Kaiser Health News Original Stories

2. ‘A Terrible Way To End Someone's Life’

Doctors often opt to forego aggressive care for terminal illnesses but fail to talk to their patients about their preferences. (Stephanie O'Neill, Southern California Public Radio, 7/6)

3. Political Cartoon: 'Worth A Shot?'

Kaiser Health News provides a fresh take on health policy developments with "Political Cartoon: 'Worth A Shot?'" by Clay Bennett, Chattanooga Times Free Press.

Here's today's health policy haiku:

THE START OF SOMETHING BIG?

Aetna to purchase
Humana. Is this the start
Of new merger craze?

If you have a health policy haiku to share, please Contact Us and let us know if you want us to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

Health Law Issues And Implementation

4. GOP Eyes Medical Device Tax, Change To Filibuster Rules To Fight Health Law

Congressional Republicans think they may have the votes to force President Barack Obama to accept a repeal of the medical device tax, which helps fund the health law, thanks to support from some Democrats. Some Republican candidates for president are also pushing for a change in the Senate's filibuster rules so they can vote to repeal the law but others in the party oppose that.

The Wall Street Journal: Fight Over Affordable Care Act Turns To Medical-Device Tax
Congressional Republicans see a repeal of a tax on medical devices as their best opportunity to chip away at the Affordable Care Act after the Supreme Court’s recent decision turning away a challenge to a key component of the law. The House has already voted to repeal the tax, and Senate Republicans are weighing the best timing for a vote to undo the levy, which helps underwrite the health law. President Barack Obama would almost certainly veto a stand-alone repeal, but with a number of Democrats also opposed to the tax, lawmakers think they may be close to having the votes needed to override the president, or insist the tax be rolled back as part of a grand bargain on spending bills later this year. (Stanley-Becker, 7/6)

The Associated Press: Q&A: As Obama Health Law Survives, GOP Split Over Next Move
Last month's Supreme Court decision upholding the statute's federal subsidies, which help millions of Americans afford health care, shattered the GOP's best chance of forcing Obama to accept a weakening of his prized law. Without that leverage, Obama would likely veto any major changes they'd send him. They could, however, try sending him veto-bait legislation designed to show voters how they'd reshape the nation's health care system — if only Republicans could agree on what to do. With the GOP-run Congress back from a July 4 break, here's a look at their problematic path. (Fram, 7/6)

Politico: Filibuster Divides GOP 2016 Contenders
The Senate’s arcane rules are creating new fissures in the 2016 presidential primary: Candidates from outside Washington are vowing to gut the filibuster in order to repeal the Affordable Care Act, while GOP senators pursuing the White House want to keep the time-honored 60-vote threshold. (Strauss and Everett, 7/6)

5. San Francisco Worries About Obamacare's Financial Burdens

County officials are considering helping residents pay for health insurance plans offered through Covered California, the state's online marketplace. Meanwhile, a study confirms what many consumers already know -- figuring out which doctors are in Obamacare plans is difficult.

Los Angeles Times: In Ironic Twist, S.F. Is Worried Obamacare Could Hurt Its Most Vulnerable Residents
Nearly 10 years ago, this county by the bay known for its progressive political leaps became one of the first in the nation to offer residents universal access to healthcare. Now the federal Affordable Care Act has been rolled out nationwide with the same goal in mind. But in an ironic twist, officials in this city are worried the new law could adversely affect some of the most vulnerable San Franciscans. The local health program known as Healthy San Francisco, which has served as many as 60,000 patients annually since its creation in 2007, is almost free. Obamacare plans, however, are not. ... County officials here are weighing ways to help residents pay for insurance plans offered through Covered California, the state's health insurance exchange. (Karlamangla, 7/6)

The Philadelphia Inquirer: Finding Which Doctors Are in Obamacare Networks Is Difficult
When economist Dan Polsky set out to study how many doctors were in the health-insurance networks available to Obamacare customers, he found out it was hard - even for him. How hard? "Nine out of 10," said Polsky, executive director of the University of Pennsylvania's Leonard Davis Institute of Health Economics. ... Polsky said insurers need to do more to help shoppers determine who is in the network they are considering. Otherwise, he predicted, lawmakers may set specific limits on how narrow networks can be. (Burling, 7/7)

Marketplace

6. Antitrust Jitters Surround Humana, Aetna Merger

Despite Aetna CEO's assurances that antitrust concerns would not stop the company's purchase of its smaller rival Humana, shares of Humana closed Monday 15.4 percent below the value of Aetna’s cash-and-stock offer, suggesting investors had worries. Aetna's stock also fell Monday.

