliffe and the state Senate support doing so, while the Republican-dominated House of Delegates does not. Supporters forced the standoff by attaching the proposal to the state spending plan, leading resolute lawmakers on both sides of the debate to adjourn their regular session in March with no budget in place. Also in the spotlight are several constitutional questions, notably whether McAuliffe has the authority to keep certain appropriations flowing after July 1 if no budget deal is reached. Under the constitution, only the legislature has the power to appropriate funds (Portnoy, 5/30).

Los Angeles Times: Thrown A Curve By Health Networks
The problem involves not just consumers who are discovering their doctors are not covered by their plans. Some doctors have themselves been confused about whether they participate in various networks, making it difficult for them to instruct their patients. Other providers are dropping out of networks, leaving patients in the lurch (Zamosky, 5/30).

The Washington Post: GOP Candidates Show Signs Of Retreat On Full Obamacare Repeal As Midterms Approach
Republican candidates have begun to retreat in recent weeks from their all-out assault on the Affordable Care Act in favor of a more piecemeal approach, suggesting they would preserve some aspects of the law while jettisoning others. The changing tactics signal that the health-care law -; while still unpopular with voters overall -; may no longer be the lone rallying cry for Republicans seeking to defeat Democrats in this year's midterm elections. The moves also come as senior House Republicans have decided to postpone a floor vote on their own health-reform proposal (Eilperin and Robert Costa, 5/30).

The Washington Post: Can Republicans Expand Their Reach In Blue States? Oregon Senate Race Provides A Test.
To Republicans, the Senate race in this solidly Democratic state presents an alluring opportunity. Oregon's health insurance exchange has been one of the country's most troubled. President Obama's approval rating has fallen below 50 percent. Sen. Jeff Merkley, a liberal Democrat first elected on Obama's coattails in 2008, is not terribly well known. And in Monica Wehby, Republicans have a fresh-faced, female challenger who they believe matches the moment: a pediatric neurosurgeon and political outsider who rails against the Affordable Care Act but is relatively moderate on social issues (Rucker, 6/1). 

USA Today: Senator Unveils Proposal To Revamp VA Health Care
Senate Veterans Affairs Committee Chairman Bernie Sanders unveiled a broad proposal Sunday to revamp health care for 6.5 million veterans as the department faces an expanding investigation into the way care is provided at VA medical facilities. "The truth is that when people get into the VA, the quality of care is good. The problem that we have to address is access to the system and waiting lines," Sanders, an independent senator from Vermont who caucuses with Democrats, said on CBS's Face the Nation. ... The proposal would authorize the VA to lease 27 new health facilities across 18 states and Puerto Rico. It includes additional funding to hire health care providers (Davis, 6/1).

The Washington Post: Senate Veterans' Affairs Committee Chairman Introduces Proposal To Overhaul VA
Senate Veterans' Affairs Committee Chairman Bernard Sanders (I-Vt.) introduced a far-reaching proposal Sunday to overhaul health care for the nation's veterans that would make it easier for the beleaguered Department of Veterans Affairs to hire and fire employees, lease new space for clinics and hospitals, and send veterans to outside providers if care isn't available within 30 days. Sanders's bill, the Restoring Veterans' Trust Act, would give the VA secretary the authority to remove senior officials based on poor job performance, grant VA expedited hiring authority for nurses and doctors, authorize the department to lease 27 new facilities in 18 states and Puerto Rico, mandate a software upgrade for the department's patient scheduling system by March 2016 and expand opportunities for eligible veterans to seek outside care if VA facilities are unavailable (O'Keefe, 6/1).

Politico: VA Moves Bernie Sanders From Stage Left To Center Stage
He's a combative, self-described "democratic socialist" more prone to hand-to-hand combat with Republicans than cutting deals with them. But Bernie Sanders now is tasked with leading Democrats through a sensitive political dilemma that's putting their party on the defensive. With Eric Shinseki out at the Department of Veterans Affairs, the focus now shifts to Capitol Hill, placing the two-term Vermont independent and Senate Veterans' Affairs Committee chairman at the center of the growing VA health care controversy. Sanders, who caucuses with Democrats, is assembling a legislative package to help address the issue in the hopes that he can consolidate support within the veterans community and assuage concerns of vulnerable Democrats (Raju and Everett, 6/1).

