Tagged Insurance

Molina Healthcare, A Top Obamacare Insurer, Investigates Breach Of Patients’ Data

Molina Healthcare, a major insurer in Medicaid and state exchanges across the country, has shut down its online patient portal as it investigates a potential data breach that may have exposed sensitive medical information.

The company said Friday that it closed the online portal for medical claims and other customer information while it examined a “security vulnerability.” It’s not clear how many patient records might have been exposed and for how long. The company has more than 4.8 million customers in 12 states and Puerto Rico.

“We are in the process of conducting an internal investigation to determine the impact, if any, to our customers’ information and will provide any applicable notifications to customers and/or regulatory authorities,” Molina said in a statement Friday. “Protecting our members’ information is of utmost importance.”

Brian Krebs, a well-known cybersecurity expert who runs the Krebs on Security website, said he notified the company of the potential breach earlier this month and wrote about it on his website Thursday. Molina said it was already aware of the security vulnerability when contacted.

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Until recently, Krebs said, Molina “was exposing countless patient medical claims to the entire internet without requiring any authentication.”

Krebs said the information he saw online included patients’ names, addresses, dates of birth and information on their medical procedures and medications.

“It’s unconscionable that such a basic, security 101 flaw could still exist at a major health care provider,” Krebs said. “This information is more sensitive than credit card data, but it seems less protected.”

Krebs said he received an anonymous tip in April from a Molina member who stumbled upon the problem when trying to view his medical claim online. The tipster found that by changing a single number in the website address he could then view other patient claims, according to Krebs.

Krebs said the Molina member showed him screenshots of his own medical records and how when he changed the web address slightly it then displayed records of another patient. On Friday, the Molina website told customers that the online portal was “under maintenance.”

Health care companies, hospitals and other providers must report data breaches to U.S. officials. Molina emphasized that it was still investigating the matter so had not yet reported it. Federal regulators can levy significant fines for violations under the Health Insurance Portability and Accountability Act, also known as HIPAA.

Many security experts question the ability of health care companies and providers to safeguard vast troves of electronic medical records and other sensitive data, particularly at a time when cybercriminals are targeting medical information.

Molina, based in Long Beach, Calif., posted $17.8 billion in annual revenue last year.

Molina made news earlier this month with the surprise firing of its top two executives, who are sons of the company’s founder. Both CEO J. Mario Molina and his brother, finance chief John Molina, were ousted. The company’s board said Molina’s disappointing financial performance led to the management change.

Molina has grown more prominent during the rollout of the Affordable Care Act, as Medicaid expanded and state insurance exchanges launched. The company serves more than 1 million people through Obamacare exchanges across several states. It has nearly 69,000 enrollees in the Covered California exchange, or about 5 percent of the market.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

Categories: California Healthline, Health Industry, Insurance

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A Busy Week For Health: Budget Cuts, CBO Scores And Mitch McConnell’s Cryptic Signal

https://kaiserhealthnews.files.wordpress.com/2017/05/052617_khn_hoth.mp3

It was a hectic week for people who follow news about health politics. Kaiser Health News’ veteran reporters Mary Agnes Carey and Julie Rovner sat down to discuss some of the major developments.

MARY AGNES CAREY: Hello, and thanks for joining us. I’m Mary Agnes Carey, partnerships editor and a senior correspondent for Kaiser Health News. Julie Rovner, KHN’s chief Washington correspondent, is here with me to talk about a very busy week in health care: Medicaid cuts in President [Donald] Trump’s budget plan and a new Congressional Budget Office analysis of the House passed ACA overhaul. We’ll also look at what Senate Republicans have in mind for their ACA replacement bill. Julie, let’s get started.

JULIE ROVNER: OK.

MARY AGNES CAREY: First the budget. President Trump released his fiscal 2018 budget plan this week. Federal spending on Medicaid and the Children’s Health Insurance Program would be cut. Can you take us through those changes.

JULIE ROVNER: Yes these Medicaid changes would be on top of what’s in the House-passed health care bill, which would be about $800 billion. What the administration says is that they’re going to let the amount that Medicaid goes up every year go up by less. So that would result in even more cuts. There’s a roughly 20 percent cut to the Children’s Health Insurance Program.

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This budget also includes big cuts to the public health infrastructure. It cuts the Centers for Disease Control and Prevention by about 17 percent. It would cut the National Institutes of Health by nearly 18 percent. It would completely eliminate the Agency for Healthcare Research and Quality and fold that into the NIH. So there’s been a lot of uproar from the medical and scientific community, although we should point out that this budget is unlikely to happen. Presidents’ budgets are mostly wish lists — that goes back decades. Congress basically decides who gets how much money.

MARY AGNES CAREY: Because they control the purse, right.

JULIE ROVNER: Absolutely.

MARY AGNES CAREY: All right. Let’s move on to the ACA. The Congressional Budget Office, or the CBO as we like to call it, released a new score or analysis for the House Republicans’ plan to replace the Affordable Care Act. What were the top takeaways for you?

JULIE ROVNER: Well, a lot of attention was paid to, you know, that sort of top line — that it would result in 23 million more people not having insurance after 10 years and then overall it would save about $119 billion from the deficit.

But what most of us were really looking at is what would happen as a result of that last-minute compromise that actually got the bill passed in the House. That was this amendment that would let states waive some of the requirements in the bill, like having a set of benefits and not charging people with preexisting conditions more. And interestingly, the CBO said that either under the Affordable Care Act or under the original House bill the market for individual insurance would probably be stable. But in those states that decided to take those waivers, it might well become unstable.

And the CBO didn’t say which states that would be, but they estimated that about one-sixth of Americans lived in states where that might happen. In those cases, people with preexisting conditions might be completely priced out of being able to get policies and even people who could get insurance might have to pay many, many thousands of dollars more because some benefits that they might need, like maternity care or mental health care, would no longer be covered. So it was not a ringing endorsement of that last-minute compromise.

MARY AGNES CAREY: And there’s also a big differential between if you’re younger or older, right?

JULIE ROVNER: That’s absolutely right. This is in sort of the original House bill. They would change the way tax credits are provided for people to help pay their premiums. Right now, they’re basically based on your income and how much insurance costs, so it doesn’t matter in different parts of the country if you’re sure insurance costs more. You only have to pay a set percent of your income.

The Republicans would change that, and they would link the tax credits more to age so older people would get more. Younger people would get less, but people would get less help overall. So for older people, premiums would spike dramatically. Sometimes you know more than $10,000 or $12,000. Some younger people, healthy younger people, would see a decrease, but it would not be nearly as large as the increase for older people.

MARY AGNES CAREY: So what does this CBO score mean for Senate Republicans as they try to draft their ACA replacement.

JULIE ROVNER: Well it certainly doesn’t help. The Senate had to wait for the Congressional Budget Office to deliver this score. That’s one of the requirements of the budget process that they’re using. But Senate Majority Leader Mitch McConnell did a couple of interviews this week where he basically said that they’re working hard on health care, but he doesn’t see a path to 50 votes, which is what they need to get this bill passed. That’s assuming Vice President [Mike] Pence could break a tie.

What we’re starting to see are conservatives saying they need to have these waivers — the ones that the CBO just said might destabilize the insurance market. Then you’ve got more moderates saying no we want fewer or no waivers. It’s hard to see where they’re going to come together. We’re told that staff is going to try to draft something next week while Congress is out for the Memorial Day break. But there’s no real anticipated timeline for this yet.

MARY AGNES CAREY: So Julie, why do you think Mitch McConnell would send such a public signal that he’s having a problem getting to 50 votes?

JULIE ROVNER: I really don’t know. I thought it was kind of curious. One of the things that it might be is that he wants to, you know, light a fire under his caucus, who are having all this disagreement, saying you know this whole thing could, you know, just dissolve if you don’t actually start coming to the table and compromising. Why else do you think he might do it?

MARY AGNES CAREY: Well you talk about how the calendar is working against him if he wants to get to tax reform. We’re at Memorial Day, and typically tax reform takes a lot of work, a heavy lift, maybe he just wants to move onto that.

JULIE ROVNER: So basically abandon the whole health reform idea?

MARY AGNES CAREY: I mean it sounds a little nutty. And obviously it’s a campaign promise they’ve all made. But also, as we’ve seen, there are problems in the marketplace. You do see insurers leaving over uncertainty. Perhaps they want to let that play out. I’m not sure.

JULIE ROVNER: Neither am I.

MARY AGNES CAREY: All right, well there you go. Thank you, Julie Rovner of Kaiser Health News.

Categories: Health Industry, Insurance, Medicaid, Public Health, Repeal And Replace Watch, The Health Law, Uninsured

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Different Takes: The Politics Of Repeal, Replace And Reform

Editorial pages across the country include thoughts about the political risks in play as Congress and states confront efforts to dismantle Obamacare.

Bloomberg: Exposing The Obvious About The GOP Health-Care Bill
The gory details of the Congressional Budget Office’s report on the House legislation to “repeal and replace” Obamacare are, in many ways, superfluous. The bill’s flaws, substantive and otherwise, have long been evident. Less clearly understood, though equally disturbing, is the larger political context. (5/25)

Roll Call: A GOP Guide To Running For Cover On Health Care
Most of the news coverage highlighted the CBO’s estimate that 23 million fewer Americans would have health coverage in 2026 under the bill. But in 2026, most current House Republicans will be lobbyists and strategic consultants — and some future Congress would get the blame. In political terms, the scariest CBO number was that 14 million fewer Americans would be without health insurance next year. And many of these suddenly uninsured people just might remember whom to blame when they cast their 2018 ballots. (Walter Shapiro, 5/26)

Los Angeles Times: Die Hard: Republican Healthcare Bill Has No Problem Throwing You Off A Building
Glendale resident David Cannizzaro has had asthma since he was 7. Prior to Obamacare, his healthcare strategy was to see the doctor as little as possible so his insurer wouldn’t notice his preexisting condition and decide to raise his rates or drop his coverage. Now that Republican lawmakers are advancing a bill that would repeal the Affordable Care Act and potentially allow insurers to jack up premiums for people with preexisting conditions, Cannizzaro, 49, said he’s once again living in fear. “It’s very, very scary,” he told me. (David Lazarus, 5/26)

The Washington Post: Senate Republicans Who Are Gunning For Obamacare Are Caught In A Trap
Republican senators who are being asked today about the brutal Congressional Budget Office score of the health-care plan that passed the House have a ready answer: That doesn’t have anything to do with us. Numerous senators released statements saying that the CBO score just shows that the American Health Care Act (AHCA) is a radioactive fungus, which is why they’re starting over on their own bill. (Paul Waldman, 5/25)

The Washington Post: Don’t Blame The CBO For Problems In The House Health-Care Bill
The new Congressional Budget Office score of the American Health Care Act is devastating. In 2026, 23 million fewer Americans would be insured with it than without it. The response of the secretary of health and human services and other defenders of the Republican bill? Attack the Congressional Budget Office. I had the honor of running the CBO a decade ago and will be the first to admit it’s not perfect. But it’s also far better than the alternatives, and most of the critiques are off base. (Peter Orszag, 5/25)

Los Angeles Times: If You Plan On Having A Baby Under Trumpcare, You Better Start Saving Now
Seventeenth century playwright William Congreve famously wrote that hell has no fury like a woman scorned. House Republicans may feel some of that heat once their constituents find out the healthcare bill they passed could make maternity coverage vastly more expensive and harder to obtain. It’s widely known that the House GOP’s proposed American Health Care Act would bar federal funding for Planned Parenthood, which provides many reproductive and maternal health services to lower-income women across the country. Less well understood is that an amendment to the AHCA would also allow states to lift the mandate that insurers include maternity coverage in all the policies they sell to people in the individual and small-group markets (i.e., everyone not covered by a large company health plan). (Jon Healey, 5/25)

Tribune News Service: Obamacare Replacement Would Give Women Better Options, Lower Costs
Women make the majority of decisions about care and insurance for our families, and we generally consume more healthcare than men. As a result, women have a lot at stake when it comes to the laws that govern American healthcare and insurance. In 2010, the Affordable Care Act — Obamacare — made it illegal for insurers to charge women more than men and mandated that insurance plans cover women’s preventive care, including birth control, with no copay. Therefore, some now suggest repealing the Affordable Care Act would be detrimental for women’s health. But the opposite is true: Repeal will afford women greater choice and lower costs when it comes to insurance plans, doctors and care. (Hadley Heath Manning, 5/25)

