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Morning Briefing

Summaries of health policy coverage from major news organizations

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Tuesday, Apr 26 2016

麻豆女优 Health News Original Stories 4

  • United鈥檚 Departure From Marketplaces Could Impact Consumers鈥 Costs, Access
  • High Court Ruling May Hinder Plans鈥 Efforts To Recoup Consumers鈥 Legal Awards
  • Administration Says New Rules For Medicaid Plans Will Improve Service For Enrollees
  • Will Covered California Sell Health Coverage To The Undocumented?

Note To Readers

Administration News 2

  • CMS' Sweeping Medicaid Managed Care Rules Set New Quality Standards
  • Despite Pleas From Patients, FDA Panel Votes Against Drug For Muscular Dystrophy

Health Law 2

  • After Serious Losses On Marketplaces, Some Insurers Likely To Sharply Raise Premiums
  • Two Louisiana Hospitals Question Projected Medicaid Expansion Savings

Supreme Court 1

  • High Court Justices Wrestle With Issues In Patent Case Backed By Drug Makers

Marketplace 2

  • In Deal With N.Y. Attorney General, Insurers To Start Covering Hep C Drugs Regardless Of Condition's Severity
  • N.Y.C. Hospitals Targeted For Overhaul

Women鈥檚 Health 1

  • Critics Attack Okla. Abortion Bill As Unconstitutional, Say It's An Attempt To Ban Legal Medical Procedure

Public Health 4

  • In Effort To Curb Opioid Overdose Pandemic, One Boston Clinic Takes Unconventional Approach
  • 'Out Of The Shadows': For Kasich, Mental Health Issues Hit Close To Home
  • Zika Funding Negotiations Could Wrap Up This Week, Sources Say
  • Teenagers Exposed To E-Cigarette Ads More Likely To Partake, CDC Finds

State Watch 3

  • Sen. Brown, Opponents Slam Ohio Medicaid Plan
  • States' Budget Woes Taking A Toll On Health Care And Medicaid Services
  • State Highlights: Minn. Lets The Sun Shine On Health Data; Despite Difficulties Southeast Mich. Health Systems Post Profits

Editorials And Opinions 1

  • Viewpoints: Detailing The Cadillac Tax; Health Care And Longevity's Decline

From 麻豆女优 Health News - Latest Stories:

麻豆女优 Health News Original Stories

United鈥檚 Departure From Marketplaces Could Impact Consumers鈥 Costs, Access

Florida and Oklahoma counties are among the hardest hit by UnitedHealthcare's pullout from health law exchanges. ( Phil Galewitz , 4/26 )

High Court Ruling May Hinder Plans鈥 Efforts To Recoup Consumers鈥 Legal Awards

When consumers who have been injured sue and win an award, insurance plans routinely demand that they be reimbursed for medical costs that they covered. The Supreme Court this term threw a small chink into that strategy. ( Michelle Andrews , 4/26 )

Administration Says New Rules For Medicaid Plans Will Improve Service For Enrollees

Private insurers that administer Medicaid for the poor also face limits on profits and requirements to provide sufficient doctors. ( Jay Hancock , 4/26 )

Will Covered California Sell Health Coverage To The Undocumented?

California is inching closer to a first-in-the-nation request for a federal ruling that would allow the state鈥檚 Obamacare exchange to sell health plans to immigrants who are living in the country illegally. ( Ana B. Ibarra , 4/26 )

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Note To Readers

Starting Wednesday, you鈥檒l notice a new weekly feature in Morning Briefing. Our Prescription Drug Watch will include news, research and opinion pieces on the pharmaceutical industry. KHN鈥檚 coverage of prescription drug development and costs is supported in part by the Laura and John Arnold Foundation. There鈥檚 no need to adjust your settings to receive this roundup; you can share your feedback .

Summaries Of The News:

Administration News

CMS' Sweeping Medicaid Managed Care Rules Set New Quality Standards

The long-awaited regulation, the biggest for Medicaid managed care in a decade, changes many aspects of how large insurance contractors who administer care for some of the most vulnerable patients.

