First Edition: August 25, 2014

Today's early morning highlights from the major news organizations include reports on Medicare ratings of nursing homes, the growing demand for home-health aides and accounts of the Obama administration's new contraception coverage rules.

Kaiser Health News: Obamacare Still 'Red Meat' For GOP Candidates But Focus Of Attacks Shift
Kaiser Health News staff writer Phil Galewitz reports: "Heading into the first congressional election since millions of Americans gained coverage under the health law, many Republican candidates are taking a more nuanced approach to how they criticize the law. Rather than just calling for repeal, they are following [North Star Opinion Research President Whit] Ayres' recommendations to focus on arguments about how the law is hurting consumers, government budgets or the economy" (Galewitz, 8/25). Read the story, which also appears on The Daily Beast.

The New York Times: Medicare Star Ratings Allow Nursing Homes To Game The System
What really sets Rosewood apart, however, is its five-star rating from Medicare, which has been assigning hotel-style ratings to nearly every nursing home in the country for the last five years. Rosewood's five-star status -; the best possible -; places it in rarefied company: Only one-fifth of more than 15,000 nursing homes nationwide hold such a distinction. But an examination of the rating system by The New York Times has found that Rosewood and many other top-ranked nursing homes have been given a seal of approval that is based on incomplete information and that can seriously mislead consumers, investors and others about conditions at the homes (Thomas, 8/24).

The Wall Street Journal: Help Wanted (A Lot): Home-Health Aides
Dolores Streater works in one of the fastest-growing professions in the country. It is also among the lowest-paying and most-demanding. And, not coincidentally, it has particularly high turnover. Ms. Streater is a home health-care aide. ... No major segment of the workforce is expected to expand faster in coming years than that of the paid caregivers who assist aging Americans at home. The jobs typically don't require a high-school diploma, there is little required training and the average workweek is 34 hours. The U.S. Labor Department predicts the profession will grow by nearly 50%, or the equivalent of nearly a million new jobs, by 2022 (Portlock, 8/22).

The Associated Press: New Obama Birth Control Fixes For Religious Groups
Seeking to quell a politically charged controversy, the Obama administration announced new measures Friday to allow religious nonprofits and some companies to opt out of paying for birth control for female employees while still ensuring those employees have access to contraception. Even so, the accommodations may not fully satisfy religious groups who oppose any system that makes them complicit in providing coverage they believe is immoral (Lederman, 8/22).

The Wall Street Journal: Administration Offers Contraception Compromise For Religious Employers
The Obama administration outlined a new compromise Friday aimed at shielding religious business owners and Christian universities and charities from the health law's contraception-coverage requirements, but a chilly initial response from Roman Catholic bishops suggested the move wouldn't assuage their concerns. ... Catholic bishops, who have led a campaign against the contraception-coverage provision that has included numerous legal challenges since its announcement in August 2011, indicated the new rules make only minor changes and are insufficient (Radnofsky, 8/22).

Bloomberg: Obama Provides Birth-Control Coverage Plan For Nonprofits
Women who work for religious nonprofits will have access to birth control at no cost under a procedure the Obama administration said would also relieve their employers of any moral objections to the coverage. The nonprofits will now only have to notify the U.S. government of their objections in writing, the administration said in a regulation published yesterday. Coverage will be arranged separately by the government through health-benefit managers (Wayne, 8/23).

The Washington Post: Administration Offers New Tweak To Birth Control Rule
The administration also intends to offer a similar work-around to for-profit businesses after the Supreme Court's bitterly debated 5-4 decision in June that owners of closely held firms could refuse contraception coverage if it conflicts with their religious beliefs (Millman, 8/22).

Politico: New Contraceptive Coverage Plan To Be Offered For Religious Nonprofits
The new plan, which addresses a high-profile component of the health care law, essentially adds HHS to the notification process for any group that objects to the coverage requirement. The legal challenges brought by scores of organizations across the country have put contraceptive coverage at risk for some women but not threatened the health care law itself (Norman, 8/22).

The New York Times: Administration Proposes New Health Rules Addressing Religious Objections
The United States Supreme Court said this summer that the government could not force a private, closely held company to pay for insurance coverage for contraceptive services at no cost to their employees if the owners of the company expressed religious objections. In a separate decision, the court also said that previous religious accommodations for some nonprofit organizations did not go far enough. For President Obama's administration, the court rulings presented a dilemma: how to stand by their insistence that all women should have easy access to contraceptive services at no cost, while also recognizing the religious objections of organizations and companies as determined by the court (Shear, 8/22).

