First Edition: July, 21, 2014

Today's headlines include a story about an effort by regulators to widen insurer networks, as well as a range of other health policy developments.

Kaiser Health News: Florida's Biggest Health Insurer Signals Rate Hikes Ahead
Kaiser Health News:staff writer Phil Galewitz reports: "Florida Blue, the state's dominant health insurer, snagged more than one in three consumers on the health law's exchange, but many could face rate hikes as the carrier struggles with an influx of older and sicker enrollees, said the company's top executive" (Galewitz, 7/21). Read the story

Kaiser Health News: Docs Slam Recertification Rules They Call A Waste Of Time
Reporting for Kaiser Health News, Roni Caryn Rabin writes: "Many specialists are balking at what they say are onerous new rules to get recertified, warning the demands will force some physicians out of practice at a time when the nation faces a shortage. Doctors say the new requirements have made maintaining specialty certifications a process that never ends. Younger doctors already retake the arduous certification exam every seven to 10 years to keep their credential, long considered the gold standard of expertise. But physicians of all ages must now complete a complex set of requirements every two to three years, or risk losing their certification" (Rabin, 7/21). Read the story, which also appeared in USA Today.

Kaiser Health News: Medicare Modifies Controversial Hospice Drug Rule
Reporting for Kaiser Health News, Susan Jaffe writes: "The four drug categories were identified in a 2012 investigation by the Department of Health and Human Services' inspector general. Investigators found that Part D prescription drug plans paid more than $33 million in 2009 that should have probably been covered by the hospice benefit" (Jaffe, 7/18). Check out what else is on the blog.

The New York Times: To Prevent Surprise Bills, New Health Law Rules Could Widen Insurer Networks
The Obama administration and state insurance regulators are developing stricter standards to address the concerns of consumers who say that many health plans under the Affordable Care Act have unduly limited their choices of doctors and hospitals, leaving them with unexpected medical bills. Federal officials said the new standards would be similar to those used by the government to determine whether Medicare Advantage plans had enough doctors and hospitals in their networks (Pear, 7/19).

The Wall Street Journal: Surveys Show Shrinking Ranks Of Uninsured
The new Affordable Care Act and the recovering economy may have helped as many as nine million Americans obtain health insurance in the past year. And while the falling jobless rate is a significant factor in the gains, health-policy analysts say the lion's share of the credit goes to the new law, commonly known as Obamacare, several key provisions of which are being implemented this year. Three studies released on July 10--by Gallup, the Commonwealth Fund and the Urban Institute--show a marked decline in the percentage of people who don't have health insurance (Gay, 7/20).

The Washington Post: Little-Known InterSystems Grows To Dominate An IT Market In Age Of Obamacare Terry Ragon's knees ache. Age and love of marathons have taken their toll on the 64-year-old billionaire owner of InterSystems, a Cambridge, Mass., database software company. Little known outside the niche its technology dominates, InterSystems underpins health-related information for the national health services of England, Scotland and Wales and the U.S. Defense Department, ... Ragon, [is] mentioning his knees for a reason. "I saw two doctors at two different facilities on the same day," he says. "Both did X-rays. I can't believe that the way they like to do them is so different they couldn't share one. But each one got reimbursed." The duplication adds time, cost and inconvenience (Coffey, 7/18).

The Washington Post: Fertile Ground For Medicaid Pitch
Gov. Terry McAuliffe renewed his pitch for expanding health care to the poor Friday by touring a field hospital set up at a county fairgrounds, where people had camped out for days for the chance to see a dentist or doctor. ... McAuliffe chatted there with a single mother who ... told him that she can get insurance through her job as a foodservice worker but that the premium would consume half her paycheck. He told her that he was "working hard so we can get health care for everyone when they want it, not just once a year." ... The event took on added political significance this year, as McAuliffe continues his push to expand Medicaid under the Affordable Care Act (Vozzella, 7/18).

Los Angeles Times: Why Experts See Little Hope For GOP Plan To Sue Obama Over Law's Delay 
Throughout American history, Congress has often been at odds with the president. But so far, the legislative body has not turned to the third government branch -; the judiciary -; with a lawsuit claiming the chief executive violated the Constitution. That may change as House Republicans say they intend to sue President Obama for failing to "take care that the laws be faithfully executed," as the Constitution requires (Savage, 7/19).

