First Edition: July 14, 2014

Today's headlines include coverage of Medicare, the health law and veterans' care policy issues as well as reports from the campaign trail.

Kaiser Health News: Veterans' Needs 'Should Drive Where They Get Their Care'
Kaiser Health News staff writer Mary Agnes Carey reports: "On Capitol Hill, lawmakers resume work this week to resolve differences over legislation aimed at alleviating long wait times for medical care at the Department of Veterans Affairs hospitals and clinics after reports that some veterans may have died awaiting appointments and that some VA staff falsified records to cover up excessive wait times. Both the House and Senate have passed bills that would allow veterans to seek medical care outside of the VA system if they meet certain conditions, including living more than 40 miles from a VA medical facility." Carey recent spoke with Dr. Kenneth Kizer, a former VA undersecretary for health, about the issue of the VA contracting with outside providers for medical care (Carey, 7/13). Read the edited transcript of that interview

The New York Times: A Two-Page Form Spawns A Contraceptive Showdown
A two-page federal form has provoked a titanic clash between the government and many religious organizations. The form allows some religious organizations to opt out of providing contraceptive coverage, which many insurers and group health plans are required to provide under the Affordable Care Act and related rules. The opt-out sounds like a way to accommodate religious beliefs. But many religious employers like Wheaton College and the Little Sisters of the Poor are unwilling to sign the form. By signing it, they say, they would authorize their insurers or plan administrators to pay for contraceptives, including some that they believe may cause abortion (Pear, 7/12).

Politico: Electronic Health Records Ripe For Theft
America's medical records systems are flirting with disaster, say the experts who monitor crime in cyberspace. A hack that exposes the medical and financial records of hundreds of thousands of patients is coming, they say -; it's only a matter of when. As health data become increasingly digital and the use of electronic health records booms, thieves see patient records in a vulnerable health care system as attractive bait, according to experts interviewed by POLITICO. On the black market, a full identity profile contained in a single record can bring as much as $500 (Pittman, 7/13). 

USA Today: Hospitals, Regulators Spar Over In-Patient Care Policy
Fewer patients linger for days in hospitals without being admitted because of a new federal rule, but hospital and consumer groups are suing the government because they say the policy compromises Medicare patients' care, and patients are often stuck with costly, unexpected bills. Doctors now have to certify that a patient has a serious enough condition to need at least two overnight stays for Medicare to cover an inpatient admission under the rule, which took effect in October. However, patients can remain in an outpatient or "observation" status -; that can even include staying overnight for several nights in a typical hospital room -; even though they haven't been formally admitted as an inpatient (O'Donnell, 7/13).

NPR/ProPublica: How A Fanny Pack Mix-Up Revealed A Medicare Drug Scam
But no one in Medicare bothered to ask her about the seemingly huge change in her practice, Ortiz-Butcher's attorney said. She stumbled across a sign of trouble last September, after asking a staffer to mail a fanny pack to her brother. Instead of receiving the pack, he received a package of prescriptions purportedly signed by the doctor, lawyer Robert Mayer said last year. Ortiz-Butcher immediately alerted authorities. Since then, investigators have uncovered a web of interrelated scams that, together, cost the federal government up to $7 million, documents show (Ornstein, 7/11).

Politico: Momentum Grows For Sex Reassignment Surgery Coverage
Medicare's recent decision to cover sex-reassignment surgery was a victory for transgender advocates seeking broader access to medical care for a condition that still carries social stigma. After all, the federal health program was one of the first to exclude such treatments more than 30 years ago (Wheaton, 7/13).

The New York Times: Republicans Replay 2010 Strategy At State Level
Four years after an economic crisis and opposition to Mr. Obama's health care law propelled Republicans to capture a lopsided majority of statehouses across the country, they are faced with a staggering political task: defending 22 of the 36 executive mansions that will be up for grabs in November, led by a governor who is trying to rebound from a scandal. While the sheer scale of Republican gains four years ago offers Democrats a wealth of opportunities to win, the political environment appears to be tilting again in the Republicans' direction (Martin and Confessore, 7/12).

The Washington Post: A Kentucky Shootout Over Stale Medicare Claims
The Democrats' $6,000 figure is outdated and discredited (note the small type in the ad with citations from 2011). It's worthy of Four Pinocchios. The Republicans' $700 billion is a stretch, but at least it's based on real numbers -; and The Washington Post has reported that the reductions in spending for Medicare Advantage have led to thousands of doctors being terminated from the program. We have been monitoring the impact of the cuts but have generally awarded this claim Two Pinocchios (Kessler, 7/11).

