First Edition: July 17, 2014

Today's headlines include reports about how Capitol Hill politics are impacting health care policy.

Kaiser Health News: Specialty Care Is A Challenge In Some ACA Plans
Houston Public Media's Carrie Feibel, working in partnership with Kaiser Health News and NPR, reports: "Primary care doctors have reported problems making referrals for patients who have purchased some of the cheaper plans from the federal insurance marketplace. Complaints about narrow networks with too few doctors have attracted the attention of federal regulators and have even prompted lawsuits. But they're also causing headaches in the day-to-day work of doctors and clinics. 'The biggest problem we've run into is figuring out what specialists take a lot of these plans,' said Dr. Charu Sawhney of Houston" (Feibel, 7/16). Read the story.

Kaiser Health News: Capsules: Registered Nurses Increasingly Delay Retirement, Study Finds
Now on Kaiser Health News' blog, Shefali Luthra writes: "Despite predictions of an impending nurse shortage, the current number of working registered nurses has surpassed expectations in part due to the number of baby-boomer RNs delaying retirement, a study by the RAND Corp. found" (Luthra, 7/16). Check out what else is on the blog.

The New York Times: Partisanship Infuses Hearings On Health Law And Executive Power
Efforts by congressional Republicans to rein in what they say are the legislative and political excesses of the Obama administration played out in simultaneous hearings on Wednesday, further highlighting how election-year politics are overtaking business on Capitol Hill. The first hearing, by the House Committee on Oversight and Government Reform, was quickly adjourned after the administration refused to allow testimony from David Simas, the White House political director, who had been called under a Republican subpoena to answer questions about Democratic campaign activities. The second, a debate in the House Rules Committee on the merits of a lawsuit that Speaker John A. Boehner plans to file against President Obama, exposed simmering partisan tensions as Democrats used the occasion to ridicule the speaker's move as a hollow ruse (Peters, 7/16).

The Wall Street Journal: Hospital Operator HCA Touts Benefits From Health-Care Reform Law
HCA Holdings Inc. said admissions to its hospitals rebounded in the second quarter and greater-than-expected benefits from the health-care reform law contributed to sharply stronger results than estimated. "Results for the second quarter of 2014 exceeded our internal expectations, both in terms of our core operations and health-care reform," Chief Executive R. Milton Johnson said, while raising the company's outlook for the year as well (Jamerson, 7/16).

The Wall Street Journal: UnitedHealth Tops Expectations, Raises Outlook
UnitedHealth, which is the biggest health insurer in the U.S., said impacts of the federal Affordable Care Act cut into its after-tax net margin for the most recent period by 90 basis points to 4.3%. This year will be the first to reflect the full implementation of the law, as cuts in government funding for certain provisions are projected to weigh on results. UnitedHealth credited growth in coverage in its public and senior sectors with helping to increase its top line, as well as improvement in its pharmacy services business (Calia, 7/17).

NPR: The Two Way: Democratic Effort To Override Hobby Lobby Ruling Fails
A Democratic effort to override the Supreme Court's recent ruling on contraceptive coverage failed in the Senate on Wednesday. Bill sponsors fell four votes short of the 60 votes needed to cut off debate on the measure (Greenblatt, 7/16).

The Wall Street Journal: Senate Bill To Nullify Hobby Lobby Decision Fails
Senate Republicans on Wednesday blocked Democrats' effort to undermine the Supreme Court's Hobby Lobby decision, ending a round of partisan jousting aimed at capturing women's votes in the fall. A bill from Senate Democrats designed to restore employers' responsibility to provide contraception coverage under the Affordable Care Act was defeated 56-43 on a procedural vote. It sought to prevent companies from using a religious-freedom law to avoid complying with a requirement to cover all forms of contraception approved by the government without charging workers a copayment (Peterson, 7/16).