The Wall Street Journal: For Federal Safety Nets, Mixed Financial Outlooks
The biggest Medicare program is expected to remain financially solvent through 2030, five years longer than previously expected, according to a government estimate released Tuesday that predicts the program's health-care costs will grow more slowly than they did before the recession. The report by the Congressional Budget Office said Medicare's financial picture had improved sharply since its February forecast and the disabled would exhaust its reserves in 2025. , when the nonpartisan budget scorekeeper projected that the portion of the government-run health (Paletta, 7/18).

The Wall Street Journal: Lucrative Drug Niche Sparks Legal Scramble
The pharmaceutical industry's battle for dominance in the fast-growing and lucrative market for treatments of hepatitis C is prompting an unprecedented legal scramble. The prospect that hepatitis-C drug sales could soar to $20 billion annually by the end of the decade is spurring attempts by drug companies to assert the patent rights they'll need to grab a piece of the pie (Loftus, 7/20). 

The Washington Post: Americans For Prosperity To Add Offices In 2 New States
AFP has about 400 field operatives in states around the country. About 40 of those operatives are in Florida, where the group considers reelecting Gov. Rick Scott (R) a top priority. AFP is also spending tens of millions of dollars on issue advocacy television advertising. It began hitting some Democratic senators with negative ads last fall, with a particular focus on the Affordable Care Act, and so far AFP has spent about $44 million on television. On Thursday, AFP announced it would begin spending $1.3 million on a new round of advertisements critical of Sen. Jeanne Shaheen (D-N.H.) and Rep. Ann Kuster (D-N.H.), both of whom face tight races next year (Wilson, 7/18).

The Wall Street Journal: Tennessee GOP Challengers Struggle
To beat Tennessee Sen. Lamar Alexander, Republican primary challengers Joe Carr and George Flinn both say they could use help from the conservative groups that propelled insurgent GOP challengers elsewhere. ... no cavalry is coming to help Mr. Carr or Mr. Flinn. The outside money has largely stayed home. ... Mr. Alexander has gone to great lengths to shore up his conservative credentials. ... Mr. Alexander is airing a statewide TV commercial featuring a clip of him confronting President Barack Obama during a 2010 forum about the Affordable Care Act (Epstein, 7/18).

The Wall Street Journal: 'Personhood' Issue Haunts Colorado Senate Candidate 
Rep. Cory Gardner, the Republican candidate for a Senate seat in Colorado, is trying to move away from the thorny issue of "personhood." His problem is that neither his foes on the left nor some friends on the right will let him. Shortly after entering the race against Democratic Sen. Mark Udall in February, Mr. Gardner disavowed his past support for the idea at the heart of the personhood movement, which is to give a fertilized egg the same rights as a person, thereby outlawing abortion and some forms of birth control. In backing away, he even called for the sale of birth control over the counter (Reinhard, 7/20).

The Associated Press: Before Doctors Check Your Vitals, Check Theirs
Americans consider insurance and a good bedside manner in choosing a doctor, but will that doctor provide high-quality care? A new poll shows that people don't know how to determine that. Being licensed and likable doesn't necessarily mean a doctor is up to date on best practices. But consumers aren't sure how to uncover much more. Just 22 percent of those questioned are confident they can find information to compare the quality of local doctors, according to the poll by The Associated Press-NORC Center for Public Affairs Research (7/20). 

The New York Times: Leading AIDS Researcher, 'Always Traveling,' Is Killed on His Way to a Conference
As the airport lounge filled with passengers waiting to board Malaysia Airlines Flight 17, a renowned professor rushed to the gate while texting a colleague, saying that he was "superbusy." Veering into the business-class line, Joep Lange, an AIDS researcher, passed a former election observer who had just returned from Ukraine. They were among 298 passengers and crew aboard the flight, which was shot down over Ukraine on Thursday. ... Dr. Lange, a former president of the AIDS society, began researching the epidemic in 1983 and had worked at the World Health Organization, heading clinical research and drug development in the mid-1990s (Erdbrink and McNeil Jr., 7/18).

USA Today: AIDS Conference Attendees Remember 6 Who Died On MH17
Organizers and attendees at the world's largest AIDS conference said six colleagues who died in the downing of Malaysia Airlines Flight 17 would want them to continue the fight against this deadly disease. The six delegates, who died Thursday, were to attend the 20th International AIDS Conference here. ... "This is not a time for silence," said Michael Kirby, former judge of the High Court of Australia. "They would expect us to pick up our shattered spirits. They would demand that we renew and redouble our efforts" (Clark, 7/20).