The Wall Street Journal's Washington Wire: Is The VA in Need Of A Major Overhaul?
The widening scandal at the U.S. Department of Veterans Affairs, which led to the ouster of Secretary Eric Shinseki last week and could fell a number of other officials, is sparking a broader debate about whether the agency should be overhauled after a decade of rapid expansion. The VA operates 150 hospitals, more than 1,000 health clinics and 131 cemeteries. It buries, houses, educates, hospitalizes, loans money to, and insures the lives of millions of veterans each year. And the veterans who intersect with the agency span decades of government service, from World War II survivors to those recently returning home from Iraq and Afghanistan (Paletta, 6/2).

The Wall Street Journal: Senate To Address Veterans' Short-Term Health-Care Needs 
[Sanders] said the system was "gamed" in many parts of the country where the VA lacked the doctors or other staff to ensure the delivery of timely patient care. ... Resolving longer-term problems will require ensuring veterans have primary-care physicians and other staff they need to get timely quality care, said Mr. Sanders, who carefully avoided blaming Mr. Shinseki and said–when asked whether he or Congress is responsible–that "everybody" can bear some responsibility for the problems (Trottman, 6/1).

The Washington Post: Did Shinseki Fail His Underlings By Trusting Them Too Much? 
To many in the trenches of the vast and decentralized VA system, Shinseki was seen as "the good guy everybody knew was trying to help,'' Nickolaus said. But of course, that undercover drop-by she hoped for never happened. And so much bad news was covered up that Shinseki resigned Friday over a widespread conspiracy to hide long wait times for military veterans seeking care. It's often said that an organization's tone is set at the top -; and that person sends employees a message of either fear or safety about speaking up to voice concerns (Henneberger, 5/31). 

Politico: VA Audit Find 'Systemic Lack Of Integrity'
Appointments' wait times were manipulated at more than 60 percent of the Department of Veterans Affairs health facilities investigated as part of a new internal audit. The White House-ordered audit found that schedulers faced pressure to manipulate the system and concluded there was a "systemic lack of integrity within some Veterans Health Administration facilities." ... The audit, issued as VA Secretary Eric Shinseki resigned Friday, found that 64 percent of the 216 VA facilities reviewed had at least one instance where a veterans' desired appointment date had been changed (Herb, 5/30).

The Washington Post: Some Of The Internal Problems That Led To VA Health System Scandal
Here is a primer on the agency and some of the internal problems that fed the scandal. ... According to the American Federation of Government Employees, some VA doctors are carrying workloads of more than 2,000 patients -; far more than the 1,200 goal set forth in the Veterans Health Administration handbook. The agency is struggling to hire 400 primary-care physicians, positions that are notoriously hard to fill because of a nationwide shortage of these types of doctors. This is not just a VA problem but an issue plaguing the U.S. medical system. ... The Government Accountability Office and the VA inspector general have for years been churning out reports about the long wait times experienced by veterans seeking medical care (Somashekhar, 5/30).

The New York Times: Many Veterans Praise Care, But All Hate The Wait
Marc Schenker, an Air Force veteran in Fort Lauderdale, Fla., is having surgery this month to remove a golf-ball-size hernia -; but not at a veterans hospital. Mr. Schenker, 67, said he had given up on the Veterans Affairs hospital in Miami after waiting months to get the procedure scheduled and had turned to a private surgeon instead, using Medicare. ... In interviews and in hundreds of responses to a questionnaire posted on The New York Times website, veterans around the country expressed frustration with delayed access to care and what many described as an impenetrable and unresponsive bureaucracy at department hospitals and clinics, even as many praised the quality of care they received once they saw doctors (Goodnough, 5/31).

Los Angeles Times: VA Chief And White House Spokesman Resign, Fueling Unease
President Obama sought to stem a growing political furor Friday by accepting the resignation of Eric K. Shinseki, the beleaguered secretary of Veterans Affairs, the second Cabinet-level official to resign under fire this year. Two hours later, Obama abruptly returned to the White House briefing room's podium to announce the departure of what he called "one of my closest friends," Jay Carney, the White House press secretary. … The next VA secretary will face enormous challenges to repair a system that has been plagued with service delays since at least 2005 and that now is struggling with a flood of claims from veterans of the wars in Iraq and Afghanistan. A White House official acknowledged Friday that the staff was in scramble mode to get to the "ground truth" of what happened at the VA and to develop a fix-it plan (Simon, Parsons and Memoli, 5/30).

Politico: Health Affairs' New Editor Brings Legal Background
Key elements of the Affordable Care Act were first previewed in the journal Health Affairs. It's where policy wonks kick the tires on big ideas for reforming Medicare, Medicaid and most every aspect of health care in the United States -; before those proposals find their way into legislation on the Hill. On Monday, a new editor-in-chief takes charge of the publication, considered unique among peer-reviewed journals for channeling new research into health policy debates with political immediacy (Norman, 6/2).