The Associated Press: Dems Seek Gains With Women In Birth Control Loss
Republicans blocked a bill that was designed to override a Supreme Court ruling and ensure access to contraception for women who get their health insurance from companies with religious objections. The vote was 56-43 to move ahead on the legislation -; dubbed the "Not My Boss' Business Act" by proponents -; four short of the 60 necessary to proceed. But Democrats hope the issue has enough life to energize female voters in the fall, when Republicans are threatening to take control of the Senate. GOP senators said Wednesday's vote was simply a stunt, political messaging designed to boost vulnerable Democratic incumbents. The GOP needs to gain six seats to seize control (7/16).

USA Today: Senate GOP Blocks Bill To Overturn Hobby Lobby Ruling
The Senate on Wednesday torpedoed a Democratic plan to reverse a recent Supreme Court ruling allowing some employers to decline to provide employees insurance coverage for some forms of birth control on religious grounds. The bill failed to get 60 votes needed to cross a procedural hurdle, as Republicans were largely united against it. Three Republican senators voted for the bill: Mark Kirk of Illinois, Lisa Murkowski of Alaska and Susan Collins of Maine. The bill had no hope of passage in the Republican-controlled House; Democrats tried and failed to force a vote in the House on a similar bill Tuesday (Singer and Dekimpe, 7/16).

Politico: Democratic Bid To Reverse Hobby Lobby Fails
A Democratic bill to reverse the Supreme Court's recent Hobby Lobby decision narrowly failed in the Senate on Wednesday, but it sparked more contentious debate over contraception and religious freedom that both sides hope will mobilize their voters in November. The bill in effect says a 1993 religious freedom law at the heart of the Hobby Lobby case doesn't apply to legally required health benefits. The Supreme Court had cited the Religious Freedom Restoration Act in ruling that certain for-profit businesses can on religious grounds be exempted from the Obamacare requirement that the health plans they offer workers include FDA-approved birth control with no co-pays (Winfield Cunningham, 7/16).

The Wall Street Journal: Costly Vertex Drug Is Denied, And Medicaid Patients Sue
Arkansas officials declined to comment on specific allegations but said they are mainly restricting access because existing data don't support the drug's use as a first option. Cost also appears to be a factor: Emails obtained by the patients' attorneys show officials discussing Kalydeco's cost, and their worries about the expense of future cystic fibrosis drugs. The legal flap is the latest example of the pressure expensive new drugs are putting on cash-strapped government insurance programs (Walker, 7/16).

Politico: Cost Debate Slows VA Reform Bill 
House and Senate lawmakers negotiating a bill to reform the Department of Veterans Affairs are being weighed down over questions about how much the overhaul will cost. Conference committee members are working with the Congressional Budget Office to get a score that lawmakers can find credible. The nonpartisan office initially put the cost of the reform bills at more than $50 billion -; an estimate lawmakers dispute -; but has recently reduced that figure to under $33 billion (French and Everett, 7/17).

The New York Times: V.A. Official Says Fixing Issues At Root of Waiting-List Scandal Will Cost Billions
Fixing the problems that led to the waiting-list scandal at the Department of Veterans Affairs will cost $17.6 billion over the next three years, the agency's acting secretary told lawmakers Wednesday, requiring the hiring of about 1,500 doctors and 8,500 nurses and other clinicians. The acting secretary, Sloan D. Gibson, told the Senate Veterans Affairs Committee that the money was necessary to "meet current demand" for medical care for veterans by addressing problems that included "shortfalls in clinical staff" as well as not having enough space in clinics and hospitals to see patients on time (Oppel, Jr., 7/16).

Los Angeles Times: Acting Head Of VA Says Agency Needs $17.6 Billion To Fix Problems
The Department of Veterans Affairs needs $17.6 billion in additional funds over the next three years to meet patients' needs and fix the troubled agency's problems, its acting director said Wednesday. Testifying for the first time on Capitol Hill, interim VA Secretary Sloan Gibson told the Senate Veterans Affairs Committee that the money would help VA medical centers decrease appointment waiting times and hire more doctors (Bratek, 7/16).