The CMS has finalized a long-awaited rule that will overhaul managed Medicaid, which has not been updated in a decade. The sweeping 1,425-page rule, which was proposed last May, caps insurer profits, requires states to more rigorously supervise the adequacy of plans' provider networks, encourages states to establish quality rating systems for plans, allows more behavioral healthcare in institutional settings and promotes the growth of managed long-term care. But the CMS deferred to state control for several issues. (Dickson and Herman, 4/25)

The Obama administration tightened rules Monday for private insurance plans that administer most Medicaid benefits for the poor, limiting profits, easing enrollment and requiring minimum levels of participating doctors. For consumers the most visible change may eventually be quality ratings intended to reflect Medicaid plans鈥 health results and customer experiences. The administration agreed to move slowly on such a sensitive industry issue, saying it would develop the scores over several years. (Hancock, 4/26)

The Obama administration Monday set new standards for Medicaid private insurance plans, which in recent years have become the main source of coverage for low-income people. The rules apply to insurers operating as Medicaid middlemen in 39 states and Washington, DC. Each state runs its own program, although the federal government pays most of the cost. Private insurers now provide coverage to about two-thirds of the more than 70 million Medicaid recipients, and the rules had not been updated for more than 10 years. (Alonso-Zaldivar, 4/25)

The regulation updates rules concerning what is known as Medicaid managed care, where states contract with private health insurers to provide benefits to low-income people through Medicaid, a system that has grown in recent years to 39 states and two thirds of enrollees. The final rule, issued Monday, imposes requirements on how much of insurers revenue must go towards paying medical costs, as opposed to administrative costs or profits. (Sullivan, 4/25)

Medicaid managed care services are offered by risk-based managed care organizations, which contract with state Medicaid programs to offer care to enrollees. Essentially, they are the private insurer alternative to traditional fee-for-service Medicaid. CMS hasn鈥檛 issued any new regulations to the program since 2002, but a lot has changed since then. Not only has the Medicaid program itself grown under the Affordable Care Act, but now about 80 percent of Medicaid enrollees are served through managed care delivery systems, according to CMS. (Owens, 4/25)

Health insurers that participate in Medicaid will have to spend a minimum amount of the money they receive on medical care, under a new Centers for Medicare and Medicaid Services rule released late Monday. (Evans, 4/25)

Despite Pleas From Patients, FDA Panel Votes Against Drug For Muscular Dystrophy

The panel members said the trial was not well-controlled, noting that it only involved 12 patients without an adequate placebo control.

In a confrontation between the hopes of desperate patients and clinical trial data, advisers to the Food and Drug Administration voted on Monday not to recommend approval of what would become the first drug for Duchenne muscular dystrophy. The negative votes came despite impassioned pleas from patients, parents and doctors who insisted that the drug, called eteplirsen, was prolonging the ability of boys with the disease to walk well beyond when they would normally be in wheelchairs. (Pollack, 4/25)

鈥淚 felt this wasn鈥檛 a well-controlled study,鈥 said panel chairman G. Caleb Alexander, an associate epidemiology professor at the Johns Hopkins School of Public Health. The panel members who abstained said they were undecided because they were moved by public testimony from parents who believed their children had been helped by the drug. The decision followed decidedly negative comments from FDA reviewers who concluded that the study fell far short of producing enough evidence. (Burton, 4/25)

Federal health advisers voted against an experimental treatment for muscular dystrophy on Monday, the latest in a series of setbacks for the Sarepta Therapeutics' drug, which has become a rallying point for patients and families affected by the deadly disease. (Perrone, 4/25)

A Food and Drug Administration advisory committee on Monday heard arguments for the approval of a drug to treat Duchenne Muscular Dystrophy, a disease that affects young boys and currently has no approved treatment. The disease, which results in the loss of muscle use, affects one in 3500 boys. It is 100 percent fatal and most affected have a lifespan of fewer than 25 years. (Siddons, 4/25)

Health Law

After Serious Losses On Marketplaces, Some Insurers Likely To Sharply Raise Premiums

Some of the companies priced their plans too low in the early years of the health marketplaces. In other news, a preview of the possible fallout for insurers if a court rules against the Obama administration on cost sharing subsidies, several outlets look at UnitedHealth's pullback and California lawmakers weigh a measure to allow immigrants in the country illegally to buy coverage on the state marketplace.

Health insurance companies are laying the groundwork for substantial increases in ObamaCare premiums, opening up a line of attack for Republicans in a presidential election year. Many insurers have been losing money on the ObamaCare marketplaces, in part because they set their premiums too low when the plans started in 2014. The companies are now expected to seek substantial price increases. (Sullivan, 4/25)

Another bombshell could soon drop on the Affordable Care Act insurance exchange market, and it might come at a highly vulnerable moment for Obamacare. Rosemary Collyer, U.S. District Judge for the District of Columbia, is expected to soon issue her ruling in U.S. House of Representatives v. Burwell, a case in which House Republicans claim the Obama administration is illegally funding the ACA's cost-sharing subsidies without a congressional appropriation. If, as some legal observers believe is possible or even likely, the George W. Bush-nominated Collyer decides against the administration, it would further rattle insurers who are facing multiple difficulties in the exchange business. (Meyer, 4/22)

