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KHN First Edition: July 21, 2015


First Edition

Tuesday, July 21, 2015
Check Kaiser Health News online for the latest headlines

Today's early morning highlights from the major news organizations.

Kaiser Health News: Despite Gains In Advance Directives, Study Finds More Intensive End-Of-Life Cancer Care
Kaiser Health News consumer columnist Michelle Andrews reports: "Conversations about end-of-life care are difficult. But even though most people now take some steps to communicate their wishes, many may still receive more intensive care than they would have wished, a study this month found. The study, published online in JAMA Oncology, examined survey data from the Health and Retirement Study, a national study of U.S. residents older than age 50. Researchers analyzed the responses from the next of kin, usually a spouse or child, of 1,985 participants with cancer who died between 2000 and 2012." (Andrews, 7/21)

Kaiser Health News: More Health Plan Choices At Work. What’s The Catch?
Minnesota Public Radio's Mark Zdechlik, working in partnership with Kaiser Health News and NPR, reports: "ntil recently, John Henry Foster, an equipment distribution firm based in Eagan, Minn., offered its employees only a couple of health plans to choose from. That’s common in companies across America. “They just presented what we got,” says Steve Heller, a forklift operator who has worked at John Henry Foster for 15 years. But these days the company’s employees have dozens of choices. And something else is new: Each worker now receives money from the company (from $350 to $1,000 a month, depending on whether Heller and his co-workers are buying insurance for a single person, a couple or a family) to buy a health plan." (Zdechlik, 7/21)

The Wall Street Journal: Medicare Expanding Access To Hospice Care
The federal government is announcing Monday the expansion of a pilot project that paves the way for Medicare beneficiaries to use hospice services while still getting treatments that aim for a cure. A successful test could lead to a fundamental shift in the delivery of health-care at the end of patients’ lives. Under current Medicare payment rules, beneficiaries can’t get both curative treatment and hospice care at the same time. (Armour, 7/20)

The Washington Post: Medicare And Medicaid Mark A Milestone
Only weeks after Obamacare survived a Supreme Court challenge, Medicare and Medicaid mark a significant milestone: July 30 will be the 50th anniversary of the law that created them. Four health-care experts connected with Princeton University and the Robert Wood Johnson Foundation (and other institutions) take this moment to produce what amounts to a written roundtable discussion: “Medicare and Medicaid at 50: America’s Entitlement Programs in the Age of Affordable Care.” The 16 essays in this collection include histories of how the programs were conceived, developed and legislated; analysis of how they were reshaped and transformed in the 1970s and ’80s; discussion of how over the years they have remade political agendas and the health-care industry; and predictions about their future. (Szokan, 7/20)

The Washington Post's Wonkblog: This $153,000 Rattlesnake Bite Is Everything Wrong With American Health Care
Earlier this month a guy named Todd Fassler was bitten by a rattlesnake in San Diego, KGTV San Diego reports. In itself this isn't terribly unusual—the CDC estimates that roughly 7,000 to 8,000 people a year get bit by a venomous snake in the U.S. And somewhere between five and six people die from these bites each year. What raised eyebrows, though, was Fassler's hospital bill—all $153,000 of it. KGTV reporter Dan Haggerty shared it on Twitter. Take a look. (Ingraham, 7/20)

The New York Times' Well Blog: ‘Illegal Activity’ Fine Print Leaves Some Insured, But Uncovered
There are no firm numbers on how often insurers deny medical coverage based on allegations of illegal activity. But cases like Mr. Bird’s “are more common than people think,” said Crystal Patterson, an attorney in Minneapolis and chairwoman of the American Bar Association’s committee on fiduciary litigation. Insurers have long relied on allegations of illegal activity to deny coverage to patients injured in a variety of contexts, from traffic infractions to gun accidents. The judicial rationale is that “we don’t want to reward illegal activity,” she said. (Rabin,7/20)

USA Today: Bartiromo: AthenaHealth's CEO Talks Health Care, Tech And Cousin Jeb Bush
Health care was one of the few industries that saw job creation in the month of June because of a revolution going on in the industry. We are living longer, getting in front of disease and monitoring everything from our fluids and heart rate to our digital records. All of this as premiums are going up and the Supreme Court rules the Affordable Care Act will stay the law of the land. I caught up with one of the leaders in this new marriage between health care and technology: AthenaHealth CEO Jonathan Bush who is providing cloud-based services for electronic health records, revenue management, and other point-of-care apps that are changing the way we approach health care. I also asked him about his first cousin who is hoping to occupy the White House in 2017. (Bartiromo, 7/20)