The Wall Street Journal: Deal-Related Jitters Hit Humana, Aetna
After weeks of banking on a takeover, Humana Inc.’s shareholders reacted coolly to news of the insurer’s $34.1 billion announced sale to Aetna Inc., amid concerns over the deal’s antitrust prospects, the possibility of an interloper and weakness in Humana’s own business. Shares of Humana closed Monday 15.4% below the value of Aetna’s cash-and-stock offer, a yawning gap that suggests investors worry the deal may face challenges. Some of the same concerns socked Aetna’s stock, which fell 6.4%. ... The largest unknown is antitrust approval, investors and analysts said. Aetna and Humana are the third- and fourth-biggest U.S. health insurers by revenue, and together would have about a million more Medicare subscribers than their next-closest competitor. (Hoffman and Wilde Mathews, 7/6)

The Washington Post: More Competition Is Supposed To Help Consumers. That Might Not Be True With Health Insurance.
You may have heard the news over the weekend of a mega-merger between two of the country's biggest health insurance companies, Aetna and Humana. The $37 billion deal is just one of a series that are expected to reshape the health insurance landscape, after the Supreme Court decision last month made it clear that health care reform was here to stay. The question most people care about outside Wall Street -- what effect these mergers will have on what we pay for health care is a source of some disagareement among specialists. One of the most surprising -- and weird -- things about the insurer merger mania is that ultimately, some analysts think it might have benefits for consumers. But others say there is some evidence that a marketplace with fewer insurers will be bad for consumers. (Johnson, 7/6)

Reuters: Aetna CEO Addresses Antitrust Concerns Over Humana Deal
Aetna Inc.'s chief executive said Monday he was confident any antitrust review of the health insurer's proposed purchase of smaller rival Humana Inc. would allow the deal to close in the second half of 2016. Mark Bertolini said Aetna had already prepared for possible divestitures to address overlaps with Humana's business in the largest-ever U.S. health insurance deal. The two sides announced the $37 billion transaction on Friday. Hospital and state officials said they would take a hard look at whether the deal would diminish competition for consumers. (Humer, 7/6)

Reuters: Humana Cuts Outlook, Raising New Concerns About Aetna Deal
Humana Inc., fresh from announcing an agreement to be purchased by larger rival Aetna Inc., prompted new investor concerns about the $33 billion deal on Monday by lowering its 2015 financial forecasts. The transaction announced on Friday is already expected to face a tough review by U.S. antitrust regulators, particularly if another major deal among health insurers emerges. (Humer, 7/6)

And in other consolidations in the health care industry -

Nashville Tennessean: Emdeon Inc. Buying Altegra Health For $910M
Emdeon Inc. is in the process of buying Altegra Health, a data aggregation and analytics company, for about $910 million. Nashville-based Emdeon will combine Altegra with its existing Intelligent Healthcare Network, enabling the company to offer products to clients that help improve care quality and customer experience. (Pickert & Fletcher, 7/6)

7. CMS Softens On New Medical Billing Code, Offers Transition Period

The new codes, known as ICD-10, are seen by some as overly bureaucratic, but are slated to begin Oct. 1. The Obama administration says it won't deny most claims during a 12-month transition. Elsewhere, the lack of federal data on industry payments to nurses is scrutinized, while sick docs and telemedicine are also examined.

The Hill: White House Eases Up On New Medical Code
The Obama administration announced on Monday that it will give doctors a 12-month transition period related to new medical codes that have drawn criticism from some Republican lawmakers as a needless expansion of bureaucracy. The deadline for doctors to adopt a new set of codes that identify medical conditions and procedures is Oct. 1. They are known as ICD-10, for the tenth version of the International Classification of Diseases. (Sullivan, 7/6)

NPR/ProPublica: Industry Payments To Nurses Go Unreported In Federal Database
A nurse practitioner in Connecticut pleaded guilty in June to taking $83,000 in kickbacks from a drug company in exchange for prescribing its high-priced drug to treat cancer pain. In some cases, she delivered promotional talks attended only by herself and a company sales representative. But when the federal government released data Tuesday on payments by drug and device companies to doctors and teaching hospitals, the payments to nurse practitioner Heather Alfonso, 42, were nowhere to be found. That's because the federal Physician Payment Sunshine Act doesn't require companies to publicly report payments to nurse practitioners or physician assistants, even though they are allowed to write prescriptions in most states. (Ornstein, 7/6)

Los Angeles Times: Why Do Doctors, Of All People, Show Up For Work Sick?
Doctors and nurses understand that working while they're sick can put their patients at risk. But most do so anyway, a new survey of workers at the Children's Hospital of Philadelphia suggests -- influenced by factors as varied as concerns over who will fill in for them, worries that their patients can't get by without them and a widespread notion that healthcare workers who stay home to nurse a cold or stomach bug are somehow weak or unprofessional. (Brown, 7/6)

USA Today: The Digital Doctor Is In: Next Wave In Health Care
In today's digitally focused world, there are some cases where a trip to the doctor can be easily replaced with the download of an app or the power of a text message. The health care industry is in the midst of a technological boom, a transition which physician Bob Wachter, author of The Digital Doctor, says is necessary – but no one has gotten it completely right yet. (Thadani, 7/6)

8. Lawmakers On Capitol Hill Weigh Adding Billions To NIH Budget

The medical research agency's popularity, fears that the U.S. is losing ground to foreign competitors and congressional efforts to show bipartisanship are contributing to political support for the proposed funding increase.

Politico: NIH Sees Reversal Of Fortune With Proposed Funding Boosts
After a dozen years of flat funding, the National Institutes of Health has become a top target on Capitol Hill — not for less money but more, potentially billions more by 2020. It’s a remarkable turnaround for the huge medical research agency, one triggered by a confluence of circumstances. Fears that the United States is losing ground to international competitors in science and technology synched with lawmakers’ need to show frustrated voters that they can work in a bipartisan manner, and NIH offered “an easy win” on both, advocates say. (Karlin, 7/7)