Iowans who want to buy subsidized health insurance under the Affordable Care Act will no longer be able to choose a policy from the country鈥檚 largest carrier, but they can switch to the state's main health insurer for the first time. UnitedHealthcare will no longer sell individual health insurance policies in Iowa, the state insurance division announced Monday. ... In Iowa, UnitedHealthcare鈥檚 withdrawal could be offset by the entry of the state鈥檚 dominant health insurance carrier, Wellmark Blue Cross & Blue Shield. Wellmark previously has declined to sell policies on the Obamacare exchanges, but spokeswoman Traci McBee confirmed Monday that it will sell policies there for 2017. (Leys, 4/25)

UnitedHealth Group Inc. will pull out of Kentucky鈥檚 individual marketplace for Obamacare plans, bringing to 26 the number of states the health insurer is quitting next year. The company plans to halt sales of individual plans in Kentucky for 2017, both inside and outside the state鈥檚 Affordable Care Act exchange, as well as the small-business exchange, UnitedHealth said in a letter to the state鈥檚 insurance department. (Tracer, 4/25)

UnitedHealthcare鈥檚 decision to quit insurance exchanges in about 30 states next year has patient advocates concerned that fewer options could force consumers to pay more for coverage and have a smaller choice of network providers. The company鈥檚 departure could be felt most acutely in several counties in Florida, Oklahoma, Kansas, North Carolina, Alabama and Tennessee that could be left with only one insurer, according to an analysis by the Kaiser Family Foundation. (KHN is an editorially independent program of the foundation.) (Galewitz, 4/26)

California legislators are attempting to clear the way for undocumented immigrants to buy health insurance through the state鈥檚 insurance exchange 鈥 potentially setting a national precedent. The fusion of illegal immigration and the Affordable Care Act, two of the most highly charged elements on the periodic table of U.S. politics, could engender a combustible reaction, especially in an election year. (Ibarra, 4/26)

Two Louisiana Hospitals Question Projected Medicaid Expansion Savings

Meanwhile, insurer Centene Corp. reports an increase in quarterly revenue of nearly 36 percent, helped by higher Medicaid enrollment rates.

Two of Louisiana's privatized former charity hospitals are questioning the savings Gov. John Bel Edwards' administration is projecting from Medicaid expansion, which includes money the state can use to help offset cuts to TOPS funding. If the hospitals are right, and it turns out the Edwards administration's projections aren't conservative enough, hospital administrators at University Medical Center in New Orleans and Lafayette General Health say they fear it could cause a midyear shortfall -- and funding cuts -- to the public-private partner hospitals. (Litten, 4/25)

The Department of Health and Hospitals is asking people enrolled in two large state health care programs to make sure their addresses are up-to-date so they can begin receiving Medicaid cards. People enrolled in the Take Charge Plus and Greater New Orleans Community Health Connection, respectively, will be automatically enrolled in the Medicaid program. The income requirements for those two programs make all of its recipients eligible for the Medicaid expansion approved by Gov. John Bel Edwards on his first full day in office. (LItten, 4/25)

U.S. health insurer Centene Corp reported a near 36 percent jump in quarterly revenue, helped by higher enrollments in its Medicaid plans for low-income families and the acquisition of rival Health Net. (4/26)

Supreme Court

High Court Justices Wrestle With Issues In Patent Case Backed By Drug Makers

The four liberal justices, joined at times by Justice Anthony Kennedy, sounded skeptical toward arguments in the case that centers around the question: What standard for interpreting patents should be used in new reviews created by Congress in 2011?

At the Supreme Court on Monday, there were signs that the pharmaceutical industry could end up on the losing side of a case with serious implications for medicine and drug prices. The case in question focused on the Obama administration鈥檚 rules for a new process to review patents. Drug makers, supporting the plaintiffs, are urging the court to change that process, which right now makes it easier to invalidate the patents that are crucial to their business. (Scott, 4/25)

The Supreme Court on Monday wrestled with the wonky issue of patent reviews in a case that has drawn heavy interest from the pharmaceutical and technology industries as they battle over reforming the nation's patent laws. (Tummarello, 4/25)

The court heard oral arguments in a case involving patents, including drug patents. It used to be that to challenge one, you'd have to actually go to court. That was a slow, expensive business, so Congress created a fast track: a patent review board. ... Big Pharma doesn't like the review board. But organizations that want to bring down the price of prescription drugs for consumers love it, and they're being joined in their fight by people who aren't usually seen as champions of consumer rights 鈥 hedge fund managers. (Gorenstein, 4/25)