The Associated Press: Families Face Tough Decisions As Cost Of Elder Care Soars
For the two-thirds of Americans over 65 who are expected to need some long-term care, the costs are increasingly beyond reach. The cost of staying in a nursing home has climbed at twice the rate of overall inflation over the last five years, according to the insurer Genworth Financial. One year in a private room now runs a median $91,000 a year, while one year of visits from home-health aides runs $45,760. Goldblum estimates that she and her mother spent at least $300,000 over the last two years for care that insurance didn’t cover. (Craft, 7/20)

The Washington Post: You Need Surgery. So How Do You Find The Right Doctor?
One of the most frustrating experiences for patients is choosing a doctor for surgery. Now two groups have come out with free ratings tools that allow people to search online for surgeons performing several major types of operations. One consumer group compiled a database that lists only top performers. The second, ProPublica, an investigative journalism group, includes information on poor performers. (Sun, 7/20)

The Washington Post's Wonkblog: A Revolution In How Doctors Are Paid Isn’t Really Changing How Doctors Are Paid
It’s one of the grand ideas that is supposed to revolutionize U.S. health care: reward doctors who keep patients well with fewer tests, procedures, and appointments. That might register as barely profound to most of us, but it is a radical shift in the incentives that doctors and hospitals face. Under the Affordable Care Act, some doctor’s groups and hospitals have banded together in accountable care organizations to treat Medicare patients under this new philosophy. If the patient stays healthier with fewer appointments, the providers get a share of the cost savings. (Johnson, 7/20)

The New York Times: John Kasich To Enter Crowded 2016 Race Facing Job Of Catch-Up
Gov. John R. Kasich, a blunt-spoken and unorthodox Republican who bucked his party by expanding Medicaid under President Obama’s health care law and says politicians must “reach out and help those who live in the shadows,” is expected to announce Tuesday that he is joining his party’s long list of candidates for president. Mr. Kasich, 63, would become the 16th prominent Republican to enter the 2016 field. As a two-term governor in a critical swing state — no candidate since John F. Kennedy in 1960 has won the White House without winning Ohio — he will be a credible candidate, though his late entry means he has catch-up work to do. (Stolberg, 7/21)

The New York Times: John Kasich On The Issues
Budget and the Economy: Mr. Kasich broke with other conservative governors by accepting funds for the expansion of Medicaid under Mr. Obama’s Affordable Care Act, though he said he opposed the law. The expansion made 275,000 Ohioans eligible for Medicaid. Mr. Kasich has in recent years defended the social safety net, taking issue with fellow Republicans who slash poverty programs. “I’m concerned about the fact there seems to be a war on the poor,” he said in 2013. He has pointed to his experience as a fiscal hawk as chairman of the House Budget Committee during the Clinton administration, when he proposed alternative budgets that cut federal spending, including military appropriations and entitlements like Medicaid. As Ohio governor, though, Mr. Kasich has emphasized his record of balancing budgets, cutting taxes and, most important, creating jobs — though critics have said he partly benefited from an improving national economy. (Mullany, 7/21)

Los Angeles Times: Ohio's John Kasich Brings Heat, Intrigue To 2016 GOP Race
In a large and varied Republican field, there may be no more confounding presidential candidate than John Kasich. In the 1990s, he was part of the conservative revolution on Capitol Hill. As Ohio governor, he has cut income taxes and government regulation, battled organized labor and approved new restrictions on abortion and voting rights. He also spared several inmates facing execution, supported higher taxes on cigarettes and fracking and horrified conservatives by expanding healthcare access under the Affordable Care Act, throwing in a lecture on what it means to be a good Christian. (Barbarbak, 7/21)

The Wall Street Journal: Then There Were 16: John Kasich To Enter GOP Fray
The two-term Republican governor’s bid will test whether a candidate who has bucked the right flank of his party on issues ranging from Medicaid expansion to immigration can gain traction in a primary. Mr. Kasich, 63 years old, is counting on his mix of executive and Capitol Hill experience to catapult him to contender status. He’ll also tout his work on national security and budget issues during his tenure as a congressman from 1983 until 2001, as well as the economic turnaround in Ohio. (McCain Nelson, 7/20)