Detroit Free Press: Who Will Play Fred Upton In Senate Sequel To House Health Care Farce?
Fred Upton is a 16-term congressman who may or may not be interested in becoming Michigan’s next U.S. senator. But there are almost certainly some Republican U.S. senators interested in becoming the next Fred Upton. A grandson of Whirlpool Corp. co-founder Frederick Upton, Rep. Upton is among the wealthiest members of Congress. Until 2016, he served as chair of the House Committee on Energy and Commerce. (Brian Dickerson, 5/25)

Sacramento Bee: California Democrats Did Far More Than Flip Off Trump 
California Democrats now number more than 8 million for the first time, hold every constitutional office, and command a supermajority in the Legislature because we reflect the values of the citizens of our state.But we are not resting on our laurels, far from it. While President Donald Trump and Republicans in Congress are talking about slashing health care for 23 million Americans, California Democrats re-emphasized their belief that health care is a right, not a privilege, as we pursue Medicare for all with Senate Bill 562. (Eric Bauman, 5/25)

Des Moines Register: Privatized Medicaid Was Supposed To Save Money?
Iowa is now 14 months into its experiment with privatized Medicaid management. … Privatization is a slow-motion train wreck, with providers across the state closing up shop or taking out loans to make payroll because the checks from Medicaid are slow to arrive and patient services are being paid at a lower rate. At the same time, the managed care organizations that Iowa hired to administer Medicaid say they are losing millions, and need an enormous increase in funding in order to make ends meet. This was not only predictable, it was predicted. (5/25)

St. Louis Post-Dispatch: Western Missouri Becomes A Canary In Obamacare Coal Mine
In what could be a disturbing portent, Blue Cross Blue Shield of Kansas City on Wednesday announced it was pulling out of the Obamacare health exchanges in 2018. The decision will leave 67,000 people in 25 Missouri counties and two Kansas counties with no option for private insurance, subsidized or not, under the Affordable Care Act. Blue Cross Blue Shield announced it had lost nearly $100 million on Obamacare policies since 2014; only last year did it take in more premium money than it paid out, and overhead costs pushed the Blues into the red. (5/25)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Early Hospital Discharges; Missed Vaccinations; Growth In Spending

Each week, KHN compiles a selection of recently released health policy studies and briefs.

JAMA Surgery: Costs And Consequences Of Early Hospital Discharge After Major Inpatient Surgery In Older Adults
Do fast-track discharge protocols and shorter postoperative length of stay after major inpatient surgery reduce overall surgical episode payments, or are there unintended increased costs because of postdischarge care? … In a cross-sectional cohort study of 639 943 risk and postoperative complication–matched Medicare beneficiaries undergoing colectomy, coronary artery bypass grafting, or total hip replacement, hospitals with shortest routine postoperative length of stay achieved lowest overall surgical episode payments and did not offset shorter hospital stays with greater postdischarge care spending. (Regenbogen et al., 5/17)

Annals of Internal Medicine: Missed Opportunities for Measles, Mumps, Rubella Vaccination Among Departing U.S. Adult Travelers Receiving Pretravel Health Consultations
40 810 adult travelers were included [in an observational study in U.S. pretravel clinics]; providers considered 6612 (16%) to be eligible for MMR vaccine at the time of pretravel consultation. Of the MMR-eligible, 3477 (53%) were not vaccinated at the visit; of these, 1689 (48%) were not vaccinated because of traveler refusal, 966 (28%) because of provider decision, and 822 (24%) because of health systems barriers. Most MMR-eligible travelers who were not vaccinated were evaluated in the South (2262 travelers [65%]) or at nonacademic centers (1777 travelers [51%]). Nonvaccination due to traveler refusal was most frequent in the South (1432 travelers [63%]) and in nonacademic centers (1178 travelers [66%]). (Hyle et al., 5/16)

Urban Institute/Robert Wood Johnson Foundation: The Evidence On Recent Health Care Spending Growth And The Impact Of The Affordable Care Act
Conventional wisdom holds that health care cost growth is high and the Affordable Care Act (ACA) has done little to address the problem. However, overall increases in national health expenditures (NHE) since the law passed have been lower than anticipated, premiums and premium growth in the ACA’s health insurance marketplaces are high in some states but quite low in others, and growth in Medicare and Medicaid spending per enrollee has been very modest. NHE are still high, now at 18.3 percent of gross domestic product …. In this brief, we attempt to address several misconceptions about recent spending increases; these misconceptions are centered in three areas: the recent and projected growth in NHE the levels and recent growth of ACA marketplace premiums the recent and projected spending growth in the Medicaid program. (Holahan et al., 5/25)

Urban Institute: Medicaid/CHIP Participation Rates Rose Among Both Children And Parents In 2015
Using the 2013-2015 American Community Survey, this brief finds improvements for both parents and children in uninsurance, Medicaid/CHIP participation, and the number who are eligible for Medicaid/CHIP but not enrolled. Uninsurance fell nationally and in nearly every state, and the number of eligible but uninsured children fell to 2.1 million – declining by over half since 2008. Children’s participation reached 93.1 percent in 2015 (exceeding 90 percent in 36 states), while participation among parents rose to 80.2 percent, with larger gains between 2013 and 2015 in expansion states than nonexpansion states. Participation grew among every subgroup of children and parents examined. (Kenney et al., 5/17)

The Kaiser Family Foundation: Financing Family Planning Services For Low-Income Women: The Role Of Public Programs
Medicaid, the Title X Family Planning Program, and Section 330 of the Public Health Service Act (PHSA) are the leading sources of federal funding for the over 10,000 safety-net clinics across the country that provide reproductive health services to low-income women, men, and teens. The Trump administration and the Republican leadership of the 115th Congress have proposed to block federal Medicaid funds from going to Planned Parenthood …. Changes to these programs and funding to the clinics that provide family planning services could limit the availability of contraceptive services, STI screenings and treatment, and preventive cancer screenings, along with other primary care services to low-income women. … One in three low-income women reported that they obtained birth control from a family planning clinic such as Planned Parenthood or another health center or public health clinic. (Ranji et al., 5/11)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Visions: Are Republicans Trying ‘To Starve’ Obamacare To Death; Analyzing The State Of ACA Insurance Markets And Premiums

Opinion writers offer a variety of thoughts on health policy issues, including whether the health law is “collapsing under its own weight,” some ominous predictions about the individual insurance markets, the importance of the public option and a range of other ideas.

The New York Times: How The G.O.P. Sabotaged Obamacare
Obamacare is not “collapsing under its own weight,” as Republicans are so fond of saying. It was sabotaged from the day it was enacted. And now the Republican Party should be held accountable not only for any potential replacement of the law, but also for having tried to starve it to death. The Congressional Budget Office on Wednesday released its accounting of the House Republicans’ replacement bill for the Affordable Care Act, and the numbers are not pretty: It is projected to leave 23 million more Americans uninsured over 10 years, through deep cuts to insurance subsidies and Medicaid. The report underscores how the bill would cut taxes for the rich to take health care away from the less well-off. (Abbe R. Gluck, 5/25)

The Wall Street Journal: How To Read An ObamaCare Prediction
The political world waited with rapt attention Wednesday for the oracles at the Congressional Budget Office to release their cost-and-coverage predictions for the revised House health reform bill, which arrived late in the afternoon. But while Washington stood by, two reports emerged from the real world that are far more consequential. (5/24)

Los Angeles Times: Trump’s Team Issues A Stunningly Dishonest Study Of Obamacare Rate Increases
The Department of Health and Human Services seemed mightily pleased with a statistic it issued Tuesday. The agency’s figures showed that premiums on the Affordable Care Act exchanges “doubled” from 2013 through this year. This might not sound like good news for the people buying their coverage on those exchanges, but to HHS it was vindication. “This report is a sobering reminder of why reforming our healthcare system remains a top priority of the Trump administration,” agency spokesperson Alleigh Marré said. (Michael Hiltzik, 5/24)

Kansas City Star: Should A Limited Public Option Be Part Of Health Care Reform? 
Weren’t we focused on health care reform just a few weeks ago? Yes we were. And as it turns out, while we’re all looking at other things, lawmakers in Washington are still working on a rewrite of the Affordable Care Act. There were two important developments over the last two weeks we should think about. (Dave Helling, 5/24)

Stat: Native Americans’ Health Threatened By Denial Of Medicaid Expansion
America has broken several centuries worth of promises to its indigenous people. And we’re poised to do it again. … The Affordable Care Act provided a way to improve the health of thousands of Native Americans through Medicaid expansion. It provided a much-needed injection of funding to the long-neglected Indian Health Service and tribal health facilities by raising the income level needed for eligibility. With the poverty rate at 28 percent among Native Americans, this group disproportionately benefited from Medicaid expansion. (Kevin Duan and Aaron Price, 5/25)

Milwaukee Journal Sentinel: Health Care Reform The Wisconsin Way
Wisconsin has been a leader in covering its residents with high-quality health care and providing community supports so people with disabilities and frail elders can stay in their homes and communities and out of costly facilities. The American Health Care Act poses a particularly dangerous threat to our state’s residents, in part because we have done so much right. (Barbara Beckert, 5/24)

Lexington Herald Leader: Calling Dr. Paul: Seriously, You Don’t Think The U.S. Can Afford Health Care?
The United States spends more per person on health care than any other country, but our health outcomes are far from the best. Simply put, the challenge facing Congress is how to get more value for all that money. Yes, the details are complex, but we’re a big, complex country with a big, complex economy. Our elected leaders should engage that complexity and produce practical reforms and solutions that inspire confidence in the future. That is a reasonable expectation. (5/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

CBO Score Of Revised GOP Health Bill: Over Next Decade, 23M Would Be Left Uninsured, Deficit Reduced By $119B

May 24 2017

The nonpartisan Congressional Budget Office issues its latest report on the American Health Care Act.

The New York Times: C.B.O. Projects Dismantling Obamacare Increases Uninsured By 23 Million In A Decade
A bill to dismantle the Affordable Care Act that narrowly passed the House this month would increase the projected number of people without health insurance by 14 million next year and by 23 million in 2026, the Congressional Budget Office said Wednesday. That 10-year figure is slightly less than originally estimated. It would reduce the federal deficit by $119 billion over a decade, less than the $150 billion in savings projected in late March for an earlier version of the bill. And in states that seek waivers from rules mandating essential health coverage, the new law could make insurance economically out of reach for some sick consumers. (Pear, 5/24)

NPR: CBO: Republicans’ AHCA Would Leave 23 Million More Uninsured
The deficit reduction in the latest version of the bill represents a decline from previous versions. When the CBO first scored the AHCA, it said the plan would save $337 billion over 10 years. Later revisions reduced those savings to $150 billion. By far the biggest savings would come from Medicaid, which serves low-income Americans. That program would face $884 billion in cuts. Cutbacks in subsidies for individual health insurance would likewise help cut $276 billion. But those are offset in large part by bigger costs, including the repeal of many of Obamacare’s taxes. (Kurtzleben, 5/24)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Viewpoints: The Rule Of Law And Subsidies; Anticipating CBO’s Score On The GOP Health Plan

A selection of opinions on health care from around the country.