In other news from the Supreme Court聽鈥

Accidents happen, and if they鈥檙e someone else鈥檚 fault, you can go to court to try to get compensation for your medical expenses, lost wages, and pain and suffering. If you win, though, the pot of gold you receive may be considerably smaller than you expect: Your health plan may claim some or all of it as reimbursement for money it spent on your medical care. It鈥檚 completely legal and it happens all the time. But a recent Supreme Court decision gives consumers ammunition to push back. (Andrews, 4/26)

Marketplace

In Deal With N.Y. Attorney General, Insurers To Start Covering Hep C Drugs Regardless Of Condition's Severity

Under the agreement, the attorney general's office will end investigations it began last year into the insurers' coverage of the $94,500 treatment. Meanwhile, the state has also informed insurers that they will have to start paying for depression screening of pregnant women and new mothers.

Seven health-insurance companies in New York will change their criteria for covering costly drugs that cure chronic hepatitis C under the terms of agreements with the office of State Attorney General Eric Schneiderman. The agreements, expected to be announced Tuesday, require the insurers to cover hepatitis C medications for nearly all patients who have commercial insurance plans in the state. (Ramey, 4/25)

New York state will soon require health insurers to cover depression screening for pregnant women and new mothers. The move follows a recommendation from a federal panel that insurers cover maternal depression screening without a co-pay or deductible. (4/25)

Elsewhere, in Ohio, a county begins covering聽sex reassignment surgery for its workers聽鈥

A Franklin County employee making a gender transition might have saved for months or years before coming up with enough money to pay for a mastectomy or sex reassignment surgery. Cost estimates vary, but they can stretch well into the thousands of dollars. Now, though, those employees can hand their doctors an insurance card. It鈥檚 covered. (Rouan, 4/26)

N.Y.C. Hospitals Targeted For Overhaul

New York City Mayor Bill de Blasio is seeking $2 billion in his budget as part of a plan to restructure the city's hospitals. Meanwhile, Modern Healthcare explores some of the difficulties that stem from hospital-system mergers. Also, Georgia Health News reports on how the state's hospital safety rankings have gone done. News outlets also report on hospital-related developments in Kansas and California.

New York City鈥檚 public hospital system 鈥渋s on the edge of a financial cliff,鈥 Mayor Bill de Blasio鈥檚 administration is warning in a report to be released on Tuesday as part of his budget, which proposes a restructuring and an infusion of $2 billion in subsidies. Along with a push for new revenue and new savings for the system, Health & Hospitals, the city subsidy 鈥 a $700 million increase over the 2016 fiscal year 鈥 is intended to shrink a gap that is projected to balloon to $1.8 billion by 2020, up from a current $600 million shortfall. (Bernstein, 4/25)

Mayor Bill de Blasio鈥檚 administration will propose an overhaul of the cash-strapped public-hospital system in the city鈥檚 budget presentation on Tuesday, people familiar with the matter said. The overhaul is expected to turn inpatient centers鈥攚hich are more expensive but often prized by communities鈥攊nto outpatient centers and focus less on emergency rooms, one of these people said. It will include retraining some employees, adding billions to the system鈥檚 budget as changes are made, and attempting to revise the formula on how health care is funded. (Dawsey, 4/25)

Hospital operator mergers have created big鈥攕ometimes behemoth鈥攈ealth systems that will provide the scale necessary to achieve operating efficiencies and compete for more cost-conscious consumers. So they say. But some of the biggest mergers in recent years have so far failed to deliver on that promise. ... their stumbles are renewing concern that mergers and acquisitions are not the best path for achieving those efficiency and competitiveness goals. (Evans, 4/23)

About one-fourth of Georgia hospitals received an 鈥淎鈥 grade on patient safety in newly published ratings. That percentage, determined by the Leapfrog Group, is down from this past autumn, when one-third of Georgia hospitals got an 鈥淎鈥 in the organization鈥檚 rating (Miller, 4/25)

One of the governor鈥檚 options to patch a hole in the state budget includes a $35 million cut from the Kansas Department of Health and Environment, a move a hospital group says could harm its members. Gov. Sam Brownback laid out three proposals to patch the budget hole last week after revenue projections for this budget year and the next were lowered by $350 million. One of the options includes the $35 million KDHE cut. (Hart, 4/25)

