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KHN First Edition: October 1, 2015


First Edition

Thursday, October 01, 2015
Check Kaiser Health News online for the latest headlines

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

Kaiser Health News: GAO: More Oversight Needed Over Medicare Advantage Provider Networks
Kaiser Health News staff writer Phil Galewitz reports: "The federal government needs to increase its oversight over private Medicare health plans to make sure seniors have adequate access to doctors and hospitals, according to a report released this week by congressional auditors. The General Accountability Office study found the Centers for Medicare & Medicaid Services, which administers Medicare Advantage plans, primarily relies on complaints from consumers to determine if they are having trouble getting appointments with providers." (Galewitz, 9/30)

Kaiser Health News: Pecked By A Chicken? Sickened By In-Laws? There’s A Code For That
Reporting for Kaiser Health News, Barbara Feder Ostrov writes: "If you're struck by an orca, sucked into a jet engine, or having relationship problems with your in-laws, fear not: Your doctor now has a medical diagnosis code for that. Today U.S. doctors, hospitals and health insurers must start using the ICD-10, a vast new set of alphanumeric codes for describing diseases and injuries in unprecedented detail. The transition, mandated by the federal government, has been called American health care’s Y2K moment, because the codes haven’t been updated in 36 years. Doctors and hospitals are on high alert since the arcane letters and digits are key to how health care providers get paid. If they don’t use the right codes, down to the decimal, they may not be paid sufficiently – or at all." (Feder Ostrov, 10/1)

Kaiser Health News: How One Minority Community In California Is Fighting ‘Environmental Injustice’
Kaiser Health News staff writer Anna Gorman reports: "Miguel Dominguez didn’t know what to make of the notices he started receiving from the state toxic substances department a couple of years ago. They warned about Exide Technologies, a company he’d barely heard of. Then a community activist knocked on the door. He explained that Exide’s battery recycling plant – just minutes from Dominguez’s home — had been polluting the air and soil with lead and other toxic chemicals for decades." (Gorman, 10/1)

Kaiser Health News: Kids With Ebola? Texas Children’s Hospital Is Ready If It Happens In U.S.
Houston Public Radio's Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: "One year ago, on Sept. 30, 2014, the CDC confirmed that Thomas Eric Duncan had Ebola. He was the first person diagnosed with the deadly virus on American soil. During his stay at Texas Presbyterian Hospital in Dallas, two nurses also contracted Ebola. Duncan died, but the nurses survived, as did a handful of Americans who fell ill in West Africa but were transported back to the U.S. for care." (Feibel, 10/1)

The Associated Press: 4 Ways Companies May Adjust To Looming Employee Benefits Tax
The taxman is coming to employer-sponsored health insurance, and his visit may trigger changes to your benefits. The health care overhaul calls for a 40-percent tax starting in 2018 on the value of employer-sponsored coverage that costs more than $10,200 for single plans and $27,500 for family insurance. Employers are working to avoid this tax by cutting costs that have been rising for several years. (9/30)

The Wall Street Journal: Congress Passes Bill To Fund Government Through Dec. 11
Congress on Wednesday avoided a government shutdown by passing a bill that keeps the government running through mid-December, but leaves unresolved a divide over federal spending that threatens to resurface this winter with more perilous economic consequences. ... Congress now confronts a new Dec. 11 deadline to try to strike a long-term budget deal at a time when House Republicans are losing their most experienced leader and remain split about how to negotiate with Mr. Obama and Democrats. (son and Timiraos, 9/30)

The Washington Post: On Eve Of Shutdown, Congress Buys More Time
The stopgap spending bill, which passed the Senate 78 to 20 and cleared the House 277 to 151, continues current funding levels through Dec. 11 and sets the stage for negotiations between congressional Republican leaders, who want to hew to strict caps on nondefense discretionary spending, and President Obama and Democrats, who want higher levels. ... Meanwhile, Republican demands to end Planned Parenthood’s access to Medicaid reimbursements and federal health-care grants, which nearly prompted a shutdown ahead of Wednesday’s midnight deadline, show no sign of abating. ... The influential conservative activist group Heritage Action for America, for instance, on Wednesday called on aspiring House leaders to end Planned Parenthood funding and respect the sequestration caps. (DeBonis and Snell, 10/1)

Politico: Shutdown Fight Pushed To December
Conservatives in both chambers wanted the continuing resolution to cut federal funding for the women’s health care organization but nearly unified Senate Democratic resistance — not to mention a promised veto from President Barack Obama, meant the defunding language was jettisoned from the bill that the House cleared on a 277-151 vote and that will move on for Obama’s signature. A coalition of 91 Republicans joined 186 Democrats to pass the bill in the House. ... Conservative Republicans are already planning an aggressive tact to strip Planned Parenthood of its funding after falling short this round. ... And with the House GOP embroiled in leadership election intrigue after Boehner’s surprise resignation last week, there are several variables in play. Minority Whip Steny Hoyer (D-Md.) told reporters on Tuesday that he is worried that fights over spending caps, Planned Parenthood and overall government funding could lead to a shutdown in December. (French and Kim, 9/30)

The Associated Press: Federal Health Program For Sept. 11 Responders Set To Expire
A law that provides medical monitoring and treatment for Sept. 11 first responders expires at midnight Wednesday due to the failure of Congress to act. For now, first responders who rushed to the World Trade Center after the 2001 terrorist attacks, worked for weeks and now suffer from illnesses like pulmonary disease and cancers will still be able to get their health care. But federal officials who administer the program say it will face challenges by February and will have to start shutting down by next summer. (9/30)