Bloomberg: Rule Of Law Actually Applies To Democrats, Too
Yes. Congress can mandate subsidies without also mandating a funding source. Medicaid is another example. This is crazy, but there it is. For once the Constitution is admirably clear on how the executive branch should handle this quandary: “No Money shall be drawn from the Treasury, but in Consequence of Appropriations made by Law; and a regular Statement and Account of the Receipts and Expenditures of all public Money shall be published from time to time.” The law appropriated no money for these cost-sharing reduction payments. But the Obama administration went ahead and paid them anyway. (Megan McArdle, 5/23)

The New York Times: How To Read The C.B.O. Score Of The Health Bill Like An Expert
Today, the Congressional Budget Office will issue important numbers about the House-passed version of the American Health Care Act, the Republican bill to repeal and replace portions of the Affordable Care Act. Although the budget office had analyzed an early version of the bill, the House on May 4 took the unusual step of voting before the budget office could gauge how several last-minute amendments might affect the deficit or the number of uninsured. (Margot Sanger-Katz, 5/24)

RealClear Health: Why Nutrition Standards And Policies Should Continue
The U.S. Department of Agriculture said recently it will delay the implementation of school lunch rules aimed at lowering the amount of sodium and raising the whole grain content of meals served to kids. At the same time, the Food and Drug Administration announced it will delay for one year the implementation of Obama administration rules to require calorie labels on menus and prepared food displays. (Deborah A.Cohen, 5/24)

WBUR: America’s Food Access Problem Starts On The Farm 
Given that we’re tangled in knots over how to pay for health care, it’s remarkable that food and farm policy isn’t more in the public’s mind. Heads of hunger programs and food banks have begun to grasp the obvious; as one told WBUR, “food is medicine, food is health,” with good health impossible in the absence of nutritious eating. (Rich Barlow, 5/23)

San Jose Mercury News: Single-Payer Detracting From Big Medi-Cal Fight
Sen. Ricardo Lara’s single-payer legislation was a non-starter in California from day one, even before it was given an eye-popping $400 billion price tag. … It’s merely an exercise in politics, which is all well and good except that it detracts from a far more important California health care issue: Can the state fight off President Trump’s inhumane effort to slash the nation’s Medicaid budget by more than $880 billion through 2026? (5/23)

Stat: Risk Scores For Preventing Heart Disease, Stroke Must Take The Long View
Back in 1998, researchers with the legendary Framingham Heart Study created the first heart risk calculator. Using answers to questions about age, cholesterol and blood pressure levels, tobacco use, and the presence of diabetes, it estimated an individual’s risk of having a heart attack or stroke over the next 10 years. Since then, this calculator has been revised and many others have been developed, including ones that extend the time horizon out to an individual’s lifetime. Yet much to our surprise, the use of these single-point-in-time risk calculators does little to reduce the risk of heart attack or stroke compared with not using such calculators. ( Kunal N. Karmali and Mark Huffman, 5/23)

On the Ground: Our Teeth Are Making Us Sick
The left side of Jacquelyn Garcia’s face throbbed fiercely. She had tried taking Tylenol and Excedrin for the pain, but threw them up. On a Monday morning straight after working the night shift as a custodian, she rushed to the N.Y.U. emergency dental clinic. Here a student delivered the verdict: decay so deep it had reached the nerve. The tooth needed to be pulled. (Zoe Greenberg, 5/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Contract Dispute In Ariz. Leaves Many Out Of Network At Dignity Health Hospitals; Texas Lawmakers OK Maternal Health Bills

Media outlets report on news from Arizona, Texas, California, Minnesota, Georgia, Colorado and Florida.

Sacramento Bee: Health Care For Illegal Immigrants Proposed By California Senator
State Sen. Ricardo Lara doesn’t only want to reconstruct the way health care is delivered and paid for in California. As the debate around publicly funded universal health care heats up in the Capitol, Lara is also seeking to expand the state’s low-income health program to undocumented adults up to age 26. (Hart and Miller, 5/23)

Georgia Health News: State AG Backs Wider View Of Records In Hospital Court Fight 
The state’s attorney general has urged the Georgia Supreme Court to reverse a lower court opinion that barred access to Northside Hospital’s financial records. Chris Carr, in office since late last year, said in a Monday court filing that the Georgia Open Records Act is broader in its applications than what Northside Hospital has argued. (Miller, 5/23)

Atlanta Journal Constitution: GA Attorney General Weighs In On Northside Hospital Open Records Case 
Georgia law requires open government even when a private party is carrying out the public’s work, Attorney General Christopher Carr argued in a brief filed Monday in the Northside Hospital open records case before the Georgia Supreme Court… The Georgia Supreme Court asked the Attorney General’s office to file an opinion in the hotly-contested case that started when attorney E. Kendrick Smith requested documents from Northside under the state’s sunshine law. (Teegardin, 5/23)

Texas Tribune: Grieving Mom “Humbled” And “Relieved” After Senate Passes Autopsy Bill 
As the Texas Senate passed a bill on Tuesday that would ensure parents can view their deceased child’s body before an autopsy is conducted, a grieving mother shed tears from the gallery… Currently, parents need permission from a justice of the peace or medical examiner to see their deceased child if his or her death occurs outside a hospital or health care institution. (Mansoor, 5/23)

Austin American Statesman: Texas Senate Approves Bill Aimed At Identifying Postpartum Depression
The Texas Senate on Tuesday approved a bill aimed at increasing identification of postpartum depression among mothers participating in federally backed health care programs for low-income families. Under House Bill 2466 by Rep. Sarah Davis, R-West University Place, mothers who bring their kids in for checkups can get screened for postpartum depression by their children’s pediatricians. (Collins Walsh, 5/23)

Denver Post: New Leadville Hospital Dealt Major Setback After Feds Withhold Loan 
Lake County’s only hospital, St. Vincent in Leadville, has put plans to build a new facility on hold after financial projections came up shorter than expected, indicating the small hospital has recovered from the financial brink but still needs to improve its balance sheet before a much-needed building upgrade. In 2014, the hospital announced it would be shutting down because of critical building repairs and declining revenues, but service cuts and a partnership struck several months later with Centura Health — which also runs St. Anthony Summit Medical Center in Frisco — kept the 138-year-old hospital open. (5/23)

Sacramento Bee: Abortion Reversal Therapy Grows More Popular Despite Doubts
Several California clinics advertise the therapy, claiming to be able to undo the effects of the first dose containing mifepristone, which blocks progesterone production and causes the uterine lining to shed. The second set of pills contains misoprostol, which makes the uterus contract and initiates bleeding and cramping. More than 350 providers nationwide perform abortion reversal therapy, according to proponents of the treatment. (Caiola, 5/23)

Kansas City Star: Kansas Records: Several Hotline Calls Still Didn’t Save Adrian Jones 
The head of Kansas’ child welfare agency said earlier this month that social workers’ last contact with the family of Adrian Jones was in February 2012. But records obtained by The Kansas City Star on Tuesday show that social workers with the Kansas Department for Children and Families investigated a hotline call 10 months later, in December 2012. (Baurer and Woodall, 5/23)

Kansas City Star: Missouri Hospital And Clinic Settle Medicare Fraud Suit 
A Missouri hospital, clinic and infusion center have agreed to pay $34 million to settle a federal lawsuit that alleged they defrauded Medicare. The suit alleged that Mercy Hospital Springfield and its affiliate, Mercy Clinic Springfield Communities, had an improper financial agreement that provided kickbacks to oncologists based on the value of their chemotherapy referrals to the infusion center. (Marso, 5/23)

KQED: Valero Outage Prompts Benicia To Consider Industrial Safety Ordinance 
City officials would have greater oversight over the Valero refinery under a proposal set to be unveiled at the Benicia City Council meeting on Tuesday—a potential reform prompted by the major outage at the facility earlier this month. Mayor Elizabeth Patterson is proposing the city develop regulations similar to those in Contra Costa County, home to several refineries. That county’s industrial safety ordinance, considered to be one of the strongest in the country, requires oil refining facilities to undergo safety audits and have risk management plans. (Goldberg, 5/23)

Miami Herald: John Morgan ‘Prepared To Invest $100M’ In Medical Marijuana 
John Morgan spent nearly $7 million pushing two statewide ballot initiatives to expand medical marijuana throughout the state of Florida. But that’s a drop in the bucket compared to what the wealthy Orlando attorney and possible gubernatorial candidate says he’s prepared to invest in the industry now that it’s about to explode. (Smiley, 5/23)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Viewpoints: ‘Taxpayer-First Budget’ Inflicting Pain; Slow Rollout Of Menu Calorie Counts

A selection of opinions on health care from around the country.

The New York Times: A Budget That Promises Little But Pain
If President Trump’s 2018 budget, to be unveiled on Tuesday, was worthy of praise, you can bet Mr. Trump would be in Washington to bask in it. But his overseas trip keeps him at a distance physically, if not politically. As detailed in a preview on Monday by Mick Mulvaney, the White House budget director, the budget is a naked appeal to far-right Republicans aiming for a partisan rallying cry, even as a legislative victory most likely remains out of reach. Of 13 major initiatives in the budget, nine are drastic spending cuts, mostly aimed at low-income Americans. The biggest of those, by far, is an $866 billion reduction over 10 years in health care spending, mostly from Medicaid. (5/23)

The Washington Post: Another Bad Budget From Trump Targets The Poor
President Trump released a proposal for fiscal year 2018 discretionary spending — the “skinny budget” — two months ago, and the $1.1 trillion plan garnered deservedly poor reviews. In a nutshell, Mr. Trump would have gutted the Environmental Protection Agency, the National Institutes of Health and similarly crucial domestic agencies to fund a big boost in defense spending and border security. On Tuesday the White House releases its ideas for the remaining $3 trillion or so in federal spending, including large-scale entitlements such as Medicaid, and the early indications are that the priorities embodied in this sequel will be no more humane or rational. (5/22)

Miami Herald: The Federal Budget Released Today Puts Taxpayers First
This Tuesday, the president will release his Fiscal Year 2018 budget request. The title on the cover reads “A New Foundation for American Greatness.” But it’s what’s inside that’s more important. What people will see there is something that has been missing from Washington for a long time: “A Taxpayer First Budget.” … For years, we’ve focused on how we can help Americans receive taxpayer-funded assistance. Under President Trump’s leadership, we’re now looking at how we can respect both those who require assistance and the taxpayers who fund that support. For the first time in a long time, we’re putting taxpayers first. (Budget director Mick Mulvaney, 5/22)

The Washington Post: Trump’s First Budget: Why Attention Must Be Paid To It
So, with two partial exceptions, the President’s budget cannot be viewed as anything other than the standard issue, highly partisan, thoroughly uncompromising budgets we’ve seen from Republicans since the rise of Paul D. Ryan. The purpose of these budgets, which even Ryan himself has characterized as more “visionary” than realistic, is to shrink government outside of defense and give the savings to their wealthy donors in the form of regressive tax cuts. Their ultimate targets are Social Security, Medicare, and Medicaid, and with this budget, we can see that strategy evolving. (Jared Bernstein, 5/22)

Los Angeles Times: Trump’s Budget Plan Continues His Deceitful Attack On The Disabled — And Violates A Campaign Pledge
We pointed out back in March that Trump budget direct Mick Mulvaney displayed an alarming ignorance about Social Security disability benefits during an appearance on the CBS program “Face the Nation.” Now it turns out that there was method to his muttering. In effect, Mulvaney was telegraphing that the Trump White House was planning to cut disability benefits sharply. Axios reported Sunday that the Trump budget due out Tuesday will include $1.7 trillion in cuts to major social insurance and assistance programs, including food stamps, the Children’s Health Insurance Program, and Social Security disability. (Michael Hiltzik, 5/22)

Forbes: This Week’s Rollout Of Trump 2018 Budget Could Be His Biggest Failure Yet
On top of everything else, the Trump 2018 budget and OMB Director Mulvaney’s first testimony about it, which is currently scheduled for Wednesday before the House Budget Committee, is virtually certain to get much less attention because the Congressional Budget Office is now expected to release its estimates of the impact of the House-passed American Health Care Act that same day … and those numbers are very likely to be devastating. … CBO’s new AHCA numbers took on dramatically increased importance last week when the Republican leadership let it be known that the House might have to vote on the bill a second time because, as reported, it might not satisfy all of the Senate’s Byrd rule requirements. (Stan Collender, 5/21)

Philly.com: Slash Medicaid And You Jeopardize Care For Everyone
Just before launching his presidential campaign, Donald Trump promised that if elected, he would not cut funding for Medicaid. Chalk that up to yet another campaign promise reneged on. Trump’s budget proposal calls for more than $800 billion in cuts. … But even more is at stake than the lives of poor and disabled Americans, something the architects of these plans don’t seem to care much about. The cuts would jeopardize the entire health care system. (Robert I. Field, 5/23)

The Washington Post: Trump’s Budget Is So Cruel A Russian Propaganda Outfit Set The White House Straight
Trump, who once vowed “no cuts” to Medicaid, would now cut Medicaid by more than $800 billion, denying support to 10 million people. He lops a total of $1.7 trillion off that and similar programs, including food stamps, school lunches and Habitat for Humanity. Mulvaney, defending the budget Monday, made a frank admission: “This is, I think, the first time in a long time an administration has written a budget through the eyes of people who actually are paying the taxes. Too often in Washington I think we often think only on the recipient side.” (Dana Milbank, 5/22)

USA Today: Calorie Labeling Isn’t Rocket Science
Watching your weight while grabbing a bite at your favorite chain restaurant, supermarket food bar or convenience store was supposed to get easier under a 2010 federal law requiring that certain businesses post calorie counts. This isn’t rocket science. But after seven years, the final posting rules are still on hold, and this month the Trump administration delayed compliance again. If the newest date — May 7, 2018 — holds, it will have taken nearly as long to post calorie counts as it did to put a man on the moon after President Kennedy announced this ambitious goal in 1961. (5/22)