The need to protect against earthquakes is about to jolt the municipal junk-bond market from its slumber. California鈥檚 Loma Linda University Medical Center on Wednesday is planning the biggest speculative grade, tax-exempt health-care deal since at least 1990, according to data compiled by Bloomberg. The $883 million sale will finance an expansion and overhaul to comply with the state鈥檚 seismic safety requirements, a project that will double the center鈥檚 debt and triggered a fall from investment grade last year. (Varghese, 4/26)

Women鈥檚 Health

Critics Attack Okla. Abortion Bill As Unconstitutional, Say It's An Attempt To Ban Legal Medical Procedure

The legislation would threaten the license of any doctor who performs an abortion except when the procedure is necessary to protect the life of the mother. In other news, Iowa's governor calls the legislature's move to ban Planned Parenthood funding a "reasonable proposal," and a new report finds that AmeriCorps "abortion doulas" were in violation of federal law.

Of the pieces of anti-abortion legislation that Oklahoma lawmakers have considered this session, one that would strip doctors of their license to practice has abortion rights activists and the state's medical association balking. The bill would prohibit any physician who performs abortions, deemed "unprofessional conduct" in the measure, from obtaining a license to practice medicine. That would be the first such law in the nation 鈥 and an unconstitutional attempt to ban abortions, according to Center for Reproductive Rights, a New-York based abortion rights organization. (4/25)

Gov. Terry Branstad said Monday he believes the Iowa House has adopted a "reasonable proposal" that would continue statewide family planning services while barring funds for Planned Parenthood and other abortion providers. (Petroski, 4/25)

Six members of the national service program AmeriCorps recently escorted young pregnant women to abortion clinics in a 鈥渄irect violation鈥 of federal funding rules, a government watchdog will report Tuesday. The volunteers served as clinic escorts, also known as 鈥渁bortion doulas,鈥 in parts of New York City, according to a source familiar with the report from a federal inspector general鈥檚 office. A summary of the report will be published online Tuesday. (Ferris, 4/25)

Public Health

In Effort To Curb Opioid Overdose Pandemic, One Boston Clinic Takes Unconventional Approach

On Tuesday, Boston Health Care for the Homeless will open a room where drug users can ride out their highs under medical supervision. 鈥淲hen you initially hear we鈥檙e going to cooperate with someone using heroin, it might be a little shock to the system,鈥 said former state senator Steven Tolman. "But with the level of pandemic we鈥檙e dealing with ... any effort to get this problem under control is a worthwhile experiment.鈥

Alarm over the rocketing fatality rate, and the need to better manage staffing disruptions from all those overdoses, has led Boston Health Care for the Homeless to adopt an unorthodox and controversial plan: On Tuesday, it will open a room where drug users can ride out their highs under medical supervision, with the aim of preventing deaths. (Pfeiffer, 4/26)

See KHN's past coverage of the clinic's plan:聽

And in other news聽鈥

Chinese laboratories are producing and openly selling a new form of deadly fentanyl to get around China鈥檚 recent export ban on the synthetic drug causing thousands of overdose deaths across the United States. The slightly tweaked version of fentanyl 鈥 called furanyl fentanyl 鈥 is so new that it is not on the US government鈥檚 list of controlled substances. That means the altered fentanyl, which was blamed for the March overdose of an Illinois man, is technically legal for drug dealers to sell. (Armstrong, 4/26)

After a floor debate laced with stories of the toll drug addiction has taken across Connecticut, the House on Monday unanimously passed what legislators described as a comprehensive measure aimed at curbing the epidemic of opioid and heroin abuse. (Levin Becker, 4/25)

'Out Of The Shadows': For Kasich, Mental Health Issues Hit Close To Home

The candidate for the Republican presidential nomination's only brother, Richard, 59, has struggled with depression disorders since college.

Gov. John Kasich often speaks about mental health in his campaign for president. He has defended his decision to expand Medicaid in Ohio by highlighting its benefits for mentally ill residents. He is probably the only Republican candidate this year to ask a crowd, 鈥淒o you know what it鈥檚 like for somebody to live with depression?鈥 The question, posed at a rally in upstate New York recently, threw a hush over a room of 1,000 people. Mr. Kasich went on: 鈥淭here are people here who know exactly what I鈥檓 talking about.鈥 (Gabriel, 4/25)

Media outlets also offer coverage of mental health issues out of the Iowa, New Mexico and North Carolina 鈥

A bill pending in the Iowa House would allow specially trained psychologists to prescribe medication to mentally ill people in hopes of alleviating a shortage of treatment options, but the proposal has run into opposition from some of the state鈥檚 psychiatrists. (Vujicic, 4/25)

The number of New Mexicans accessing behavioral health services through government-funded programs has increased nearly 5 percent within a year's time, adding to a surge that began with the expansion of the state's Medicaid program. (Bryan, 4/25)

Three of North Carolina鈥檚 Medicaid mental health organizations announced last week that they鈥檒l be jointly launching a workforce-development initiative to offer training resources to frontline professionals who provide services to people with disabilities. (Sisk, 4/26)

Zika Funding Negotiations Could Wrap Up This Week, Sources Say

And in Dallas, health officials are taking pro-active measures to control the virus' spread before mosquito season even starts.