The New York Times: Pathogen Mishaps Rise As Regulators Stay Clear
The recently documented mistakes at federal laboratories involving anthrax, flu and smallpox have incited public outrage at the government's handling of dangerous pathogens. But the episodes were just a tiny fraction of the hundreds that have occurred in recent years across a sprawling web of academic, commercial and government labs that operate without clear national standards or oversight, federal reports show (Grady, 7/19).

The Associated Press: RJ Reynolds Vows To Fight $23.6B In Damages
The nation's No. 2 cigarette maker is vowing to fight a jury verdict of $23.6 billion in punitive damages in a lawsuit filed by the widow of a longtime smoker who died of lung cancer. R.J. Reynolds Tobacco Co. executive J. Jeffery Raborn has called the damages awarded by a Pensacola jury "grossly excessive and impermissible under state and constitutional law" (7/20). 

The New York Times: Jury Awards $23.6 Billion In Florida Smoking Case
A jury in northwestern Florida awarded a staggering $23 billion judgment late Friday against the country's second-largest tobacco company for causing the death of a chain smoker who died of lung cancer at the age of 36. The company, the R. J. Reynolds Tobacco Company, promised a prompt appeal. Michael Johnson Sr. died in 1996 after smoking for more than 20 years (Robles, 7/19).

USA Today: Jury Hits Tobacco Company R.J. Reynolds With $23B Verdict
The jury in the case Cynthia Robinson v. R.J. Reynolds Tobacco Company sided Friday night with Robinson, the widow of a longtime smoker who died of lung cancer in 1996, to award her more than $16 million in compensatory damages and $23 billion in punitive damages. Following a nearly four-week trial, the jury deliberated for 15 hours to eventually determine that the tobacco company was negligent in informing Robinson's husband, Michael Johnson Sr., that smoking causes lung cancer and that nicotine is highly addictive (Isern, 7/19).

The Washington Post: Florida Jury Slams R.J. Reynolds With $23.6 Billion In Damages 
The case is one of thousands filed in Florida after the state Supreme Court in 2006 tossed out a $145 billion class-action verdict. That ruling also said smokers and their families need only prove addiction and that smoking caused their illnesses or deaths. Last year, Florida's highest court reapproved that decision, ... Reynolds's vice president and assistant general counsel, Jeffery Raborn, called the damages in Robinson's case "grossly excessive and impermissible under state and constitutional law (Kay, 7/19).

USA Today/Des Moines Register: Iowa Puts $5 Million Into Autism Program
[T]herapist Kara Jorgensen, was trying to correct the fidgety boy's habit of spewing out his thoughts without starting a conversation properly. When she turned away, he hesitated, looking perplexed. Then she tapped her own shoulder and made a suggestion. "Say, 'Hey, Kara,' " she instructed, still looking away. [Eight year old Sidney Trees] understood immediately and did just that. After swinging back to face him and smiling, Jorgensen rewarded Sidney by listening enthusiastically and playing trains with him. The simple interaction -; cheerful reinforcement of a seemingly normal behavior -; is significant for families of autistic children like Sidney. The method, known as Applied Behavior Analysis, has shown such promise that Iowa is pouring nearly $5 million into it (Leys, 7/20).

NPR: As New York Embraces HIV-Preventing Pill, Some Voice Doubts
AIDS researchers and policymakers from around the globe are gathering in Melbourne, Australia, for a major international conference that starts this Monday. They'll be mourning dozens of colleagues who died in the crash of Malaysia Airlines Flight 17 (Rose, 7/19).

The New York Times: Missouri Alone In Resisting Prescription Drug Database
Not having the database has not only hampered Missouri's ability to combat prescription drug abuse, but also attracted people from neighboring states looking to stockpile pills and bring them home to take themselves or sell to others, according to law enforcement officials, legislators and data compiled by a prescription drug processing firm (Schwarz, 7/20).

The Texas Tribune/New York Times: State Weighs Restructuring Health Plans For Women
Texas lawmakers are looking for ways to fill the gaps in access to health care for the state's poorest women, three years after making sharp cuts to the state's family planning budget and rejecting a federally financed women's health program in favor of their own (Ura, 7/19).

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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