USA Today: Pizza Makers Weigh In On Calories
America’s pizza delivery companies want a reasonable 21st century solution to the nutrition labeling challenge: We simply want approval to put the information where our customers look for it. At Domino’s, we’ve been posting nutritional information on our website for nearly 14 years because it’s the easiest way to provide the information to our customers where they will most likely see it. Unfortunately, the menu labeling rule as written does not make accommodations for brands whose majority of orders come from people who order online. The rule seems better suited to sit-down chains and fast-food joints. (Tim McIntyre, 5/22)

Forbes: North Carolina Poised To Reform Welfare Programs To Protect Truly Needy
A provision in the [North Carolina] Senate’s budget proposal, spearheaded by Sen. Ralph Hise, would rein in frequently-exploited loopholes in the state’s food stamps and Medicaid systems, bringing overdue protection to valuable resources for families who need them most and protecting the system from abuse. North Carolina’s current broad-based eligibility expansion in food stamps has been ripe for reform since 2010 when former Gov. Bev Perdue took advantage of a loophole that expanded welfare eligibility beyond the federal limits. (Josh Archambault, 5/22)

The New York Times: Hey Parents, Surprise, Fruit Juice Is Not Fruit
Many American children consume more than half of their fruit as juice, and the American Academy of Pediatrics has issued new guidelines clarifying its stance on that substitution: For most kids, it’s a bad thing. The new guidelines aren’t just intended to persuade pediatricians to talk to parents about the disadvantages of the ubiquitous juice box. They also take aim at the federal government’s Dietary Guidelines for Americans, which are the basis for the nutritional guidelines in the Department of Agriculture’s School Lunch Program — guidelines that allow for the replacement of half of the recommended daily servings of fruits with 100 percent fruit juice. (KJ Dell’Antonia, 5/22)

Louisville Courier-Journal: Fighting The Opioid Epidemic
As many as two million Americans are struggling with prescription drug addiction across the nation. Tragically, heroin and opioid overdoses claim an average of 91 lives every day. This startling trend continues to get worse, especially here in Kentucky. … I made securing crucial new resources to help combat heroin and prescription opioid abuse a top priority in the government funding bill that was recently signed into law. These new resources, which dedicates substantial funding through the appropriations process to address this crisis, will allow us to take another step towards ending it. (Senate Majority Leader Mitch McConnell (R-Ky.), 5/23)

Stat: Training Medical Students How To Teach Helps Them Embrace Ambiguity
In volunteering to help teach the course, neither of us anticipated that questions asked by first-year medical students would heighten our curiosity and passion for medicine. But they did. We looked for answers and followed up with the students who asked them. In the process, we also reflected on how to be better self-directed learners and more effective teachers. (Jasmine Rana and Taylor Freret, 5/22)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Price Tag For Universal Health Care In California Would Run $400B

A state Senate panel considering the measure says that money for existing public programs could cover half the cost of a single-payer system to cover all 39 million Californians. But the rest might have to come from new taxes — a serious political obstacle.

The Associated Press: $400 Billion Price Tag For California Single-Payer Bill
A California bill that would eliminate health insurance companies and provide government-funded health coverage for everyone in the state would cost $400 billion and require significant tax increases, legislative analysts said Monday. Much of the cost would be offset by existing state, federal and private spending on health coverage, the analysis found, but total health care costs would increase by an estimated $50 billion to $100 billion a year. That’s a massive sum in a state where the entire general fund budget is $125 billion. (5/22)

California Healthline: Tab For Single-Payer Proposal In California Could Run $400B
A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis. The report by the state Senate Appropriations Committee, issued Monday, put a price tag for the first time on legislation that would make the state responsible for providing health coverage to all 39 million Californians. The state-run system would supplant existing employer health insurance in California, as well as coverage through public programs such as Medicaid and Medicare. (Terhune, 5/23)

Sacramento Bee: Universal Health Care Cost In California $400 Billion A Year
The price tag is in: It would cost $400 billion to remake California’s health insurance marketplace and create a publicly funded universal heath care system, according to a state financial analysis released Monday. California would have to find an additional $200 billion per year, including in new tax revenues, to create a so-called “single-payer” system, the analysis by the Senate Appropriations Committee found. (Hart, 5/22)

KQED: Single-Payer Plan’s Price Tag In California: $400 Billion Per Year 
It would cost the state of California an estimated $400 billion per year to cover all of its 39 million residents, according to a staff analysis by the state’s Senate Appropriation Committee. That’s more than twice the state’s total annual budget of $180 billion. But the main legislative advocate for single-payer, Senator Ricardo Lara (D-Bell Gardens), explained the state could get access to half of that amount, $200 billion, by shifting over what it already spends on Medicare, Medi-Cal and other state-run health services. (Feibel, 5/22)

POLITICO Pro: California Lawmakers Get First Look At Single-Payer Cost: $400 Billion 
California’s universal health care bill could cost the state about $400 billion a year. Half of that could be covered by existing federal, state and local funding streams, but additional taxes would be required to make up the balance, according to a state committee fiscal analysis released Monday. While the bill’s financing has yet be worked out, the Senate appropriations committee’s report provides the first insight into what an audacious overhaul of the state’s health system could cost. It concluded that $200 billion would be needed in new taxes. (Colliver, 5/22)

San Jose Mercury News: Healthy California Act Annual Price Tag: $400 Billion
The annual price tag for California’s proposed universal, single-payer health care system would come to a staggering $400 billion and possibly trigger substantial tax increases, according to a state review released Monday. That eye-popping number means the cost of Senate Bill 562, known as The Healthy California Act, would be three times higher than the state’s proposed $124 billion general fund budget for next year. (Seipel, 5/22)

San Francisco Chronicle: Single-Payer Health Care Would Cost More Than California Budget
Creating a single-payer health care system in California would cost $400 billion a year — including $200 billion in new tax revenue, according to an analysis of legislation released Monday by the Senate Appropriations Committee. The projected cost far surpasses the annual state budget of $180 billion, and skeptics of the bill say the price tag is “a nonstarter.” (Ho, 5/22)

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New Hampshire Governor Supports Moving State To High-Risk Pool Model

Meanwhile, the state’s conservatives speak out against reported rate increases for next year. “The latest premium increases under Obamacare will break many families’ budgets,” says New Hampshire Republican State Committee Chairman Jeanie Forrester.

New Hampshire Union Leader: Sununu Proposes Return Of High-Risk Pool
Gov. Chris Sununu and the state’s top insurance official on Monday backed a revision in state law that would allow officials to waive some of the provisions of Obamacare — including provisions addressing pre-existing conditions. In a joint statement, Sununu and New Hampshire Insurance Commissioner Roger Sevigny endorsed an amendment to House Bill 469, which they said would authorize Sevigny to seek federal waivers if they would keep insurance affordable and available in the state. On Sunday, the New Hampshire Sunday News reported about a document that details a potential premium increase of 44 percent next year on the Obamacare Exchange. (Hayward, 5/23)

New Hampshire Union Leader: NH Conservative Groups Critical Of Possible Obamacare Rate Increases 
Granite State conservative groups weighed in Monday on a report in the New Hampshire Sunday News that health insurance policies through the Affordable Care Act could see high rate increases in the coming year. “The latest premium increases under Obamacare will break many families’ budgets. The law is obviously failing working people and is doing far more harm than good. Republicans in Congress are actively working to reform our nation’s healthcare system with a plan that lowers premiums while ensuring folks have access to quality coverage,” said New Hampshire Republican State Committee Chairman Jeanie Forrester. (5/22)

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$2M Ad Blitz In Support Of GOP Health Plan Targets Vulnerable Republicans’ Districts

The group launching the campaign, the American Action Network, is aligned with House Speaker Paul Ryan (R-Wis.).

The Hill: Ryan-Allied Group Launches $2M Ad Campaign Ahead Of Healthcare CBO Score 
An outside GOP group aligned with Speaker Paul Ryan (R-Wis.) unveiled a $2 million TV ad blitz on Tuesday defending the legislation to replace ObamaCare ahead of the highly anticipated Congressional Budget Office analysis of its effects. American Action Network’s ad will run in 21 House districts and nationally on MSNBC’s “Morning Joe” to tout the GOP’s bill, known as the American Health Care Act. (Marcos, 5/23)

Los Angeles Times: Conservative Group Runs Ads Thanking California GOP For Health Care Vote
A conservative advocacy group will run television ads thanking six California Republicans for voting for the GOP bill to roll back the Affordable Care Act. All 14 Republicans in California’s congressional delegation voted for the bill, called the Affordable Health Care Act, when it passed the House without Democratic support last month. Democrats have pledged to make it a campaign issue. (Wire, 5/22)

And in other election-related news —

Kaiser Health News: Health Debate Heats Up In Montana For This Week’s Special Election
Montana’s one and only seat in the House of Representatives is up for grabs, and in the final weekend before Thursday’s special election, the underdog Democrat was hammering the Republican health care bill in TV ads. The ads open with Democrat Rob Quist asking, “Did you know half of all Montanans have a preexisting condition?” He then attacks Republican challenger Greg Gianforte for supporting the House-passed American Health Care Act, which would allow states to drop preexisting conditions protections. (Whitney, 5/23)

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Disagreement Over Preexisting Conditions Reveals Deep Intra-Party Divide Over Health Law

The push-and-pull between moderate and conservative Republicans is not limited to the House debates. Cracks in the Senate are showing as well.

The Hill: Divisions Emerge In The Senate On Pre-Existing Conditions 
Senate Republicans are showing early divisions over what to do about ObamaCare’s protections for people with pre-existing conditions. Some conservatives, including Sen. Mike Lee (R-Utah), want to simply repeal those provisions and other ObamaCare regulations and leave them up to the states. But advocates of a more centrist approach, like Sen. Bill Cassidy (R-La.), are speaking out in favor of pre-existing condition protections and endorsing a “Jimmy Kimmel test” for the bill, where no one can be denied coverage.  (Sullivan, 5/23)

Nashville Tennessean: Senate Republicans Consider ‘Two-Step’ Process For Obamacare Replacement
Republican senators working to craft their own bill to replace the Affordable Care Act are looking at possibly phasing out the requirement that Americans buy health insurance instead of ending it abruptly. Sen. Lamar Alexander, who chairs the committee that oversees health care issues, said Monday a “two-step” process for ending the insurance mandate and other provisions is something that senators have been discussing. (Collins and Whetstone, 5/22)

The Hill: Conservative Groups Press Senate On ObamaCare Repeal 
Two conservative groups are seeking to influence the Senate’s healthcare bill with a list of recommendations aimed at keeping the bill to the right. Americans for Prosperity and Freedom Partners detailed their requests in a letter sent Monday to Senate Majority Leader Mitch McConnell (R-Ky.), who has convened a working group of senators to examine what ObamaCare repeal-and-replace bill can pass the chamber. (Roubein, 5/22)

Kaiser Health News: GOP’s Health Bill Could Undercut Some Coverage In Job-Based Insurance
The American Health Care Act that recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too. The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, drugs and maternity care. (Andrews, 5/23)

Meanwhile, back in the House —

Politico Pro: House Panel To Start Work On ‘Third Bucket’ Obamacare Bills 
House Republicans on Wednesday plan to start work on three Obamacare replacement bills they’re hoping to pass with bipartisan support, sources familiar with the matter said. These bills are part of the so-called third bucket of the GOP repeal and replace strategy — legislation that doesn’t fit the fast-track budget reconciliation procedure being used to get Obamacare repeal through the Senate, but which further advances the Republican vision of reshaping health care. (Haberkorn and Everett, 5/22)

And, a look at how many people have gained coverage under the Affordable Care Act —

The New York Times: Nearly 20 Million Have Gained Health Insurance Since 2010
The number of Americans without health insurance has fallen drastically in recent years, according to new data from the National Center for Health Statistics. In 2016, there were 28.6 million Americans without health insurance, down from more than 48 million in 2010. Some 12.4 percent of adults aged 18 to 24 were uninsured, 69.2 percent were covered by private plans and 20 percent had public coverage. (Bakalar, 5/22)

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Head Of CMS Accused Of Offering Insurers Quid Pro Quo For Support Of GOP Health Bill

According to a Los Angeles Times investigation, during a meeting with industry officials, Centers for Medicare and Medicaid Services head Seema Verma linked payment of the insurers’ subsidies to providers’ support of the American Health Care Act.