The Associated Press: Biden Calls On Governors To Lead Nation
The vice president's comments came during the first day of the governors' three-day conference in Nashville, where state leaders from both parties gathered to collaborate despite intensifying partisan differences on immigration, health care and education (7/11). 

Politico: GOP Governors See Scant Hobby Lobby Political Fallout
Democrats see the Supreme Court decision of limiting birth control coverage in some employee health plans as galvanizing voters for November, but Republican governors say the Hobby Lobby case is barely a blip, let alone a reprise of the "war on women." Republicans interviewed at the National Governors Association summer meeting here this weekend described the high court ruling exempting some religious owners of for-profit businesses from the Obamacare contraceptive coverage requirement as a welcome brake on President Barack Obama and his intrusive health law. And they didn't see it causing problems (Cheney, 7/13). 

Politico: Poll: Most GOP Approve Of SCOTUS
Republican support for the Supreme Court has increased 21 percent since last September, a new poll says. According to a Gallup poll released Monday, 47 percent of Americans approve of the high court, compared with 46 percent who disapprove, nearly identical results to last September. … Democrats have had a relatively high approval rating of the court since 2012, when the Supreme Court preserved the Affordable Care Act's individual mandate and largely upheld President Barack Obama's health care law as constitutional. Sixty-eight percent of Democrats reported approving of the court then. In its most recent term, the court delivered several landmark conservative decisions. In Burwell v. Hobby Lobby, the court ruled 5-4 that for-profit corporations could decline to pay for contraceptive coverage under the ACA, citing religious opposition (Topaz, 7/14). 

The Washington Post: VA Overhauling Medical Inspector's Office After Scathing Report
The Veterans Affairs Department is overhauling its medical inspector's office after a federal investigative agency slammed the division for its frequent use of the "harmless error" defense when problems occur within the VA health network. The agency this week appointed a new acting director for the medical inspector's office and decommissioned the division's hotline and its Web site: Individuals are now redirected to file concerns about the medical system with the VA's inspector general (Hicks, 7/11).

Los Angeles Times: With U.S. Encouragement, VA Disability Claims Rise Sharply
With the government encouraging veterans to apply, enrollment in the system climbed from 2.3 million to 3.7 million over the last 12 years. The growth comes even as the deaths of older former service members have sharply reduced the veteran population. Annual disability payments have more than doubled to $49 billion -; nearly as much as the VA spends on medical care. More than 875,000 Afghanistan and Iraq war veterans have joined the disability rolls so far (Zarembo, 7/12).

USA Today: Report Cites VA Struggles With Benefits Paid To Veterans
The federal department responsible for caring for America's veterans, already mired in scandal over delays in health care, continues struggling with another major responsibility: paying compensation to those wounded or injured or who grew ill from service in uniform. While the VA managed last year to reduce a huge backlog in veteran claims for money, it was at the expense of appeals to those decision which are rapidly mounting, according to testimony slated for Monday by the VA Office of Inspector General (Zoroya, 7/14). 

The Associated Press: Lawmakers Seek Lower Price For Bill On Vets' Care
Stung by sticker shock, members of Congress are scrambling to lower the cost of a bill to fix veterans' health care amid a growing uproar over long waits for appointments and falsification of records to cover up the delays at Veterans Affairs hospitals. At the same time, deficit hawks fear that letting veterans turn more to providers outside the VA for health care could cost far more if Congress, under pressure from powerful veterans groups, decides to renew that program rather than let it expire in two years (7/11).

The Wall Street Journal: Congressional Inaction Threatens Program For Brain-Damaged Vets
The Department of Veterans Affairs has begun ousting dozens of brain-damaged veterans from special therapeutic group homes, setting off a scramble for housing and care. In recent weeks, VA case workers have warned 53 veterans they'll have to leave the privately run homes by Sept. 15, according to the agency. Ten have already been discharged from the care facilities and sent to nursing homes, state veterans homes or to live with family members (Phillips, 7/11).

NPR: Veterans Kick The Prescription Pill Habit, Against Doctors' Orders 
Troops coming home from war, like Will, are often prescribed drugs for PTSD and other conditions. Hundreds of thousands of veterans are on opiates for pain, and 1 in 3 veterans polled say they are on 10 different medications. While there is concern about overmedicating and self-medicating -; using alcohol or drugs without a doctor's approval -; there are also some veterans who are trying to do the opposite: They're kicking the drugs, against doctor's orders (Lawrence, 7/11).