The Washington Post: Ban Lifted On Medicare Coverage For Sex Change Surgery
The ruling by a Department of Health and Human Services board was in response to a lawsuit filed last year on behalf of Denee Mallon, 74, a transgender woman and army veteran from Albuquerque. The blanket Medicare ban was put in place in 1981 when such surgeries were considered experimental. But now most medical groups, including the American Medical Association and the American Psychological Association, consider it a safe option for those suffering from gender dysphoria, a condition that is characterized by intense discomfort -; or "incongruence," according to the official definition -; with one's birth sex (Cha, 5/30).

The New York Times: Medicare To Now Cover Sex-Change Surgery
The decision, handed down Friday by a Department of Health and Human Services appeals board, reverses a Medicare policy in place since 1981. It comes as a small but growing number of university health plans and large companies -; including some Fortune 500 companies like Shell Oil and Campbell Soup -; have started covering gender transition services, and could signal further changes since many health plans follow Medicare's lead on coverage. ... The Medicare decision, which applies to beneficiaries of the health plan for older Americans and people with disabilities, covers only surgery, not other treatments like hormones (Rabin, 5/31),

The Wall Street Journal: Medicare Ban On Sex-Reassignment Surgery Lifted
Transgender people who receive Medicare benefits will no longer be automatically denied coverage for sex-reassignment surgery, a federal review board ruled Friday. The decision means that Medicare, the federal health insurance program for seniors and those with disabilities, will now cover sex-reassignment surgery on a case-by-case basis rather than routinely denying the surgery under guidance adopted during the 1980s (Armour, 5/30).

Los Angeles Times: Cancer Survivors In The U.S. -- 14.5 Million Strong And Growing
The authors of the report – from the ACS and the National Cancer Institute – define a cancer "survivor" as anyone who has been diagnosed with cancer and is still alive. That includes patients who are undergoing treatment as well as those who have finished treatment and are considered cancer-free. ... "The growing number of cancer survivors in the U.S. makes it increasingly important to understand the unique medical and psychosocial needs of survivors," ACS epidemiologist Carol DeSantis, the lead author of the report, said in a statement. "Cancer survivors face numerous, important hurdles created by a fractured healthcare system, poor integration of survivorship care, and financial and other barriers to quality care, particularly among the medically underserved." (Kaplan, 6/1).

The Washington Post: Drugmakers Find Breakthroughs In Medicine Tailored To Individuals' Genetic Makeups
When the Food and Drug Administration recently a promising new lung cancer drug named Zykadia four months ahead of schedule, it heralded the medication as a "breakthrough" therapy. The drug isn't meant for everyone with the devastating disease, which kills an estimated 160,000 Americans each year. Or even for the majority of patients with its most common form, non-small-cell lung cancer (Dennis, 6/1).

The Associated Press: Kentucky Studies Private Nursing Homes For Inmates
The state legislature has approved a pilot program that requires Kentucky to parole some infirm inmates -; excluding sex offenders and death row inmates -; to private nursing homes where the federal government, through Medicaid, would pay most of the medical bills. For the plan to work, inmates cannot be in prison. The federal government will not pay for inmates' medical expenses. But if the inmates are paroled to a private facility, they become eligible for Medicaid. Inmates who leave the nursing home would be returned to prison for violating parole (6/1).

The New York Times: Panel To Create Plan To Reduce Number Of Mentally Ill People In New York City Jails
Mayor Bill de Blasio has asked several of his commissioners and aides to provide him with a plan by September to reduce the rate of incarceration among New Yorkers with mental illness. The effort, which City Hall will announce on Monday, is the administration's first major criminal justice initiative. Named the Task Force on Behavioral Health and the Criminal Justice System, it will include recommendations from the police and correction commissioners, the Manhattan district attorney, hospital administrators and judges (Goldstein, 6/1). 

NPR: Abortion Services Return To Town Where George Tiller Was Murdered
Five years ago, Dr. George Tiller was shot and killed at the Wichita, Kans., church where he was an usher. Tiller was widely known for performing abortions in late pregnancy and had become a target for protests. ... But in April of last year, South Wind Women's Center opened in the very same building where Tiller's clinic was. Executive Director Julie Burkhart worked for Tiller for seven years. Her clinic now offers abortion care for pregnancies less than 22 weeks along. "About 1 in 3 women are going to have abortions in their lifetimes -; so we all know somebody. If you think about women who are having abortions, nationally about 60 percent of women who are having abortions are already mothers," Burkhart says (Leblanc, 5/31).