Politico: John Kasich Throws A Hail Mary
The two-term governor will announce his bid during a Tuesday appearance at The Ohio State University, his alma mater, where he will highlight his long career in public office and his success in turning around his state’s troubled economy. Yet as Kasich embarks on his quest for the party’s nomination, he confronts a big challenge: He’s starting late. ... Nationally, his decision to embrace a key component of Obamacare — the expansion of Medicaid to low-income adults — could hurt him with conservative voters, who despise the president’s health-care law, and puts him at odds with his primary opponents. Kasich, though, has a more immediate concern: qualifying for the first Republican primary debate, slated for Aug. 6 in Cleveland. (Isenstadt, 7/21)

The Washington Post: Ohio’s Kasich Poised To Join Big Field Of GOP Candidates
Kasich served in the House for 18 years and was chairman of the Budget Committee at a time when Washington balanced the federal budget for the first time in a generation. He spent another decade in the business world before winning the governorship in 2010. He won reelection in a landslide last November after his Democratic opponent imploded a few months before the general election. ... In Ohio, he engineered an expansion of Medicaid under the Affordable Care Act, in contrast to many Republican governors. He has championed spending more money on such things as treatment for drug and alcohol addiction. He cites his religious faith as motivating him to help those in need. (Balz, 7/21)

Politico: Scott Walker In Iowa: Relentlessly On Message
In Cedar Rapids, when a voter asked him Friday during a town hall about what he would do to keep jobs in Iowa, Walker took that as an opportunity to dive into his five-point economic plan, making a few connections between Obamacare and her question, but generally sticking to a script that he used everywhere else. (Glueck, 7/20)

The New York Times: Veterans’ Groups Take Their Shots At Donald Trump As He Backs Off A Bit On McCain
Mr. Trump’s attacks were all the more misguided, veterans’ advocates said, because Mr. McCain has an extensive record of being helpful and involved. ... In just the last year, Mr. McCain was a key player in negotiations with Senator Bernie Sanders, a Vermont independent who was then chairman of the Veterans Affairs Committee, to pass a broad-based overhaul of the Department of Veterans Affairs after the disclosure that staff members had been manipulating wait times to make it appear that patients were receiving care faster than they were. Mr. McCain was also a lead sponsor of the Clay Hunt Suicide Prevention for American Veterans Act — one of the first pieces of legislation that became law after Republicans took over Congress this year. (s, 7/20)

The Associated Press: FACT CHECK: Trump Shortchanges McCain's Record On Veterans
TRUMP: "I'm very disappointed in John McCain because the vets are horribly treated in this country. I'm fighting for the vets. I've done a lot for the vets ... He's done nothing to help the vets. And I will tell you, they are living in hell." ... THE FACTS: McCain ... was instrumental in a landmark law approved last year to overhaul the scandal-plagued Department of Veterans Affairs. McCain worked with the chairman of the Senate Veterans Affairs Committee, independent Bernie Sanders of Vermont, as well as Rep. Jeff Miller, R-Fla., chairman of the House veterans panel, to help win passage of the law, which aims to alleviate long delays veterans faced in getting medical care. The VA says it has completed 7 million more appointments for care in the past year, compared with the previous year, but veterans still face increased wait times in Phoenix, Las Vegas and other places. ... McCain pushed for a provision in the law allowing veterans who live more than 40 miles away from a VA health care site to get government-paid care from a local doctor. (7/21)

The Washington Post: Poll: Trump Surges To Big Lead In GOP Presidential Race
Businessman Donald Trump surged into the lead for the 2016 Republican presidential nomination, with almost twice the support of his closest rival, just as he ignited a new controversy after making disparaging remarks about Sen. John McCain’s Vietnam War service, according to a new Washington Post-ABC News poll. ... The rankings are more important than early national surveys in previous campaigns because only the top 10 candidates, based on an average of the most recent national polls, will qualify for the first Republican debates. The first debate will be held Aug. 6 in Cleveland. Fox News Channel is the sponsor of that event and established the rules for eligibility. (Balz and Craighill, 7/20)

Los Angeles Times: Bush And Clinton Highlight Sharp Contrast In Dueling Policy Speeches
The speech drew a sharp contrast in tone and content with Hillary Rodham Clinton, the Democratic front-runner, who has begun rolling out a series of policy proposals, many of which would involve expanding government’s role. ... Jeb Bush’s pledge to “turn off the automatic switch on discretionary spending increases” also struck an odd note. That category of spending, which covers federal spending governed by annual appropriations bills, has been shrinking as a share of the budget. Bush said that he would propose ideas later for the entitlement programs, such as Social Security and Medicare, that account for most of the long-term growth in federal spending. (Lauter, 7/20)