The Wall Street Journal: Medicare Overpays For Intensive Therapy, Watchdog Says
Medicare could make changes to its nursing-home payment system that save billions of dollars and stem a shift to higher-cost services that don’t always correspond with patients’ needs, a government watchdog said in a report Wednesday. The report, by the Health and Human Services Department’s Inspector General, found that nursing facilities billed for increasing rates of what Medicare terms “ultra high” therapy, leading to the extra spending. The report said an analysis of claims data found facilities billed for ultrahigh therapy 57% of the days they billed to Medicare in 2013, compared with 49% in 2011. (Weaver, 9/30)

The Washington Post: Burned By Flaming Water-Skis? Bitten By A Macaw? There’s A Medical Code For That.
So you've been burned by flaming water skis? Attacked by an orca? Sucked into a jet engine? Try to remember the details for your doctor, because there's now a medical code for your condition. The crazy-sounding diagnostic codes are part of a huge change set to take place Thursday in doctor's offices, hospitals, nursing homes, insurance companies and just about every part of the U.S. health system. If things go according to the long-delayed plan, patients shouldn't notice and care shouldn't be affected. (Sun, 9/30)

The Wall Street Journal: Rift Over Drug Protections Complicates Trans-Pacific Partnership Trade Talks
A fight over how long to protect certain high-end drugs from lower-cost imitators has emerged as the leading obstacle to negotiations aimed at completing a 12-nation trade agreement spanning the Pacific. While officials from the U.S. and other counties cite some progress on two other thorny issues, the drug debate continues to divide Australia and other countries from America in the high-level talks that began Wednesday in Atlanta. (Mauldin, 10/1)

The Washington Post: How Bernie Sanders Would Transform The Nation
The biggest pieces of Sanders’s domestic agenda — making college, health care and child care more affordable — seek to capture these industries and convert them to run chiefly on federal money. ... Bernie Sanders — a senator from Vermont who describes himself as a “democratic socialist” — will never get everything he wants in Washington. And that still would be true if he became President Sanders. Republicans in the Congress would fight him fiercely. Democrats might not be much help. In fact, Sanders’s most recent Senate bills — legislation that would make college free and provide universal health care — attracted exactly zero Democrats as co-sponsors. (Fahrenthold, 10/1)

Los Angeles Times: UN: HIV Patients Should Start Treatment Immediately
The World Health Organization has revised its HIV guidelines to recommend that anyone who tests positive for the virus that causes AIDS should be treated immediately. That guidance fits with what is already recommended in many developed nations, including the United States. (Cheng, 9/30)

The New York Times: Millions More Need H.I.V. Treatment, W.H.O. Says
The World Health Organization issued sweeping new guidelines on Wednesday that could put millions more people on H.I.V. drugs than are now getting them. The recommendations could go a long way toward halting the epidemic, health officials say, but would cost untold billions of dollars not yet committed. (McNeil Jr., 9/30)

The Associated Press: Medicare Fraud Trial For Doc Tied To Sen. Menendez Postponed
It will be at least another year before a Florida doctor charged with corruption alongside New Jersey Sen. Bob Menendez will go to trial on Medicare fraud charges. The Palm Beach Post reports Dr. Salomon Melgen’s trial was moved to September to accommodate a federal trial in New Jersey where he is facing corruption charges along with Menendez. (10/1).

Los Angeles Times: Not Enough Signatures: Vaccine Opponents Fall Short In Ballot Effort
Opponents of a new child vaccination law in California have reported that they turned in some 228,000 signatures on petitions for a referendum to overturn the measure, far short of the number needed to qualify it for next year's ballot. Referendum supporters needed the signatures of 365,880 registered voters by Monday to place the measure before state voters in November 2016. (McGreevy, 9/30)

Reuters: Bid To Repeal California School Vaccination Law May Falter
A plan to ask voters to repeal a new California law tightening vaccination requirements for school-age children may falter due to a shortfall in signatures needed to put the referendum on the ballot. The effort is part of a backlash against a bill signed into law this summer by Democratic Governor Jerry Brown that requires pupils to be vaccinated against childhood diseases unless they have a medical reason to refuse. It was passed after a measles outbreak among unvaccinated people at Disneyland last year. (9/30)

The Wall Street Journal: New Legionnaires’ Outbreak In The Bronx Claims A Life
One of the people sickened in a new outbreak of Legionnaires’ disease in the city has died, health officials said Wednesday. The Department of Health and Mental Hygiene released few details about the person, saying only that the patient was between the ages of 40 and 49 and had “severe underlying health conditions.” (Gay, 9/30)

The Wall Street Journal: Mayor’s Initiative Could Boost Immigrant Health-Care Access
New York City Mayor Bill de Blasio is expected on Thursday to introduce a multimillion-dollar initiative to improve health-care access for some of the city’s low-income, uninsured immigrant population by connecting them to primary and preventive health-care services. The initiative, called Direct Access, isn’t an insurance program, but it aims to create a kind of universal health care using existing providers already paid for by city, state or federal funds. Patients would have a primary-care doctor and a so-called medical home where care would be coordinated. (West, 10/1)

Kaiser Health News is an editorially independent operating program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.

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