The Hill: Dems Demand Answers On Report That Admin Tried To Trade ObamaCare Payments 
Top Democrats are demanding answers from the Trump administration about whether a top healthcare official offered insurance companies a quid pro quo to get their support for the GOP’s ObamaCare repeal bill. Centers for Medicare & Medicaid Services Administrator Seema Verma sought political support from insurance companies for the American Health Care Act (AHCA) by offering a deal to continue funding congressionally mandated cost-sharing reduction (CSR) payments, the Los Angeles Times reported. (Weixel, 5/22)

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Tab For Single-Payer Proposal In California Could Run $400 Billion

A proposed single-payer health system in California would cost about $400 billion annually, with up to half of that money coming from a new payroll tax on workers and employers, according to a state analysis.

The report by the state Senate Appropriations Committee, issued Monday, put a price tag for the first time on legislation that would make the state responsible for providing health coverage to all 39 million Californians. The state-run system would supplant existing employer health insurance in California, as well as coverage through public programs such as Medicaid and Medicare.

One of the chief obstacles to the legislation, Senate Bill 562, is the prospect of higher taxes. It also has exposed deep divisions among Democrats over whether now is the time to pursue single-payer — just as the Affordable Care Act comes under attack from Republicans in Washington. At a hearing Monday, one Democratic legislator questioned whether the state can effectively manage a universal health care system.

The legislative analysis estimates a total annual cost of $400 billion to enact the Healthy California program for all residents, regardless of their immigration status.

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To put that in perspective, about $367 billion was spent on health care last year statewide, including public and private spending by employers and consumers, according to the UCLA Center for Health Policy Research.

Legislative analysts said federal, state and local taxpayer funding of about $200 billion a year for existing programs could be available to offset the overall tab of $400 billion for universal coverage. But additional tax revenue would be needed to foot the other half of the cost, according to the report, which raised the possibility of a 15 percent payroll tax on earned income.

Of course, the shift to a single-payer system should reduce current spending on health insurance by employers and workers, so those savings could offset some of the new taxes, the analysts said. The report estimated that employers and employees in California spend $100 billion to $150 billion a year now on health insurance and medical care.

“Total new spending required under the bill would be between $50 billion and $100 billion per year,” the report said.

The Senate analysis noted that all of its projections were “subject to enormous uncertainty” because the bill would mark “unprecedented change in a large health care market.”

A single-payer system likely “would be more efficient in delivering health care,” said Larry Levitt, a senior vice president at the Kaiser Family Foundation. (California Healthline is produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.)

But the proposal expands coverage to all and eliminates premiums, copayments and deductibles for enrollees, and that would cost more money, Levitt said. “You can bet that opponents will highlight the 15 percent tax, even though there are also big premium savings for employers and individuals,” he added.

State Sen. Ricardo Lara (D-Bell Gardens), a chief sponsor of the legislation, said the present system is unsustainable because health spending continues to grow faster than the overall economy, making coverage unaffordable for too many people.

Lara touted the potential savings from creating a public plan with greater bargaining power and cutting out the administrative overhead and profits of private health insurers acting as middlemen.

Overall, many of the details behind California’s single-payer proposal remain in flux. Under questioning from fellow lawmakers, Lara said the 15 percent payroll tax is “hypothetical” and “we don’t have a financing mechanism yet for this bill.”

Lara said he has sought a review from researchers at the University of Massachusetts-Amherst into potential funding sources for the measure.

Lara also said there’s no guarantee the Trump administration would grant the federal waivers necessary for California to shift Medicare and Medicaid funding into a single pot for universal health care.

With so many unknowns, the Senate Appropriations Committee didn’t vote on the measure Monday. Backers of the legislation are hopeful for a vote in the full Senate next month and then lawmakers can continue to work on the financial aspects during the summer.

At Monday’s hearing, many consumers pointed to Medicare as a model for how single-payer works now and urged lawmakers to make California the proving ground for how it can succeed at the state level.

Business groups and health insurers spoke out in opposition, saying it would lead to massive disruption and escalating costs. Even if it passes the legislature, California Gov. Jerry Brown hasn’t endorsed the idea and new taxes may require a statewide ballot measure, which are always hard-fought campaigns.

The California Chamber of Commerce said the costs would likely be far higher than what was projected and the taxes imposed on employers would trigger major job losses.

State Sen. Jim Nielsen (R-Tehama), a member of the Appropriations panel, expressed similar concerns. “The impact on employers will be astounding,” Nielsen said. “How can you say this will be fiscally prudent for the state? The state has never gotten anything right in health care.”

State Sen. Steven Bradford (D-Gardena) also preached caution, questioning whether state agencies are up to the task. “I don’t want California to move toward a program that is not sustainable and one that we can’t manage,” Bradford said.

Other states have taken a close look at single-payer and balked. Colorado voters rejected a ballot measure last year that would have used payroll taxes to fund a near-universal coverage system.

This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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GOP’s Health Bill Could Undercut Some Coverage In Job-Based Insurance

This week, I answer questions about how the Republican proposal to overhaul the health law could affect job-based insurance and what the penalties for not having continuous coverage mean. Perhaps anticipating a spell of uninsurance, another reader wondered if people can rely on the emergency department for routine care.

Q: Will employer-based health care be affected by the new Republican plan?

The American Health Care Act that recently passed the House would fundamentally change the individual insurance market, and it could significantly alter coverage for people who get coverage through their employers too.

Michelle AndrewsInsuring Your Health

The bill would allow states to opt out of some of the requirements of the Affordable Care Act, including no longer requiring plans sold on the individual market to cover 10 “essential health benefits,” such as hospitalization, drugs and maternity care.

Small businesses (generally companies with 50 or fewer employees) in those states would also be affected by the change.

Plans offered by large employers have never been required to cover the essential health benefits, so the bill wouldn’t change their obligations. Many of them, however, provide comprehensive coverage that includes many of these benefits.  

But here’s where it gets tricky. The ACA placed caps on how much consumers can be required to pay out-of-pocket in deductibles, copays and coinsurance every year, and they apply to most plans, including large employer plans. In 2017, the spending limit is $7,150 for an individual plan and $14,300 for family coverage. Yet there’s a catch: The spending limits apply only to services covered by the essential health benefits. Insurers could charge people any amount for services deemed nonessential by the states.

Similarly, the law prohibits insurers from imposing lifetime or annual dollar limits on services — but only if those services are related to the essential health benefits.

In addition, if any single state weakened its essential health benefits requirements, it could affect large employer plans in every state, analysts say. That’s because these employers, who often operate in multiple states, are allowed to pick which state’s definition of essential health benefits they want to use in determining what counts toward consumer spending caps and annual and lifetime coverage limits.

“If you eliminate [the federal essential health benefits] requirement you could see a lot of state variation, and there could be an incentive for companies that are looking to save money to pick a state” with skimpier requirements, said Sarah Lueck, senior policy analyst at the Center on Budget and Policy Priorities.

Q: I keep hearing that nobody in the United States is ever refused medical care — that whether they can afford it or not a hospital can’t refuse them treatment. If this is the case, why couldn’t an uninsured person simply go to the front desk at the hospital and ask for treatment, which by law can’t be denied, such as, “I’m here for my annual physical, or for a screening colonoscopy”?

If you are having chest pains or you just sliced your hand open while carving a chicken, you can go to nearly any hospital with an emergency department, and — under the federal Emergency Medical Treatment and Active Labor Act (EMTALA) — the staff is obligated to conduct a medical exam to see if you need emergency care. If so, they must try to stabilize your condition, whether or not you have insurance.

The key word here is “emergency.” If you’re due for a colonoscopy to screen for cancer, unless you have symptoms such as severe pain or rectal bleeding, emergency department personnel wouldn’t likely order the exam, said Dr. Jesse Pines, a professor of emergency medicine and health policy at George Washington University, in Washington, D.C.

“It’s not the standard of care to do screening tests in the emergency department,” Pines said, noting in that situation the appropriate next step would be to refer you to a local gastroenterologist who could perform the exam.

Even though the law requires hospitals to evaluate anyone who comes in the door, being uninsured doesn’t let people off the hook financially. You’ll still likely get bills from the hospital and physicians for any care you receive, Pines said.

Q: The Republican proposal says people who don’t maintain “continuous coverage” would have to pay extra for their insurance. What does that mean? 

Under the bill passed by the House, people who have a break in their health insurance coverage of more than 63 days in a year would be hit with a 30 percent premium surcharge for a year after buying a new plan on the individual market.

In contrast, under the ACA’s “individual mandate,” people are required to have health insurance or pay a fine equal to the greater of 2.5 percent of their income or $695 per adult. They’re allowed a break of no more than two continuous months every year before the penalty kicks in for the months they were without coverage.

The continuous coverage requirement is the Republicans’ preferred strategy to encourage people to get health insurance. But some analysts have questioned how effective it would be. They point out that, whereas the ACA penalizes people for not having insurance on an ongoing basis, the AHCA penalty kicks in only when people try to buy coverage after a break. It could actually discourage healthy people from getting back into the market unless they’re sick.

In addition, the AHCA penalty, which is based on a plan’s premium, would likely have a greater impact on older people, whose premiums are relatively higher, and those with lower incomes, said Sara Collins, a vice president at the Commonwealth Fund, who authored an analysis of the impact of the penalties.

Please visit khn.org/columnists to send comments or ideas for future topics for the Insuring Your Health column.

Categories: Health Care Costs, Health Industry, Insurance, Insuring Your Health, Repeal And Replace Watch, The Health Law

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Viewpoints: Opening For Medicare Long-Term Care?; Texas Seeks Planned Parenthood Money

A selection of opinions on health care from around the country.

Forbes: Congress May Open The Door To Some Medicare Long-Term Care
Congress is taking a small, but important, step towards expanding Medicare to include some long-term supports and services. … the biggest changes would apply to the care provided by managed care programs. One would expand the use of those special needs plans, which are explicitly aimed at people with chronic conditions and high medical needs. Some of these programs already provide supports and services as part of their benefit packages but they remain relatively small. The other would give Medicare Advantage plans important new flexibility to offer social supports and other non-medical services to their members. (Howard Gleckman, 5/17)

Los Angeles Times: Texas Wants To Use Federal Money To Attack Planned Parenthood — And Might Get It
Five years ago, Texas voluntarily gave up $30 million a year in federal funding for women’s health programs, just so it could exclude Planned Parenthood from the roster of approved providers. Instead, the state established its own so-called Healthy Texas Women program in which it could set its own rules. Now, staggering under the cost of the program and hopeful that the Trump administration will see things its way, Texas is applying for a restoration of the federal subsidy under the same terms. Signals from the White House and the Department of Health and Human Services suggest the state might succeed. If so, some other states may follow, and the cause of women’s reproductive health will suffer a major blow. (Michael Hiltzik, 5/18)

Des Moines Register: Health Has No Religion; Health Care Shouldn’t Have One Either
A policy with wide-ranging consequences for patients of Mercy Medical Center was made public recently through a Facebook post on a page for mothers. It came from a woman who was denied a tubal ligation after having a cesarean section because Mercy is a Catholic hospital. In verifying that prohibition, I discovered other religious-based restrictions at Mercy and 547 other Catholic hospitals across the U.S. How are these institutions fulfilling their legal and professional obligations to their patients and the taxpayers who subsidize them with billions of dollars? (Rekha Basu, 5/18)

Next Avenue: Aging at Home Will Be Harder With Medicaid Cuts
Proposed cuts to Medicaid under the American Health Care Act passed by the House recently could change life for (Ti) Randall and many others. Medicaid is not only an insurance program for low-income people. It’s a lifeline for older adults like Randall who need supportive services to stay at home. At-home services are a lifeline for Medicaid as well, which would otherwise be paying for more expensive care in an institutional setting. (Beth Baker, 5/17)

Stat: Doctors Must Be Honest About Their Own Biases When Treating People In Pain
Many doctors enter medicine to prevent and treat suffering. Yet it seems that as we advance in our training, the more bothersome and frustrating evaluations of pain become. We want to make people feel better, but we don’t always know why or how much someone is hurting. And there are consequences of both prescribing too much or too little pain relief. So we turn to this language to minimize the pain we don’t understand or can’t fix. Unfortunately, this tends to occur more often with patients of color. (Katherine Brooks, 5/17)

Stat: Why Taking Drugs To Treat Addiction Doesn’t Mean You’re ‘Still Addicted’
My patient was lucky: He didn’t die because of a widely held, and completely inaccurate, definition of addiction — one that was recently supported by remarks from Health and Human Services Secretary Tom Price, who disparaged medication use as merely “substituting one opioid for another.” But until politicians, the media, and the public catch up with addiction science, we will not be able to stop the epidemic of overdose deaths. (Sarah E. Wakeman and Maia Szalavitz, 5/18)