The Washington Post: Acting VA Chief Seeks $17.6 Billion
After vigorously defending the progress made in cutting medical-service wait times for veterans since he took over the Department of Veterans Affairs, acting secretary Sloan D. Gibson said the troubled agency needs $17.6 billion in additional funds and 10,000 additional staffers to truly address its systemic problems. Without increasing the number of doctors, staffers and beds in VA facilities, Gibson warned the Senate Veterans' Affairs Committee, "the wait times just get longer" (Lowery and Hicks, 7/16).

The Associated Press: New Guidelines Could Help Many Pregnant Workers
New federal guidelines on job discrimination against pregnant workers could have a big impact on the workplace and in the courtroom. The expanded rules adopted by the bipartisan Equal Employment Opportunity Commission make clear that any form of workplace discrimination or harassment against pregnant workers by employers is a form of sex discrimination -; and illegal (7/16).

The Wall Street Journal's The Numbers: Does Sexual Orientation Matter When It Comes To Health?
The 2013 survey was the first time the annual National Health Interview Survey included questions to measure sexual orientation. The survey collected information from 34,557 people over 18 in the U.S. It showed about 96.6% of adults in the United States identified themselves as straight, 1.6% identified as gay or lesbian and 0.7% identified as bisexual. A little over 1% didn't respond to the sexual orientation question. Looking at health-related behavior, there were some significant differences based on sexual orientation. Overall, gays/lesbians and bisexual people were much more likely to smoke cigarettes than a straight person. When broken down by gender, there wasn't much significant difference with men, but gay/lesbian women (25.7%) and bisexual women (28.5) were much more likely than their straight counterparts (15%) to smoke (Sparks, 7/16).

The Washington Post: McAuliffe To Visit Free Health Clinic To Expand Health-Care
Gov. Terry McAuliffe, due to return Thursday from an eight-day trade mission to China and London, will hop on a plane the very next day to fly to a free medical clinic in far southwest Virginia. While McAuliffe's overseas journey was meant to boost trade and investment in Virginia, the Democrat's trip to the Remote Area Medical expedition in Wise County is intended to highlight the plight of the state's uninsured citizens -; and bolster the governor's bid to expand access to health-care (Vozzella, 7/17).

The Wall Street Journal: Missouri To Allow Med-School Grads To Work As Assistant Physicians
Missouri will allow medical-school graduates to work as "assistant physicians" and treat patients in underserved rural areas, though they haven't trained in residency programs, despite strong opposition from some doctors' groups. At least one year of residency is usually required to practice medicine independently in the U.S.; most young doctors spend at least three years in such programs, which include intense on-the-job training and supervision (Beck, 7/16).

The Wall Street Journal's Washington Wire: Despite Challenges, Union Seeks To Win Over Home Health Workers
But a more important number might actually be a smaller one in AFSCME's quest to convert these workers who had been resistant to joining their workplace union: A significant subset of them – more than 21,000-; are home health care workers, the very kinds the U.S. Supreme Court recently said can't be forced to pay dues to unions they don't want to join. The union, said AFSCME President Lee Saunders, was dealt a "serious blow" last month by the court, which ruled that home care workers in Illinois – and possibly other states -; aren't full-fledged public employees, and therefore can't be forced to pay dues to a public-sector union that represents them but that they don't want to join. The ruling set the stage for more legal challenges to these dues, known as agency fees, down the road. It will also make it harder for AFSCME to represent home care workers, Mr. Saunders said (Trottman, 7/16).

Los Angeles Times: Swimmer Bitten By Shark Has No Insurance, Mounting Medical Bills
More than 20 people spoke during the public comment period of the council meeting, echoing ongoing debate ignited when a long-distance swimmer was bitten by a juvenile great white shark July 5. It's believed the shark was thrashing to free itself from a fisherman's line when it bit Steven Robles, 50, in the side not far from the pier. … Robles continues to recover from his injuries and had more stitches removed from his abdomen Monday. He said he has no health insurance and is facing large medical bills (Troung, 7/16).