Senate appropriators are aiming to wrap up this week their negotiations on how they'll pass an emergency spending package to address the Zika virus as well as its cost, sources familiar with the negotiations told Roll Call Monday. (McCrimmon, 4/25)

Officials are warning Dallas County residents of the dangers of mosquito-transmitted diseases 鈥 even though mosquito season hasn鈥檛 started yet. Zac Thompson, the county鈥檚 director of the Health and Human Services Department, wants people to focus on preventing the spread of the Zika and West Nile viruses before mosquito season starts the first week of May. (Siron, 4/25)

Teenagers Exposed To E-Cigarette Ads More Likely To Partake, CDC Finds

An increase in e-cigarettes usage among the younger generation correlates with the rise in spending on e-cigarette advertisements to $115 million in 2014. Elsewhere, The Baltimore Sun shines a light on the vaping culture and those who support it.

A new government study sheds light on the popularity of electronic cigarettes among youth. The Centers for Disease Control and Prevention (CDC) found that teenagers who are exposed to e-cigarette advertisements are more likely to vape. 鈥淜ids should not use any type of tobacco product, including e-cigarettes,鈥 CDC Director Tom Frieden said in a statement. 鈥淓xposure to e-cigarette advertising is associated with youth e-cigarette use." (Devaney, 4/25)

Look through the window of the gathering place on York Road some night, and you'll think it's a tavern from another time. Men and women shoot pool. People cluster, chat and flirt. A haze hangs thick in the air. But it isn't smoke 鈥 and if you make the mistake of using the S-word here, the habitues of Towson Vaporium will likely look at you as though you've come from another planet. (Pitts and Waseem, 4/25)

State Watch

Sen. Brown, Opponents Slam Ohio Medicaid Plan

The proposal would require Medicaid recipients to pay a monthly premium of 2 percent of their income to receive benefits.

Opponents of a state plan to charge new fees to Medicaid beneficiaries are urging federal regulators to reject the proposal. At a Statehouse press conference today, U.S. Sen. Sherrod Brown, D-Ohio, said the Republican-backed plan aims "to gut" the recent expansion of Medicaid through Obamacare, which has extended tax-funded health coverage to more than 600,000 poor Ohioans. (Candisky, 4/25)

A proposal to require working poor Ohio adults to pay more toward their government-funded health care is a Republican effort to undermine the Affordable Care Act, U.S. Sen. Sherrod Brown said Monday. ... Mr. Brown also urged the federal government to reject the request to waive rules so the state may charge premiums from as many as 1.4 million nondisabled, nonelderly people on the rolls. (Provance, 4/26)

States' Budget Woes Taking A Toll On Health Care And Medicaid Services

News outlets report on efforts around the country to close state budget gaps that may cut health services for low-income residents.

Even as the White House touts the Affordable Care Act's successful coverage of nearly 20 million people, residents across the country are struggling to access and afford healthcare and social service programs. State legislatures are seeing shrinking revenue because of tax cuts and low energy prices. North Dakota and Texas, which rely on oil tax revenue, are facing huge budget shortfalls. ... Now, after years of threatening to do so, health and social service programs are cutting services or folding outright. Medicaid programs are seeing monthslong delays in approving beneficiaries. (Munchmore, 4/23)

West Virginia officials warn that payments to Medicaid providers may be delayed amid state budget woes. The Department of Health and Human Resources told providers in a letter Monday. (4/25)

Health care providers around the state are being put on notice that the state may have trouble paying for Medicaid services if the budget impasse is not resolved. About 24,000 Medicaid providers are receiving letters sent Monday by the state Bureau of Medical Services warning that there could be delays receiving payments for services provided, resulting from potential cash flow issues caused by ongoing budget shortfalls. (Kabler, 4/25)

The funding problems for the 2016 fiscal year have been known to both executive and legislative leaders. In early April, Department of Revenue officials told the Charleston Gazette-Mail the state was some $146 million short of what it would need to keep the government open through June 30. (Marra, 4/25)