JAMA: Primary Care Of Patients With Chronic Pain
Primary care physicians have the responsibility for the care of patients with chronic pain, often in follow-up to an episode of acute pain treated in an urgent care center, emergency department, or specialty clinic setting. The lack of a full understanding of how chronic pain differs from acute pain can lead to all pain being treated as acute pain, often with opioids. The current widespread use of opioids is essentially a case-finding system that identifies the roughly one-sixth of the adult population particularly susceptible to opioid misuse, sometimes leading to escalating doses, a shift to illegal nonprescription opioids, addiction, and unintentional overdose. (Jill Schneiderhan, Daniel Clauw and Thomas L. Schwenk, 5/18)

Des Moines Register: Iowa Should Allow Needle Exchange Programs
The Iowa Department of Public Health in February released its first report on hepatitis C infections in this state. The number of Iowans diagnosed with the liver-damaging virus that can lead to death has increased nearly three-fold, from 754 cases in 2000 to 2,235 cases in 2015. The number of infected Iowans aged 18 to 30 has quadrupled in recent years. … preventing the spread of the virus is so important, and Iowa is not doing all it can. Unlike several other states, we do not have a needle exchange program, which is an important part of infection prevention. (5/18)

The (Eugene, Ore.) Register-Guard: Oregon’s Medicaid Mess
“Troubling” doesn’t begin to describe the current situation at the Oregon Health Authority, which, state auditors have discovered, has been doling out hundreds of millions of dollars to tens of thousands of Medicaid recipients who may or may not be eligible for the benefits. … About three years ago, Oregon got permission from federal regulators to temporarily quit verifying that each OHP patient still qualified for Medicaid. At the time, the state was in the throes of extricating itself from Cover Oregon, which failed spectacularly in setting up an online program to enroll people in health care. Somehow, the state never got around to resuming these routine eligibility checks. (5/19)

Morning Consult: Turning Up The Volume On Over-The-Counter Hearing Aids
Hearing aids currently cost around $5,000 per pair. Fitting and tuning are not covered by Medicare or most private insurance plans. Unable to afford these out-of-pocket costs, nearly 80 percent of Americans with hearing loss choose to suffer on their own. … It shouldn’t be this way. The technology exists to deliver relief to these patients and the families that love them. But government has to act to ensure that those who stand to gain the most from that innovation are able to access it. The Over-the-Counter Hearing Aid Act of 2017 would be a needed update to federal policy. (Rep. Joe Kennedy III (R-Mass.) and Rep. Marsha Blackburn (R-Tenn.), 5/18)

The Kansas City Star: Vital Diabetes Device Denied By Medicare
I’m angry because people like me are being denied an essential medical treatment by Medicare, the federal program that’s supposed to be supporting seniors, not forcing them to abandon an essential medical device. The device I use is called Omnipod. It’s a wireless insulin delivery pump. … A few months before turning 65, I was told that unlike almost all private insurers in this country, Medicare wouldn’t pay for Omnipod. And I was even more confused to learn that this was the only FDA-approved insulin pump not covered by Medicare. (Susan Vietti, 5/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Perspectives On Health Debate: GOP Disregard Of ACA Maintenance; Miss USA’s Health Stand

Even as other issues are overtaking the air waves, some opinion writers keep an eye on the health debate.

The New York Times: Trumpcare Is Already Hurting Trump Country
The mere threat that Obamacare will be dismantled or radically changed — either by Congress or by President Trump himself — has persuaded several big insurance companies to stop selling policies or significantly raise premiums. The practical effect is that some lower-income and middle-class families may have no good options for insurance and will have to spend more on health care. (5/19)

Los Angeles Times: Miss USA Spoke For Many Americans When She Said Healthcare Isn’t A Right
[W]e probably shouldn’t be surprised that the person who has most clearly articulated America’s core philosophical belief when it comes to healthcare is our newly crowned Miss USA, Kara McCullough. She was asked at this week’s celebration of swimsuits, evening gowns and womanhood whether she thought “affordable healthcare for all U.S. citizens is a right or a privilege.” “I’m definitely going to say it’s a privilege,” the 25-year-old answered without hesitation. … Miss USA initially was voicing a position common to many Americans, mostly conservatives — a stance that has prevented the United States from joining all other developed countries in providing its citizens with universal coverage. (David Lazarus, 5/19)

Morning Consult: Despite What You’ve Read, Many Small Businesses Support Obamacare
Now, the latest round of stories on the Republican attempt to repeal and replace the Affordable Care Act give the impression that America’s small businesses will be glad to see the ACA go if and when Congress manages to repeal it. While most small business owners agree there are portions of the ACA that can and should be improved, polling shows that a majority of small businesses actually prefer the current law over the GOP replacement plan, and that key provisions of the ACA are helping entrepreneurs succeed. (John Arensmeyer, 5/19)

Medscape: Is Medicaid Only For Those Who ‘Deserve’ It?
I am irritated today. Why? Because we keep getting proposals from Washington that suggest that people ought to work if they want to be eligible for Medicaid. What bothers me about this is that it is a reversion to 19th-century thinking, that the people who deserve healthcare are only those who earn it. This was the attitude when Charles Dickens wrote Oliver Twist, which was a bit biographical in that his own dad was hauled off to debtor’s prison when the author was a child. He bemoaned the idea that only the “deserving” poor should get our aid. (Art Caplan, 5/18)

The New York Times: The Best Replacement For Obamacare Is Medicaid
In defending their efforts to repeal the Affordable Care Act, Republican leaders in Congress argue that the insurance marketplaces created by the law are failing. They aren’t completely wrong. Trouble began with faulty websites during the rollout in 2013. Since then, enrollment continues to be below expectations. Obamacare plans often have higher premiums and out-of-pocket expenses than expected. Some markets, mainly in rural areas, may not attract a single insurer in 2018. And insurers that stay are likely to impose double-digit premium increases. (Michael S. Sparer, 5/18)

Louisville (Ky.) Courier-Journal: A Country Of The Well, A Country Of The Sick
I am alarmed at many of the ideas underlying the House Republican health care plan and the administration’s proposed budget. Each seems to be driven by an idea that there is an “us” (rich, healthy, young) and a “them” (poor, sick, old). The winners and the losers, each residing in their unchanging, indisputable categories. This cold-blooded social Darwinism is poised to deprive millions of health care, while millions more will find insurance prices prohibitive and go without basic health care, or the astronomical cost of insurance and health care will bankrupt them. According to the logic of this health care plan, it is their own fault for having pre-existing conditions, or being old, or poor. (Sara T. Baker, 5/18)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Research Roundup: Medicaid Wellness Programs; Preexisting Conditions; Changes In Subsidies

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: Iowa’s Medicaid Expansion Promoted Healthy Behaviors But Was Challenging To Implement And Attracted Few Participants
As part of Iowa’s Medicaid expansion, the Healthy Behaviors Program was designed to provide members with incentives to complete specified healthy activities in return for waiving monthly premiums. We used claims data and interviews to document the first year (2014) of the program’s implementation. Healthy activities completion rates did not exceed 17 percent. Interviews with members and clinic managers revealed low levels of awareness of the program’s existence, deficits in knowledge about how the program works, and a variety of barriers to activity completion. … The results suggest that efforts by federal and state governments to reform Medicaid by shifting responsibility onto program members for healthy behaviors are unlikely to succeed. (Askelson et al., 5/2)

JAMA: Trends And Patterns Of Geographic Variation In Cardiovascular Mortality Among US Counties, 1980-2014
In this study of small area estimation models applied to death records from the National Center for Health Statistics, the difference between county-level mortality rates declined substantially over the past 35 years for both ischemic heart disease and stroke; however, large differences remained in 2014. The largest concentration of counties with high cardiovascular disease mortality extended from southeastern Oklahoma along the Mississippi River Valley to eastern Kentucky, and several cardiovascular disease conditions were clustered substantially outside the South, including atrial fibrillation (Northwest), aortic aneurysm (Midwest), and endocarditis (Mountain West and Alaska). (Roth et al., 5/16)

The New England Journal of Medicine: Aerobic Or Resistance Exercise, Or Both, In Dieting Obese Older Adults
In this clinical trial involving 160 obese older adults, we evaluated the effectiveness of several exercise modes in reversing frailty and preventing reduction in muscle and bone mass induced by weight loss. Participants were randomly assigned to a weight-management program plus one of three exercise programs — aerobic training, resistance training, or combined aerobic and resistance training — or to a control group (no weight-management or exercise program). … Of the methods tested, weight loss plus combined aerobic and resistance exercise was the most effective in improving functional status of obese older adults. (Villareal et al., 5/18)

JAMA Internal Medicine: Perceived Discrimination Experienced By Physician Mothers And Desired Workplace Changes
In a large cross-sectional survey of physician mothers, we found that perceived discrimination is common, affecting 4 of 5 respondents, including about two-thirds of the respondents who reported discrimination based on gender and more than a third who reported maternal discrimination. The overlap of groups reporting gender and maternal discrimination was less than half, suggesting that they are somewhat different phenomena. (Adesoye et al., 5/8)

International Journal of Health Services: Availability Of Outpatient Mental Health Care By Pediatricians And Child Psychiatrists In Five U.S. Cities
The authors sought to assess the availability of outpatient mental health care through pediatrician and child psychiatrist offices in the United States and to characterize differences in appointment availability by location, provider type, and insurance across five cities. To do so, the authors posed as parents of a 12-year-old child with depression, gave a predetermined insurance type, and asked to make the first available appointment with the specified provider. They called the offices of 601 individual pediatricians and 312 child psychiatrists located in five U.S. cities and listed as in-network by Blue Cross Blue Shield, one of the largest private insurers in the United States. Appointments were obtained with 40% of the pediatricians and 17% of the child psychiatrists. The mean wait time for psychiatry appointments was 30 days longer than for pediatric appointments. (Cama et al., 5/9)

The Kaiser Family Foundation: Gaps in Coverage Among People With Pre-Existing Conditions
The American Health Care Act (AHCA), which has passed the House of Representatives, contains a controversial provision that would allow states to waive community rating in the individual insurance market. In this brief we estimate the number of people with pre-existing conditions who might be affected by such a policy. … Using the most recent National Health Interview Survey (NHIS), we estimate that 27.4 million non-elderly adults nationally had a gap in coverage of at least several months in 2015. This includes 6.3 million people (or 23% of everyone with at least a several-month gap) who have a pre-existing condition that would have led to a denial of insurance in the pre-ACA individual market and would lead to a substantial premium surcharge under AHCA community rating waiver. (Levitt et al., 5/17)

Urban Institute: Premium Tax Credits Tied To Age Versus Income And Available Premiums: Differences By Age, Income, And Geography
This paper compares tax credits offered through the Affordable Care Act (ACA) with those in the American Health Care Act (AHCA). They examined the premium levels in 10 cities, five of which have relatively low premiums and five of which have relatively high premiums. The authors find that younger people typically receive larger insurance premium tax credits under the AHCA, while older adults typically receive larger premium tax credits under the ACA. The analysis also shows that lower-income older adults currently receive higher tax credits under the ACA than they would under the AHCA regardless of where they live. (Holahan, Blumberg and Wengle, 5/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Viewpoints: New FDA Commissioner Will Wrestle With Several High-Profile Issues; Reactions To The Administration’s Stepped-Up War On Drugs

A selection of public health opinions from around the country.