Los Angeles Times: With Millions More Expected To Develop Alzheimer's, More Research Funding Demanded
Over the next 35 years, about 28 million baby boomers will likely develop Alzheimer's disease, and the annual bill for their care will balloon from $11.9 billion in 2020 to more than $328 billion in 2040, says an analysis released Monday. Barring the discovery of treatment that could delay or prevent the onset of Alzheimer's disease, the cost of caring for baby boomers with the disorder by 2040 will eat up a quarter of the nation's total Medicare spending, researchers have estimated. (Healy, 7/20)

The Associated Press: Obama Marks 25th Anniversary Of Federal Disability Act
President Barack Obama on Monday celebrated the 25th anniversary of the Americans with Disabilities Act, which he said has ushered in a "bright new era of equality, freedom and independence" for millions of Americans. Obama was joined by Vice President Joe Biden during a White House reception to commemorate the law. (7/20)

The Washington Post: VA Manager Indicted On 50 Counts Of Falsifying Records Of Veterans Waiting For Medical Care
A manager at a Veterans Affairs medical center in Georgia is on leave with pay following his indictment on 50 counts of ordering his staff to falsify medical records of veterans waiting for outside medical care. The case against Cathedral Henderson appears to be the first round of criminal charges stemming from a wait-times scandal that came to light last year and led to the resignation of VA Secretary Eric Shinseki. (Rein, 7/20)

The Washington Post: Indicted VA Manager Worked In Hospital In Turmoil
The Charlie Norwood Veterans Affairs Medical Center in Augusta, Ga., was a hospital with systemic failures. Its gastrointestinal clinic was so overwhelmed and mismanaged that close to 5,000 referrals for endoscopies were delayed, auditors found, resulting in the deaths of three cancer patients in 2011 and 2012, hospital officials acknowledged in published reports. (Rein, 7/20)

The Associated Press: GOP Presidential Hopeful Walker Signs Abortion Ban Bill
Republican Wisconsin Gov. Scott Walker, one week after launching his bid for the 2016 presidential nomination, signed a bill Monday that outlaws non-emergency abortions at or beyond 20 weeks of pregnancy. Abortion is a core issue for the conservative Republican base whose support Walker will seek as he tries to stand out in a crowded presidential field that also includes former Florida Gov. Jeb Bush, Florida Sen. Marco Rubio and billionaire Donald Trump. (7/20)

Politico: Scott Walker Signs Wisconsin Abortion Bill
The legislation makes performing an abortion a felony punishable by up to three and a half years in prison and $10,000 in fines. The only way abortions after 20 weeks are allowed is if the mother is likely to die or be severely injured. Anti-abortion activists have coalesced around 20 weeks because, they say, that’s when fetuses begin to feel pain. The American Congress of Obstetricians and Gynecologists, however, says that pain doesn’t occur until 27 weeks. (Collins, 7/20)

The New York Times: Confederate Flag Down, But Black South Carolinians See Bigger Fights
But for years state government here has been dominated by Republicans. Most of them are white, and deeply skeptical about the power of government to solve South Carolina’s problems. In the midst of the recession, the state’s previous governor, Mark Sanford, refused to take $700 million in federal stimulus money to help the state’s struggling schools, and did so only after the State Supreme Court forced his hand in 2009. And Mr. Sanford’s successor, Nikki R. Haley, is among a number of Republican governors who have declined to use the Affordable Care Act to expand Medicaid eligibility to the working poor in their states. Some Democrats here interpret such stands in the context of the state’s troubled racial history. (Blinder and Fausset, 7/20)

NPR: Expanding, Not Shrinking, Saves A Small Rural Hospital
Putnam County Memorial was ailing from the same conditions squeezing the finances of many of the nation's rural hospitals. At least 55 have closed since 2010 across the U.S., with another 1 in 10 at risk of going under, by one talley. Only about 5,000 people live in Putnam County, and they tend to be older, poorer, sicker and less insured than the rest of the state. Health care analysts says Medicare and Medicaid's relatively low reimbursements, combined with dwindling populations in rural regions, are forcing many hospitals like Putnam to operate with tighter profit margins than suburban institutions — and sometimes even at a loss. (Sable-Smith, 7/21)

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