The Republican proposal does call for reductions to mental health funding compared to what was originally budgeted, but they are far smaller than [Gov. Dannell] Malloy鈥檚 proposed cut and would not affect grants paid to providers for mental health and substance abuse treatment. (Phaneuf, Rabe Thomas and Levin Becker, 4/25)

State Highlights: Minn. Lets The Sun Shine On Health Data; Despite Difficulties Southeast Mich. Health Systems Post Profits

News outlets report on health issues in Minnesota, Michigan, Oregon, Pennsylvania, California, Washington, Wyoming, Kansas, Colorado, Maryland and Alabama.

A treasure trove of information on health conditions, medical services and costs in Minnesota is now available to researchers, providers and insurers. The Minnesota Department of Health is publishing the first batch of data from its Minnesota All Payer Claims Database this week, and lawmakers hope researchers will mine the information to learn more about variations in health care services and patient outcomes. (Benson, 4/25)

Southeast Michigan health systems last year battled double-digit increases in drug prices and historically low rate increases from commercial and government payers to post the highest profit margins in several years, according to top system executives. (Greene, 4/25)

Oregon Health & Science University is looking for people with autism for a national registry that aims to accelerate research. The registry is open to anyone diagnosed with autism spectrum disorder and their families. The idea is to gather genetic information from 50,000 people to give researchers a big pool of data to help them better understand the condition and find treatments. (Terry, 4/25)

Paula Hart and Dave Toeniskoetter sat outside the Cannon House Office Building last week after a day of back-to-back meetings with Minnesota鈥檚 congressional delegation had ended. ... Hart, the CEO of Volunteers of America Minnesota, and Toeniskoetter, CEO of the Mendota Heights-based independent living business Dungarvin, are trying to balance fair pay for workers with the cost of serving their intellectually and developmentally disabled clients. The pair ... want Minnesota鈥檚 federal politicians to press the U.S. Labor Department to extend the time they get to apply rules that will more than double the base salary of workers who can be declared exempt from overtime. (Spencer, 4/24)

For years, Medicare Advantage plans have been big business for private insurers offering one-stop shopping, low premiums and extra benefits to an aging Western Pennsylvania population. But there are signs lately that the plans are losing some luster, as more retirees choose traditional plans with a Medigap supplement that sidestep concerns about access to providers and may represent better value in the long run. (Twedt, 4/26)

Former banker Sanford Weill transformed the Weill Cornell Medical College in New York with more than half-a-billion in donations in recent years. Now he is pivoting to the West Coast, pledging $185 million to create a neuroscience institute at the University of California, San Francisco. (Piller, 4/26)

Officials say a Tacoma School District manager has been put on paid administrative leave after it was discovered Friday that tests done nearly a year ago showed high lead levels in drinking water at two public elementary schools. District spokesman Dan Voelpel said Monday that the district's safety and environmental health manager was placed on leave. (4/25)

This February, the email accounts of two Wyoming Medical Center employees were compromised in a phishing scam. A phishing scam is an email that looks like it came from a credible source, and tricks the recipient into providing passwords and usernames in an attempt to access sensitive information. The scam won't work if the recipient ignores the email, and doesn't open any links. (Sanders, 4/25)

When Shannon Lindsey moved from Missouri to Kansas two years ago, she decided she wanted to go to Johnson County Community College to get a nursing degree that would make her more employable. Lindsey, now 49, has several disabilities, so she contacted Kansas鈥 vocational rehabilitation office for assistance. In Missouri she had the same vocational rehabilitation counselor for years 鈥 a state worker who understood her needs, what was available to help her and how to get it to her quickly. (Marso, 4/25)

Leukemia patients out of options and given just months to live have achieved sustained remissions thanks to a new twist on cancer immunotherapy, according to a highly anticipated study from scientists at Seattle鈥檚 Fred Hutchinson Cancer Research Center. (Aleccia, 4/25)

A federal advisory board designed to help workers sickened while working at former nuclear weapons facilities in the United States, including Rocky Flats west of Denver, get compensation and medical benefits will meet for the first time this week. (Aguilar, 4/25)

To wrap up [a] series on public health in Baltimore, Audie Cornish met up with Baltimore City Health Commissioner Leana Wen in Freddie Gray's neighborhood of Sandtown-Winchester. The health department recently opened a new outpost of its violence prevention program Safe Streets there, employing ex-offenders to mediate conflicts before they erupt in violence. Wen spoke about pushing a public health agenda in a city that has long struggled with poverty, violence and addiction. She also talked about what she, as an emergency physician, has learned in her first stint in government. (4/25)