The Washington Post: Trump’s New FDA Commissioner Has A Huge Decision To Make
Last week, the Senate confirmed Scott Gottlieb to lead the Food and Drug Administration. That puts the new commissioner in the hot seat to tackle several high-profile issues that are critically important to patients and consumers. Among the most important decisions he’ll have to make early on is whether to accept industry proposals to reduce standards under which drugs can be advertised — regulations that have protected patients for more than 50 years. (William B. Schultz, 5/16)

Lexington Herald-Leader: Paul Right To Reject Failed War On Drugs
The need for criminal justice reform is one of the precious few policy areas that garners widespread bipartisan agreement. Yet, Attorney General Jeff Sessions — a former U.S. attorney and longtime anti-drug crime warrior — reversed an Obama-era policy aimed at keeping non-violent drug offenders out of the federal prison system. Sessions ordered federal prosecutors to charge forward with a policy that has generated enormous human and economic pain with no quantifiable benefits. Kentuckians can be proud that our junior U.S. senator, Rand Paul, called Sessions out on his disastrous decision. (5/16)

The Baltimore Sun: Sessions’ Foolish Drug Policy
The War on Drugs has been such an abject failure — the get-tough approach having served to crowd prisons with non-violent offenders who are disproportionately African-American while having little to no discernible impact on actual narcotics use — that the country’s elected leaders seemed to have reached a bipartisan consensus in recent years that it was better to focus on prevention and treatment. Prosecutors should throw the book at violent, repeat criminals, but they should not pursue long mandatory, minimum sentences for suspects who don’t fit that description. (5/15)

The New York Times: If You’re In A Wheelchair, Segregation Lives
Last year, the former chief of the Santa Fe, N.M., police department, Donald Grady II, said something that stuck with me. “There’s a thing that we call freedom of movement,” he said in an interview with The Atlantic, “which is really revered in this country — that we should have the right to move freely without impingement from the police simply because.” He was speaking as both a black man and a police officer about the ways racial discrimination can limit a basic right. But I related to this on more than one level. (Luticha Doucette, 5/17)

RealClear Health: Over-The-Counter Hearing Aids Legislation Not As Simple As It Seems
One attempted small fix is the Over-the-Counter Hearing Aid Act of 2017 that was introduced on March 21 by Sens. Elizabeth Warren (D-MA), Chuck Grassley (R-IA), Maggie Hassan (D-NH), and Johnny Isakson (R-GA). This bill, which was reported out of the Senate Health Education Labor and Pensions Committee on May 11 — together with a companion measure introduced in the House by Reps. Joe Kennedy III (D-MA) and Marsha Blackburn (R-TN) — has the admirable intent of expanding access to hearing aids for some of the 37.5 million Americans with varying degrees of hearing loss. The bill would for the first time create an over-the-counter (OTC) hearing aid category, allowing the devices to be sold directly to the customer like cheap drug-store eyeglasses. (Andrew Yarrow, 5/17)

Boston Globe: Ambulance Firms Try To Take Insurers For A Ride 
Hope springs eternal on Beacon Hill — and unfortunately, that’s particularly true when it comes to the politically powerful ambulance companies and their desire to leverage higher rates for their services. This year, those companies and their legislative allies are once again hoping to use the budget to advance goals that have otherwise gone nowhere through the more traditional legislative process. (5/17)

Los Angeles Times: Another Way The Rich Get Richer: Study Shows A Widening Gap In Life Expectancy Between Rich And Poor
The United States can take pride in one indisputable marker of racial equality: The gap in life expectancy between the white and black populations has narrowed over time. What was a disparity of more than eight years for Americans born in 1950 has closed to just over three years for those born in 2014, according to actuarial estimates. But let’s not pat ourselves on the back. A different disparity has opened up: The gap in life expectancy between wealthy and low-income Americans is wide and growing wider. And that has implications not only for lifetime health and wealth, but for Social Security. (Michael Hiltzik, 5/16)

The New York Times: Undue Burden: Trying To Get An Abortion In Louisiana
When I set out to make this film in late 2015, the battle over restricting access to abortions in Texas was a national news story. Coverage featured graphs charting the hours women had to drive to find an abortion clinic in the state and maps tracing their paths. Experts weighed in on both sides of a gaping moral divide — politicians made pleas, doctors wrote op-eds. But amid the debate I felt a critical perspective was missing — that of the women across the country who were actually experiencing the effects of these laws. (Gina Pollack, 5/16)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

Different Takes: Benefits Of Broad Health Reform Consensus; Senate’s Path To Crafting Its Repeal-And-Replace Bill

Editorial writers examine different aspects of the current debate surround the GOP repeal-and-replace measure in Congress and the status of Obamacare’s marketplaces.

JAMA: Building A Broader Consensus For Health Reform
Republican leaders in Congress are trying to pass legislation rolling back and replacing key features of the Affordable Care Act (ACA) without securing any Democratic support in the effort. … In political terms, it might be best for Republicans if their effort stalls. The ACA was passed in 2010 with only Democratic votes, and that is a major reason the law remains politically and, to a degree, programmatically unstable. … It would be better for the United States if a broad consensus could be reached on health care. A bill that passed with support from some Republicans and some Democrats has a better chance of political survival than a bill passed by just one party. It should be possible to reach a broader consensus on health policy because both sides of the debate are forced to work within the significant constraints of existing arrangements. (James C. Capretta, 5/15)

Huffington Post: Hope You Don’t Expect The Senate GOP To Be Transparent About Obamacare Repeal
Senate Republicans have spent the last 10 days or so promising not to tackle health care in the same hurried, irresponsible way that their House counterparts did. “We are not under any deadlines,” Sen. John Cornyn (R-Texas) said last week, “so we are going to take our time.” … All of that is probably true ― and less meaningful than it sounds at first blush. It’s possible to write a bill in a slower, more deliberative manner than the House did without allowing the kind [of] lengthy, open public debate that legislation of such magnitude would seem to require. It’s also possible to pass less disruptive, less extreme legislation that would nevertheless take away insurance from many millions of people, causing widespread hardship. (Jonathan Cohn, 5/13)

Los Angeles Times: The Costs Of Trump’s Sabotage Of Obamacare Already Are Showing Up In Rate Hikes
The easiest prediction to make about the healthcare business was that the efforts by Congress and the Trump administration to sabotage the Affordable Care Act would produce a flood of rate hikes by insurers for 2018. We are now standing on the edge of the water. Early rate requests have come in from insurers in five states, according to ace ACA-tracker Charles Gaba, who calculates the weighted average rate request increase in those states at about 30% (that is, weighted for the enrollment of each insurer). (Michael Hiltzik, 5/16)

Cleveland Plain Dealer: GOP Health Care Reform Plan Could Cripple Ability To Treat Opioid Addiction Victims
At the same moment I was caring for more patients struggling with addiction and its devastating health effects, House Republicans passed the American Health Care Act (AHCA). Sadly, the AHCA would replace President Barack Obama’s Affordable Care Act with a law that would end Medicaid expansion and simultaneously make health care more expensive for my most vulnerable patients and reduce important protections for them. (Robert Bonacci, 5/17)

Bloomberg: Cost Of Health Insurance Isn’t All About Fairness
Should women have to pay more for health insurance than men? That has been a critical question for opponents of Republican health-care reform, and it requires grappling with the fundamental nature of insurance, market prices and fairness. Related are questions about how much older people should pay relative to the young, or to what extent individuals with pre-existing conditions should be vulnerable to higher premiums. (Tyler Cowen, 5/16)

WBUR: Hey, Millennials: Want To Help The Underserved? Sign Up For Insurance
I often wonder why President Obama, when he was promoting the Affordable Care Act to millennials, didn’t bring out a young person like me to help my peers understand why it matters… As politically aware, or “woke” as my peers seem to me, I worry that making the effort to understand and sign up for health insurance is low on people’s priority list. (Aditi Juneja, 5/17)

WBUR: Single-Payer Health Care Is The Key To Democratic Victory In 2018 
The Democratic base wants a single-payer system, a slight majority of Independents are warming to the idea and even some conservative voters appear to be growing amenable to cutting insurance companies out of the picture. Thanks to the GOP health care bill’s creation and advancement, the Republican Party’s dream of turning American health care over to the private sector is becoming our new, shared reality. (Miles Howard, 5/17)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: N.Y. State Assembly OKs Single-Payer Bill; Ga. Scrambles To Address Nursing Shortage

Media outlets report on news from New York, Georgia, Massachusetts, Texas, Florida, Illinois, Maryland, California, Minnesota, Wisconsin and Oregon.

The Wall Street Journal: N.Y. Single-Payer Health-Care Bill Passes State Assembly
Democrats in the New York Assembly are relaunching a push for a statewide single-payer health-care program in hopes that the national debate over health care will give their legislation new momentum. The “Medicare-for-all” bill—designed to provide health insurance to all state residents—passed the predominantly Democratic Assembly Tuesday afternoon following several hours of partisan back-and-forth on the chamber floor. (Vilensky, 5/16)

Georgia Health News: Re-Entry Program Brings Former Nurses Back Into The Profession
According to the Georgia Nurses Association, more than 50 percent of the nursing workforce is nearing retirement age. Meanwhile, the aging of the population as a whole means that more nurses and health professionals are needed to act as caregivers. In the Northwest Georgia mountains, Blue Ridge Area Health Education Center (AHEC) is scrambling to relieve the nursing shortage. (Thomas, 5/16)

KXAN: Report: Texas Falling Short On Police Safety During Mental Health Crises 
This investigation involved a 10-month analysis of court and police records, medical histories, media reports and dash and body camera footage, much of it obtained under the Texas Public Information Act. The research revealed shortfalls in police protection statewide: a need for improved mental health training for officers and better communication between law enforcement agencies about potentially violent individuals with mental health issues. (Hinkle and Barer, 5/16)

Orlando Sentinel: Dead Optometry Bill May Be Seen Again
The optometry bill, which for a few weeks reignited the so-called “eyeball wars” between doctors of optometry and doctors of medicine, died in the Legislature this year, but that doesn’t mean the war is over. The state optometry association will decide later this year if it’s going to once again pursue efforts to expand the scope of practice for optometrists in Florida. (Miller, 5/16)

Chicago Tribune: Seniors Seek Affordable Dental Care Options
Like many older people on a fixed income, Ed Slavik knew he couldn’t keep up with the high cost of dental care. So a few years ago, the retired school teacher was relieved to find the Dental Division at Stickney Public Health District, where he had fillings and other routine dental work done for free…But public health researchers are hoping to persuade legislators to add a dental benefit to Medicare by highlighting the many seniors forgoing care until their dental health has deteriorated, sometimes causing trouble eating, swallowing or speaking, and igniting other health problems. (Newumann, 5/16)

The Baltimore Sun: State Approves Apprenticeship Program For Hospital Workers 
State officials have approved Maryland’s first apprenticeship for environmental care supervisors, who work in hospitals cleaning areas such as surgical rooms…Apprentices will receive technical instruction through the Community College of Baltimore County and be paired with mentors Baltimore-area hospitals. Trainees’ wages will increase when they show proficiency in a list of predetermined job functions. Johns Hopkins Hospital will be the first institution to offer the on-the-job training. (Mirabella, 5/16)

Orlando Sentinel: Global Cyberattack Spares Local Health Systems 
The malicious software that quickly spread across six continents last week and locked more than 200,000 computers, including U.K.’s National Health Service, has not affected Central Florida’s two major health systems, officials told the Orlando Sentinel. But their relief is by no means a reassurance for protection from future cyberattacks. (Miller, 5/16)

Sacramento Bee: Botulism Outbreak From Gas Station Nacho Cheese Prompts Lawsuit 
Sacramento County health officials have confirmed five cases of botulism in patients who ate at the Valley Oak Food and Fuel gas station, and are investigating three other probable cases and one suspect case, with all nine patients still hospitalized. Officials believe the outbreak is linked to nacho cheese sauce that was served at the station, but the exact cause of the poisoning is still under investigation, officials said. (Caiola, 5/16)

Pioneer Press: HealthEast, Fairview Merger To Be Completed June 1
The boards of Fairview and HealthEast have approved the merger of the two metro-area hospital systems, and the deal is now expected to be completed June 1, the two organizations announced Tuesday. The combined system will be led by Fairview President and CEO James Hereford. HealthEast CEO Kathryn Correia will join the senior executive team as chief administrative officer. (5/16)

Miami Herald: How Profitable Will Medical-Marijuana Shops Be? Very, Says Confidential Pitch For Investors
A private equity firm’s confidential pitch deck obtained by the Miami Herald shows that only days ago Surterra Florida was seeking investors to buy a $10 million minority stake while also arguing against limits on the number of retail outlets any licensed operator can open. Some potential investors were lured with projections that show Surterra grossing $138 million in sales by 2021 thanks largely to the operation of 55 retail outlets — nearly four times the cap desired by the Florida Senate. (Smiley and Auslen, 5/16)

The Oregonian: Oregon Day Care Closes As Kids Fall Sick After Insecticide Exposure 
A Coos Bay day care center shut down Monday in the aftermath of an insecticide-spraying incident that left at least a half-dozen children and two staff members suffering from inflamed eyes and breathing problems. State regulators opened an inquiry into the May 5 incident but have not sent anyone to visit the Coos Bay Children’s Academy Inc., which had an enrollment of about 80 kids. Instead, the owner voluntarily closed the center Monday as several key employees quit and parents pulled children en masse over concerns about transparency and safety. (Schmidt, 5/16)

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It’s Time To Take The Pulse Of Our Readers

Even the most exalted among us realize health care policy is complicated.
Here’s a pop quiz to see what you have learned as a regular reader of Kaiser Health News.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

Categories: Aging, Health Industry, Insurance, Medicaid, Medicare, Multimedia, Pharmaceuticals

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A Hard Look At GOP Repeal-And-Replace Efforts: Examining Who Is Left Behind; Defending The House Vote

Opinion writers and stake holders offer their takes on the current health policy debate.