The Wall Street Journal: Senate Committee Is Investigating Pricing Of Hepatitis C Drug
The U.S. Senate Finance Committee launched an investigation into Gilead Sciences Inc. 's high pricing of the hepatitis C drug Sovaldi, adding its voice to a chorus of criticism accompanying the highest-grossing drug launch in history. Sen. Charles Grassley, a longtime industry watchdog and member of the committee, and the panel's chairman, Sen. Ron Wyden, sent a letter to Gilead Chief Executive John Martin on Friday announcing the probe and requesting a wide range of documents on how the Foster City, Calif., company decided on the price. Sovaldi costs about $1,000 a pill, or about $84,000 for a patient on a standard, 12-week regimen (Loftus, 7/11).

Los Angeles Times: U.S. Senators Ask Gilead Sciences To Explain High Cost Of Hepatitis C Drug
Pharmasset, the drug's original developer, priced the treatment at $36,000, the senators wrote, citing documents filed with the Securities and Exchange Commission. Gilead acquired Pharmasset in 2012 for $11 billion. Sovaldi sales could hit around $8 billion this year, analysts estimated, which would make it one of the top-selling pharmaceutical drugs worldwide (Khouri, 7/11).

The Washington Post: CDC Says It Improperly Sent Dangerous Pathogens In Five Incidents In Past Decade
Federal government laboratories in Atlanta improperly sent potentially deadly pathogens, including anthrax, botulism bacteria and a virulent bird flu virus, to other laboratories in five separate incidents over the past decade, officials said Friday (Sun and Dennis, 7/11).

The New York Times: CDC. Closes Anthrax And Flu Labs After Accidents
After potentially serious back-to-back laboratory accidents, federal health officials announced Friday that they had temporarily closed the flu and anthrax laboratories at the Centers for Disease Control and Prevention in Atlanta and halted shipments of all infectious agents from the agency's highest-security labs. The accidents, and the C.D.C.'s emphatic response to them, could have important consequences for the many laboratories that store high-risk agents and the few that, even more controversially, specialize in making them more dangerous for research purposes (McNeil, 7/11).

The Wall Street Journal: CDC Closes Labs After Accidents With Flu, Anthrax Samples
CDC Director Tom Frieden on Friday said a lab that works regularly with flu viruses at the agency had accidentally cross-contaminated a low-pathogenic H9N2 virus sample with a strain of H5N1 flu, one of the most deadly viruses known. The sample was then shipped to a lab at the U.S. Department of Agriculture, which discovered the contamination, he said. Dr. Frieden said he found the flu lab incident particularly distressing because it happened six weeks ago, yet he learned about it only this week (McKay, 7/11).

The Wall Street Journal: Truvada, The Drug In Cuomo's AIDS-Eradication Plan, Spurs Debate
A cutting-edge medication that can help prevent HIV in healthy individuals is gaining favor with government officials, including New York Gov. Andrew Cuomo. But in advocating for the drug, sold under the brand name Truvada, officials seeking to curtail HIV/AIDS infections are going up against some surprising opponents: high-profile AIDS activists who say they have serious questions about the drug's cultural and health impacts (Vilensky, 7/13). 

Los Angeles Times: L.A. County Board To Vote On Court-Ordered Mental Health Treatment Law
The Board of Supervisors is expected to vote Tuesday on a proposal that would increase money for outpatient treatment of people with a history of mental illness and expand efforts to identify potential patients. The vote would also set in motion a process that would allow family members, treatment providers and law enforcement officers to seek a court order to make people take part in the program, under which people can be ordered to undergo treatment but can't be forced to take medication (Sewell, 7/13). 

The New York Times: Rikers: Where Mental Illness Meets Brutality In Jail
The study, which the health department refused to release under the state's Freedom of Information Law, found that over an 11-month period last year, 129 inmates suffered "serious injuries" -; ones beyond the capacity of doctors at the jail's clinics to treat -; in altercations with correction department staff members. The report cataloged in exacting detail the severity of injuries suffered by inmates: fractures, wounds requiring stitches, head injuries and the like. But it also explored who the victims were. Most significantly, 77 percent of the seriously injured inmates had received a mental illness diagnosis (Winerip and Schwirtz, 7/14).

http://www.kaiserhealthnews.orgThis article was reprinted from with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.


The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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