Harley Ezelle gently rocked back and forth on a yoga ball in a meeting room at Tutwiler Prison as the woman next to her helped set her legs for maximum balance. It was the second meeting of the Alabama Prison Birth Project, which is bringing certified doulas to the women's prison to support pregnant inmates. (Yurkanin, 4/25)

Editorials And Opinions

Viewpoints: Detailing The Cadillac Tax; Health Care And Longevity's Decline

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

In December 2015, Congress delayed implementation of the so-called Cadillac tax, a 40 percent excise tax on high-cost employer health benefit plans. Now scheduled to be implemented in 2020, the Cadillac tax would effectively cap the current tax exclusion for employer health benefits. By excluding health benefits from taxable incomes, the current tax break creates incentives for employers to pay more of employees鈥 compensation via health benefits instead of taxable wages, possibly leading to overuse of health care services and driving up health costs. (Jeff Lemieux and Chad Moutray, 4/25)

If Stephen Curry misses a free throw with the game on the line in the NBA finals, everyone will say he choked. If the two highest-paid teams in Major League Baseball this year (the Los Angeles Dodgers and New York Yankees) fail to make the playoffs, no one will congratulate them on a job well done. (Merrill Goozner, 4/23)

Historian David Maraniss notes, in Sunday鈥檚 Post, that President Obama came to office with the goal of changing 鈥渢he trajectory of America鈥 and leaving 鈥渁 legacy as a president of consequence, the liberal counter to [Ronald] Reagan.鈥 On the foreign-policy front, he is the anti-Reagan for certain. Reagan defeated Soviet communism and left us a safer world; Obama presided over the rise and metastasis of the Islamic State and left us a far more dangerous one. Domestically, Ronald Reagan told the American people: 鈥淭he nine most terrifying words in the English language are 鈥業鈥檓 from the government, and I鈥檓 here to help.鈥 鈥 Obama wanted to convince Americans that they were not terrifying. And the way he was going to do it was through the only great liberal legislative achievement of his presidency: Obamacare. (Marc A. Thiessen, 4/25)

There has been a lot of health news over the past year, but which health stories really got through to the public? How about stories about Obamacare ranging from Republican efforts to repeal the law to stories about progress meeting enrollment targets? Or public health scares such as measles outbreaks or Zika? The scandals in VA health care? What about the stories about the political fight in Congress over Planned Parenthood funding? It turns out Obamacare, known formally as the Affordable Care Act, didn鈥檛 make the list of top health stories. The story that broke through the most? The fight over Planned Parenthood funding. Public health scares also broke through. And one health policy story with a consumer angle made the top group: rising drug prices. (Drew Altman, 4/25)

With surprise medical bills and high out-of-pocket costs getting increasing political attention, some hospitals and physician groups are drawing criticism for aggressive collection actions against patients. (Harris Meyer, 4/25)

Antibiotic resistant bacteria, or "superbugs," are on the rise. The recent outbreak of an antibiotic resistant strain of the rare blood disease, Elizabethkingia, that has killed 18 people total in Wisconsin and Michigan serves as a reminder of the growing public health threat of resistant bacterial infections. (Cody Carroll, 4/24)

In Missouri, getting an abortion is a herculean task. Restrictive abortion legislation has caused all but one abortion provider in the state to shut down. If you do manage to get an appointment at that clinic, you are legally required to receive in-person 鈥渟tate-directed counseling that includes information designed to discourage [women] from having an abortion,鈥 and then wait at least 72 hours after said counseling to get the procedure. This makes Missouri one of the most restrictive states in the U.S. when it comes to abortion, in a country where more than 230 abortion restrictions were enacted between January 2011 and January 2015. (Emma Gray, 4/25)

Give Oklahoma lawmakers points, at least, for honesty. They wanted to ban abortion, so they voted effectively to do just that 鈥 without offering any pretense of trying to protect women鈥檚 health, as supporters of other virulent anti-choice laws in states like Texas have done. Last Thursday, the Oklahoma House of Representatives voted overwhelmingly to bar doctors from performing abortions in all cases except to save the woman鈥檚 life. A doctor who violates the law would be committing a felony, punishable by up to three years in prison and the loss of his or her medical license. (4/25)

It's widely recognized that the U.S. pays more for healthcare than other developed nations, yet achieves comparatively worse health outcomes, leading for calls to lower costs to improve value. But what if we increased quality at the same cost? (Catherine MacLean, 4/23)

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