Cincinnati Enquirer: Health Care Bill Approved By House Leaves Too Many Behind
Simply put, the status quo on health care is unsustainable. … Congress has the responsibility to fix this mess and lower health care costs. At the same time, these changes must be made in a way that doesn’t leave people behind. … After the House of Representatives passed its bill, I said I could not support it as currently constructed because it does not do enough to help those currently receiving coverage, including the 700,000 Ohioans who receive health care through expanded Medicaid, especially those who are receiving treatment for drug addiction. Our state is in the midst of an unprecedented drug crisis right now. About half of all expanded Medicaid dollars spent in Ohio go to mental health and substance abuse treatment – much of that driven by the opioid epidemic. (Sen. Rob Portman, 5/15)

Los Angeles Times: Trump And Congress Are About To Take An Ax To Children’s Healthcare
We’ve said it before and we’ll say it again: In the ridiculous mess that is the American healthcare system, there’s one indisputable success — children’s health coverage. Over the last two decades, the uninsured rate for children under 18 has fallen from 14% to less than 5%. Today that achievement is under threat as never before. “We’re at real risk of moving backward,” says Joan Alker, executive director of the Center for Children and Families at Georgetown University. That’s because children’s healthcare in the U.S. is heavily dependent on three public programs, Medicaid, the Affordable Care Act, and the Children’s Health Insurance Program, or CHIP. (Michael Hiltzik, 5/15)

San Antonio Press-Express: Coverage Mostly Fit For The Healthy 
There is a petition-driven movement — sure to fail — to strip members of Congress of their health care coverage. We don’t have the heart to deny people the coverage they need to keep themselves and their families healthy, even if they are making a minimum of $174,000 annually. But we understand the argument. (5/15)

The Washington Post: I Was Arrested For Asking Tom Price A Question. I Was Just Doing My Job.
I was arrested last week after asking Health and Human Services Secretary Tom Price a question about the American Health Care Act while he walked toward a meeting in the West Virginia State Capitol. He didn’t respond, so I asked a few more times, holding my phone out to record the reply he didn’t make. The criminal complaint accused me of a misdemeanor — “willful disruption of governmental processes” — and said I was “aggressively breaching the secret service agents.” I wasn’t. I went to the capitol to do my job and ask a question — not looking for trouble or intending to disrupt some state process. But for asking a question, the capitol police took my phone, handcuffed me, fingerprinted me and sent me off in an orange jumpsuit. (Dan Heyman, 5/16)

The Washington Post: A Congressman Said Making A Man Get Maternity Insurance Was ‘Crazy.’ A Woman’s Reply Went Viral.
Between rounds of jeering that interrupted his every sentence, Rep. Rod Blum (R-Iowa) took a little more than two minutes to explain what else he’d like to change about the Obama-era health-care law now that he has voted for the GOP’s partial repeal of the Affordable Care Act. “Get rid of some of these crazy regulations that Obamacare puts in,” Blum suggested at an Iowa town hall meeting Monday, “such as a 62-year-old male having to have pregnancy insurance.” The crowd yelled all the louder. (Avi Selk, 5/15)

Austin American-Statesman: Keeping Our Promise
House Republicans have long promised to repeal and replace Obamacare, and earlier this month, we delivered. After voting more than 60 times to repeal and replace Obamacare, I supported the American Health Care Act when it passed the House of Representatives on May 4. (John Carter, 5/16)

Arizona Republic: Our Turn: Businesses Have A Stake In Health
With President Trump’s reaffirmed commitment to passing health-care reform, lawmakers have a fresh chance to overcome recent setbacks and modernize the American health care system. The business community remains committed to helping our leaders expand access to coverage, improve quality of care and reverse the rise of health-care costs.​ We applaud the members of the House who worked diligently to put together the American Health Care Act (AHCA). (Thomas Donohue, 5/15)

Modern Healthcare: Healthcare Lobbyists Wait To See If Senate More Pliable Than House On ACA Repeal
Healthcare industry groups are guardedly hopeful they will have more influence on the Senate’s healthcare overhaul bill than they had on the House bill passed earlier this month. That’s not saying much, given how House Republicans shut them out. And it’s far from a sure thing, because Senate GOP leaders hope to push through their legislation rapidly to clear the way for passing a major tax overhaul in late summer or fall. (Harris Meyer, 5/15)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.

State Highlights: Blue Cross Blue Shield Of KC Asks Mo. Regulators For Filing Deadline ‘Flexibility’; Harken Health Shuts Down In Ill., Ga.

Media outlets report on news from Missouri, Illinois, Georgia, Wisconsin, Texas, Kansas, California, Louisiana, Minnesota, Massachusetts, Ohio and Florida.

Kansas City Star: Blue Cross Blue Shield Of KC Requests Obamacare Filing Flexibility 
A spokeswoman for Blue Cross Blue Shield of Kansas City said Monday the company has “requested flexibility” from the Kansas Insurance Department on a deadline to file plans to sell on the Affordable Care Act exchange next year. The company’s decision not to file by Monday’s midnight deadline casts uncertainty on 2018 “Obamacare” coverage options for people in two eastern Kansas counties and 30 western Missouri counties. (Marso, 5/15)

Chicago Tribune: Insurer Harken Health Shutting Doors
Insurer Harken Health is closing its doors in Illinois and Georgia, ending an experiment to combine health insurance and care. The insurer, which operates five health clinics in Chicago, Skokie and Des Plaines, began selling plans in Illinois and Georgia in 2015. A subsidiary of UnitedHealthcare, Harken offered its members unlimited free doctor visits at its health centers, which also offer wellness programs, such as acupuncture, yoga and meditation. (Schencker, 5/15)

Milwaukee Journal Sentinel: Doctors’ Fees In Milwaukee Area 41% Higher Than National Average, Study Says
By one important measure, doctors in the Milwaukee area are paid 41% more than the estimated national average for the services they provide, a new study says. The same was true across much of eastern Wisconsin: Fees paid to doctors by employers’ health plans in the Sheboygan area were 63% above the national average, ranking them the highest among the 61 markets included in the study by the Health Care Cost Institute. (Boulton, 5/15)

Stat: Texas Leans Into Unproven Stem Cell Treatments, To The Dismay Of Scientists
HB 810 is one of three bills being considered in the Texas Legislature that would make it easier for sick people to try unproven therapies at their own risk, and cost. Springer’s bill would allow clinics offering unapproved stem cell treatments to treat patients in Texas. HB 661 would permit people with chronic illness to get therapies in early-stage clinical trials — not just terminally ill patients, as the state’s current “right-to-try” law does. And HB 3236 would allow companies to charge patients for unproven therapies. (Joseph, 5/16)

St. Louis Public Radio: Missouri Budget Cuts Family Planning Funds For Uninsured Women, Restricts Provider Choice
Missouri is poised to strip additional providers from a state-run program that provides family planning services for uninsured women. The budget lawmakers are sending to Gov. Eric Greitens contains a provision that prohibits hospitals and clinics from participating in the Missouri Women’s State-Funded Health Services Program if the organization also provides abortion services, as defined by a state law for sexual education in schools. (Bouscaren, 5/15)

KCUR: As Kansas Foster Care System Sets Records, Advocates Call For More Family Services
Family preservation services — including training for parents, referrals for food assistance and other support — are designed to promote that healing. According to DCF, most families that receive preservation services succeed: About 82 percent of families who participated statewide were able to avoid having a child removed from the home. But many at-risk families don’t receive preservation services, and some people who have worked for years in the social services system say the lack of help is pushing more children into foster care. (Wingerter, 5/15)

Modern Healthcare: Kaiser Hits $1 Billion Operating Gain In Q1 
Kaiser Permanente Monday posted a record $1 billion operating gain in its first quarter, just days after holding its largest-ever bond offering. The Oakland, Calif.-based health plan and hospital giant eclipsed the $1 billion barrier on revenue of $18.1 billion. That compared with an operating gain of $701 million on revenue of $16.3 billion in the year-earlier quarter. The 5.5% operating margin in the first quarter beat the strong 4.3% operating margin from the year-earlier period. (Barkholz, 5/15)

New Orleans Times-Picayune: This Man Went To An In-Network ER In New Orleans. Why Did He Get A $1,360 Doctor’s Bill? 
What happened to [Steve] Fair is known as “balance billing,” an increasingly common practice in our nation’s convoluted health care system. Rather than staff their own ERs, many hospitals around the country hire physicians employed by staffing companies like Schumacher, experts say. Insurance companies then pay these contract physicians a pre-negotiated rate for their hospital services. Because they have no contract with the insurer, however, these doctors don’t have to accept the negotiated rate as their total fee. Instead, they go after patients for the full amount. Since the prices of most medical procedures are hidden from view, doctors have no incentive to lower them.  (Lipinski, 5/15)

Minnesota Public Radio: Minnesota Measles Outbreak Spreads To Le Sueur County
Minnesota health officials say the number of measles cases rose by four over the weekend and the highly contagious disease has now moved into a southern Minnesota county. Two new cases of measles were discovered in Le Sueur County, the Minnesota Department of Health reported Monday in its daily measles tally. (Zdechlik, 5/15)

Boston Globe: Disabled Homeless Girl At Center Of Fight Over Housing Policy 
Cristal is a 2-year-old girl born with spina bifida, a condition that has required multiple surgeries and left her with limited sensation in her lower extremities.Over the past month, she has endured long, uncomfortable commutes between the Lowell homeless shelter where the state is housing her family and frequent appointments with her medical providers in Boston, according to recent court filings… The case illustrates the human dimension of one of thorniest entitlement program debates facing Massachusetts as Baker works to reduce the number of homeless families in motels at state expense to zero. (Miller, 5/15)

California Healthline: California Bill Would Protect Patients’ Access To Their Chosen Family Planning Providers
As national Republican leaders continue to try to defund Planned Parenthood, California and other states are considering steps to protect access to family planning services. California legislators have introduced a bill that would lock into state law a federal rule that allows Medicaid patients to see family planning providers of their choice. The bill is designed to preserve Californians’ access to Planned Parenthood and other reproductive health clinics should federal officials drop the rule. (5/16)

Boston Globe: Walmart Settles Discrimination Lawsuit On Spousal Benefits For Same-Sex Couples 
A federal judge approved a $7.5 million settlement Monday in a class-action lawsuit against Walmart that found the retail giant violated gender-discrimination laws for years when it denied spousal benefits to same-sex couples. The lawsuit was filed on behalf of a New Bedford woman by the advocacy group GLAD. The settlement was based in large part on US Supreme Court rulings affirming the rights of same-sex couples to marry and, in an earlier ruling, their entitlement to federal spousal benefits. (Valencia, 5/15)

Cincinnati Enquirer: Transgender Lawsuit Settled, Cincinnati Public Library Now Covers Transgender Surgery
Rachel Dovel didn’t mean to become a crusader for transgender rights. But the library employee found herself cast in that role last year when the library’s health insurance refused to pay for her gender confirmation surgery – and the library’s board wouldn’t budge. She underwent surgery in December – and Monday she and her legal team announced she settled a lawsuit against the Public Library of Cincinnati and Hamilton County. (Coolidge, 5/15)

Boston Globe: Newburyport Hospital Joining Beth Israel Deaconess-Lahey Merger
Beth Israel Deaconess Medical Center and Lahey Health have enlisted another hospital in their campaign to create a stronger rival to Partners HealthCare, the market leader. Anna Jaques Hospital of Newburyport said Monday that it plans to join the Beth Israel Deaconess-Lahey merger, which was announced in January after years of on-again, off-again talks. (Dayal McCluskey, 5/15)

Boston Globe: Spaulding To Cut 35 Jobs
Spaulding Rehabilitation Network, part of the Partners HealthCare network, is slashing 35 jobs to cut costs. The cuts come as the entire Partners network embarks on a three-year initiative to rein in spending and become more efficient. (Dayal McCluskey, 5/15)

Health News Florida: Orlando Air Quality Prompts Warning For People With Asthma
The Environmental Protection Agency is warning that the Orlando area’s air quality is not healthy for sensitive groups. That means people with asthma and lung disease, as well as the elderly and children, should cut down on prolonged or heavy exercise outside. They recommend keeping asthma medication nearby. (Aboraya, 5/15)

This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.