First Edition: July 10, 2014

Today's headlines cover health policy headlines from the marketplace, the campaign trail and regarding the health law's implementation.

Kaiser Health News: Will Health Reform Bring New Role, Respect To Primary Care Physicians?
Kaiser Health News staff writer Jay Hancock reports: "The company's move to shift that balance tells a lesser-known story of CareFirst BlueCross BlueShield spent billions on hospital procedures, drugs and specialty physicians to treat sick patients. Only one dollar in 20 went to the family-care doctors and other primary caregivers trained to keep people healthy. The Affordable Care Act and efforts to change the health system. While much attention has focused on expanded coverage and online insurance bazaars, policymakers' bigger challenge is improving Americans' health while putting a brake on the cost of their care. The keys to that puzzle, CareFirst and many others are deciding, are the internists and general practitioners who have largely been left behind by health care's financial boom" (Hancock, 7/10). Read the story, which also appeared in the Washington Post.

Kaiser Health News: Putting The Home In A Nursing Home
Kaiser Health News staff writer Marissa Evans reports: "Mealtime. Naptime. Bath time. Bedtime. Everything is on a schedule for residents in a traditional nursing home, leaving little flexibility for personal decision making. But LaVrene Norton is working to change that. Norton is founder and president of Action Pact, a national consulting firm. It specializes in helping retirement communities and nursing homes train staff and design their facilities to feel and be more like living at home. Since beginning work on the "household model" in 1984, Norton has helped design hundreds of these communities" (Evans, 7/10). Read the interview.

Kaiser Health News: Capsules: Feds Demand Medicaid Backlog Fixes By Six States; CMS May Soften Paperwork Requirements For Home Health Care; Report: Adults With Serious Mental Illnesses Face 80% Unemployment
Now on Kaiser Health News' blog, Phil Galewitz reports on a federal push for six states to address their Medicaid backlogs: "Tired of waiting for states to reduce their backlogs of Medicaid applications, the Obama administration has given six states until Monday to submit plans to resolve issues that have prevented more than 1 million low-income or disabled people from getting health coverage. The targeted states are Alaska, California, Kansas, Michigan, Missouri and Tennessee" (Galewitz, 7/10). 

In addition, Jenny Gold reports on a new report about unemployment and mental illness: "Employment rates for people with a serious mental illness are dismally low and getting worse, according to a report from the National Alliance on Mental Illness. Just 17.8 percent of people receiving public mental health services were employed in 2012 – down from 23 percent in 2003" (Gold, 7/10). 

Also on the blog, Lisa Gillespie reports on a proposed change to Medicare home health coverage rules: "Doctors may not have to write a narrative summary for patients needing home health care if a proposed rule by the Centers for Medicare and Medicaid Services is finalized.For Medicare to pay for a home health visit, which includes physical therapy, speech therapy and skilled nursing care, the patient must be seen by a doctor either 90 days prior to the start of the home health care or 30 days after the start of the services. Currently, Medicare also requires that physicians certify that these patients are under their care and that they have trouble leaving home without the help of a walker or special transportation because of an illness or injury. To do so, doctors have to fill out what's referred to as a face-to-face document, which states when the doctor saw the patient, and includes a narrative summary stating why the patient is homebound" (Gillespie, 7/10). Check out what else is on the blog.

The New York Times' The Upshot: Newest Health Insurance Customers Are Generally Happy
We've known for a few months now that lots of people signed up for health insurance this year in new marketplaces. A new survey shows that the people who did so are also pretty happy with their purchases (Sanger-Katz, 7/10).

The New York Times: Health Insurers Are Trying New Payment Models, Study Shows
Health insurers are experimenting with new formulas for reimbursing doctors and hospitals, slowly moving away from the traditional approach of basing payments on the numbers of tests and procedures performed, according to a survey of Blue Cross insurers, among the most dominant plans in the country (Abelson, 7/9).

The Washington Post: In Va. Legislature, Republicans Plan Medicaid Debate In Late September
Republican leaders plan to call the House and Senate back into session in late September to debate Medicaid expansion, a move intended to give legislators another chance to weigh in on the issue as Gov. Terry McAuliffe (D) tries to find a way to expand the program without their approval (Vozzella, 7/9).

The Associated Press: Republicans Announce Special Session On Medicaid
House Speaker William J. Howell and Senate Majority Leader Thomas K. Norment announced Wednesday that the General Assembly will be back in session the week of Sept. 22 for a "full and fair" debate on whether Virginia should accept federal Medicaid funds to provide health insurance for as many as 400,000 low income residents (7/9).

The Associated Press: Medicare Providers Complain Of Duplicative Audits
Health care companies say they're losing millions of dollars that are tied up in appeals because of increasing numbers of Medicare audits. But the rise in the often duplicative audits has failed to reduce Medicare fraud, according to a report released Wednesday. In recent years, the Obama administration has added manpower to investigate cases, increase audits and analyze more data to fight fraud in the taxpayer-funded Medicare program. Yet a report from the U.S. Senate Special Committee on Aging criticized the government for not targeting its resources more effectively (7/9).

Los Angeles Times: Congress Has Heavy Workload But Limited Time Before Summer Recess
And even as they face a series of time-sensitive votes, both parties continue to push symbolic legislation that has little hope of passage but appeals to their respective bases in an election year. Senate Majority Leader Harry Reid (D-Nev.), for example, told reporters Tuesday that he was committed to taking action in the Senate to address the Supreme Court's ruling in the Hobby Lobby case. That decision gave businesses owned by devout Christians the right to refuse to pay for insurance covering contraceptives for female employees (Memoli, 7/9).