The Associated Press: Tax Refunds May Get Hit Due To Health Law Credits
Taxes? Who wants to think about taxes around Labor Day? But if you count on your tax refund and you're one of the millions getting tax credits to help pay health insurance premiums under President Barack Obama's law, it's not too early. Here's why: If your income for 2014 is going to be higher than you estimated when you applied for health insurance, then complex connections between the health law and taxes can reduce or even eliminate your tax refund next year (Alonso-Zaldivar, 8/24).

The Associated Press: Oregon Sues Oracle Over Failed Health Care Website
The state of Oregon filed a lawsuit Friday against Oracle America Inc. and several of its executives over the technology company's role in creating the troubled website for the state's online health insurance exchange. The lawsuit, filed in Marion County Circuit Court in Salem, alleges that Oracle officials lied, breached contracts and engaged in "a pattern of racketeering activity" (Cooper, 8/22).

Los Angeles Times: Oregon Sues Oracle, Blaming Tech Giant For Failed Healthcare Website
The Oregon attorney general sued Oracle America Inc. on Friday, charging that the technology giant committed what "amounts to a pattern of racketeering activity" that cost the state hundreds of millions of dollars during the faulty rollout of its troubled health insurance exchange. In a scathing, 126-page civil complaint, Oregon Atty. Gen. Ellen Rosenblum accused the company and several of its high-level executives of repeatedly lying to state officials, of failing to deliver on contracts and of filing an estimated $240 million in false claims after it was hired to build the Cover Oregon website (La Ganga, 8/22).

Los Angeles Times: Covered California Officials, Insurance Chief Clash Over Prop. 45
California's Obamacare exchange and the state insurance commissioner are on a collision course over Proposition 45, a popular ballot measure aimed at reining in health insurance rates. Covered California officials lashed out at the statewide ballot initiative this week and warned that it could be disastrous to the state's implementation of the federal healthcare law. ... Until now, the state-run exchange had largely avoided a public clash over Proposition 45 with [Insurance Commissioner Dave] Jones, a Democrat who supports the health law. That restraint disappeared at an exchange board meeting Thursday, and officials there will take up a vote next month to formally oppose it. These moves thrust Covered California into the middle of what's expected to be a highly contentious and costly campaign (Terhune, 8/22).

The Associated Press: California: Insurers Must Cover Elective Abortions
Health insurance companies in California may not refuse to cover the cost of abortions, state insurance officials have ruled in a reversal of policy stemming from the decision by two Catholic universities to drop elective abortions from their employee health plans. Although the federal Affordable Care Act does not compel employers to provide workers with health insurance that includes abortion coverage, the director of California's Department of Managed Health Care said in a letter to seven insurance companies on Friday that the state Constitution and a 1975 state law prohibits them from selling group plans that exclude the procedure. The law in question requires such plans to encompass all "medically necessary" care (8/23).

The Washington Post: Md. Approves Smaller Rate Hikes For CareFirst, Lowers Rates For 3 Others
Maryland officials approved final insurance rates Friday for consumers buying individual health plans next year under the federal health-care law. Regulators cut proposed premiums by more than half for CareFirst, the region's dominant insurance company, and approved lower rates for three other carriers (Sun, 8/22).

The New York Times: Blood Industry Shrinks As Transfusions Decline
Changes in medicine have eliminated the need for millions of blood transfusions, which is good news for patients getting procedures like coronary bypasses and other procedures that once required a lot of blood. But the trend is wreaking havoc in the blood bank business, forcing a wave of mergers and job cutbacks unlike anything the industry, which became large scale after World War II, has ever seen (Wald, 8/22).

The New York Times: Chicago And 2 California Counties Sue Over Marketing Of Painkillers
As the country struggles to combat the growing abuse of heroin and opioid painkillers, a new battlefield is emerging: the courts. The City of Chicago and two California counties are challenging the drug industry's way of doing business, contending in two separate lawsuits that "aggressive marketing" by five companies has fueled an epidemic of addiction and cost taxpayers millions of dollars in insurance claims and other health care costs (Schwartz, 8/24).