First Edition: August 7, 2014

Today's headlines include stories about how uninsured people fare with the health law's exemptions.

Kaiser Health News: Obamacare Creates 'Upheaval' At Free Clinics
Kaiser Health News staff writer Phil Galewitz reports: "Worried that patients like Milliken would leave their care and struggle to find doctors accepting new Medicaid patients, the clinic took a rather radical step: It became a Medicaid provider and started billing the state-federal health insurance program for the poor" (Galewitz, 8/7). Read the story, which also ran in USA Today.

Kaiser Health News: Capsules: First Look At Medicare Quality Incentive Program Finds Little Benefit
Now on Kaiser Health News' blog, Jordan Rau reports: "The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law's campaign to use the government's financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that. Hospitals were judged both on how they compare to others and how much they are improving" (Rau, 8/6). Check out what else is on the blog.

The Wall Street Journal: Fewer Uninsured Face Fines As Health Law's Exemptions Swell
Almost 90% of the nation's 30 million uninsured won't pay a penalty under the Affordable Care Act in 2016 because of a growing batch of exemptions to the health-coverage requirement. The architects of the health law wanted most Americans to carry insurance or pay a penalty. But an analysis by the Congressional Budget Office and the Joint Committee on Taxation said most of the uninsured will qualify for one or more exemptions (Armour, 8/6).

The Wall Street Journal: The Short Answer: Affordable Care Act Exemptions
Almost 90% of the 30 million Americans expected to be uninsured in 2016 won't pay a penalty under the Affordable Care Act because most will qualify for one or more exemptions, according to a June report by the nonpartisan Congressional Budget Office and the Joint Committee on Taxation. A page-one article in The Wall Street Journal examines the expansion of exemptions (8/6).

The Wall Street Journal: Small Firms Hit By Big Changes In Health Coverage
Businesses with fewer than 50 workers are exempt from the most stringent requirements for larger employers under the federal health-care law. But that doesn't mean they're off the hook entirely. Smaller employers aren't required under the Affordable Care Act to offer coverage for their full-time workers-;as larger firms must by 2016 or face penalties, for instance. But many owners of small ventures and startup entrepreneurs are nonetheless facing big changes to how they obtain their own health coverage, as well as to the benefits they're able to offer employees (Loten, 8/6).

USA Today: The Kaiser Way: Lesson For U.S. Health Care?
The Affordable Care Act has been dramatically changing the way hospitals do business, forcing them to rethink which patients they admit and focus on keeping people healthy. For Kaiser Permanente, however, it's been largely business as usual, says CEO Bernard Tyson, who took the helm a year ago (O'Donnell, 8/6).

The Washington Post: Rising Rates Of Hospice Discharge In U.S. Raise Questions About Quality Of Care
At hundreds of U.S. hospices, more than one in three patients are dropping the service before dying, new research shows, a sign of trouble in an industry supposed to care for patients until death. When that many patients are leaving a hospice alive, experts said, the agencies are likely to be either driving them away with inadequate care or enrolling patients who aren't really dying in order to pad their profits (Whoriskey and Keating, 8/6).

The Washington Post's Wonkblog: Why Immigrants Are The Best Thing That Happened To Medicare
America's growing immigrant population might not be all that bad for the country's health-care system. In fact, it's probably playing an important role in helping to keep it afloat. U.S. immigrants' net contribution to Medicare's Hospital Insurance Trust Fund, the program's core funding source, was $183 billion between 1996 and 2011. US-born Americans? Negative $69 billion, according to a new report by the Partnership for the New American Economy, an immigration advocacy group. That means that immigrants have been pumping a lot more money in than they take out, while the rest of the population has been doing just the opposite. On a per person basis, immigrants contributed $62 more per person to the trust fund than the U.S.-born, and claim $172 less in benefits (Ferdman, 8/6).

The Associated Press: AIDS Patients Fear Discrimination In ACA Exchange
Patient advocates say some insurance companies are making HIV and AIDS drugs unaffordable in plans issued through the Affordable Care Act by shifting much of the cost to customers. While the issue applies broadly to all patients with chronic illnesses that require expensive medication, HIV and AIDS advocates say they were the first to file a formal complaint with the government about pricing (8/6).

Politico: State Abortion Restrictions Fuel Fight For Senate
The 2014 campaign hasn't had the equivalent of Todd Akin's infamous rape comments driving the abortion debate. Instead, Democrats and Republicans are using a slew of new state abortion restrictions as weapons in the tight battle for control of the Senate. The fight this year centers on the dozen or so states that have banned abortions after 20 weeks of pregnancy under so-called fetal pain laws, as well as on the renewed push in a few states for personhood legislation, which confers full legal rights to an embryo from the moment of conception (Winfield Cunningham, 8/6).

The Wall Street Journal's Pharmalot: Docs Urge CMS To Postpone Deadline For 'Sunshine' Data Disclosures
More than 100 medical societies are urging the federal government to delay the launch of a widely anticipated database that will show payments from drug and device makers to physicians (Silverman, 8/6).

USA Today's The Oval: Obama's Day: The VA Bill
Health care for veterans tops President Obama's agenda Thursday as he signs a bill designed to reform and improve VA hospitals. The president travels to Fort Belvoir, Va., to sign the Veterans' Access to Care through Choice, Accountability, and Transparency Act of 2014 (Jackson, 8/7).

The Washington Post: Veterans Can Share Their VA Experiences With This Survey
A veterans group on Wednesday launched a new survey to gather information about veterans' experiences with the troubled Department of Veterans Affairs. The Iraq and Afghanistan Veterans of America, which developed the survey, including extensive wait times at the agency's medical centers and a longstanding backlog of disability claims (Hicks, 8/6).

The Washington Post: Promising New Approach Helps Curb Early Schizophrenia In Teens, Young Adults
The program involves an intensive two-year course of socialization, family therapy, job and school assistance, and, in some cases, antipsychotic medication. What makes the treatment unique is that it focuses deeply on family relationships, and occurs early in the disease, often before a diagnosis. So far, the results have been striking: In Portland, Maine, where the treatment was pioneered, the rate of hospitalizations for first psychotic episodes fell by 34 percent over a six-year period, according to a March study (Somashekhar, 8/6).

The Associated Press: Dr. Jesse Steinfeld, Surgeon General Who Fought Tobacco Dies At 87
Dr. Jesse Steinfeld, who became the first surgeon general ever forced out of office by the president after he campaigned hard against the dangers of smoking during the Richard Nixon era, died Tuesday. He was 87 (8/6).