Los Angeles Times: Sen. Mark Udall Skips Obama Colorado Visit To Focus On Women's Issues
As Obama was on his way to deliver remarks on the economy in Denver's Cheesman Park on Wednesday morning, Udall held a news conference in Washington with female senators and House members to announce a new bill that would bar employers from denying contraceptive coverage. In a direct appeal to women voters, who could be the most crucial swing voters in Colorado's Senate race this year, Udall has made contraceptive coverage a central issue in his campaign (Reston, 7/9).

Politico: Hill Democrats See Hobby Lobby Contraception Fight In 2014 Races
With an eye on the November elections, congressional Democrats on Wednesday introduced a bill that would overturn the Supreme Court's Hobby Lobby contraception decision. Democrats and women's health groups believe they have a powerful campaign weapon in pushing back on the Supreme Court's 5-4 ruling that Hobby Lobby and other closely held for-profit companies don't have to comply with the health law's contraceptive coverage requirement if it violates the owners' religious beliefs (Haberkorn, 7/9).

The Associated Press: Fact Check: It's 'Mediscare' Time In Kentucky
Shaky claims about Medicare were common in the 2012 campaign, from President Barack Obama on down. Now they've surfaced in this year's midterm elections, in one of the hottest Senate races in the country. Alison Lundergan Grimes, Republican Senate leader Mitch McConnell's Democratic opponent, released her first attack ad Tuesday, accusing McConnell of voting to raise a retired coal miner's Medicare costs by $6,000. He didn't (7/9).

Politico: Mitch McConnell Strikes Back On Medicare Ad
Mitch McConnell has decided to quickly and strongly counterpunch on Medicare. Just 24 hours after Democrat Alison Lundergan Grimes began running an attack ad about the entitlement, the Kentucky senator is firing back with a Larry McCarthy-produced spot that says it is Democrats who cut Medicare under Obamacare (Hohmann, 7/9).

The Washington Post's The Fact Checker: Did Health Insurance Premiums Jump 50 Percent Because Of Obamacare?
This campaign ad highlights Alexander's role as one of the chief GOP critics of President Obama's health-care law during a nationally televised "health-care summit" held on Feb. 25, 2010. The ad shows Alexander debating the president over whether the Congressional Budget Office predicted a rise in premiums because of the Senate version of the bill. Then the ad asserts that individual premiums have gone up more than 50 percent, citing 2010 and 2013 data from the Kaiser Family Foundation and the Department of Health and Human Services. It ends with the image of a quote from a Fox New reporter from the day of the summit, "Lamar Alexander was right," but the voiceover slightly tweaks the quote to say: "Lamar was proven right" (Kessler, 7/10).

The New York Times: Race Is On To Profit From Rise Of Urgent Care
For more than eight hours a day, seven days a week, 52 weeks a year, an assortment of ailments is on display at the tidy medical clinic on Main Avenue here. But all of the patients have one thing in common: No one is being treated at a traditional doctor's office or emergency room. Instead, they have turned to one of the fastest-growing segments of American health care: urgent care, a common category of walk-in clinics with uncommon interest from Wall Street (Creswell, 7/9).

The Associated Press: Who Pays Your Doc? Coming Soon To A Site Near You
When many of us have a medical appointment we're concerned about our finances: how much will we owe out-of-pocket? What's our co-pay? But next time, you may also want to ask your doctors about their financial situation. That's because nearly 95 percent of U.S. physicians accept gifts, meals, payments, travel and other services from companies that make the drugs and medical products they prescribe, according to the New England Journal of Medicine (7/9).

USA Today: 'Bleak Picture' For Mentally Ill: 80% Are Jobless
About 60% of people with mental illness want to work. And two-thirds can successfully hold down a job, if they're given appropriate support, the report says. Yet fewer than 2% of people in the public mental health system receive this help, a cost-effective program called supported employment, which has been studied in 20 high-quality clinical trials over the past 25 years (Szabo, 7/10).

Los Angeles Times: Anthem Blue Cross Faces Another Suit Over Obamacare Doctor Networks
Amid growing scrutiny statewide, insurance giant Anthem Blue Cross faces another consumer lawsuit over its use of narrow networks in Obamacare coverage. A group of Anthem policyholders sued California's largest for-profit health insurer Tuesday in state court, accusing the company of misrepresenting the size of its physician networks and the insurance benefits provided (Terhune, 7/9).

The Associated Press: Va. Prison Health Provider Change Could Delay Suit
A lawsuit alleging deficient medical services at a Virginia women's prison could be delayed by a change in health care providers. The Department of Corrections announced Tuesday that it has hired Armor Correctional Health Services Inc. to provide medical care at the state's prisons starting Oct. 1 (7/9).

The Associated Press: NY Awards $462M To Help Hospitals Keep Services
New York health officials have awarded $462 million to help 22 hospitals and five large public hospital systems statewide continue key services. The funds followed a federal agreement in April for New York to reinvest $8 billion in Medicaid savings to support hospital overhauls and expand primary medical care over five years. The goal is to reduce avoidable hospital use by 25 percent while helping financially struggling institutions shift to more primary and outpatient care (7/9).