Abortion debate surfaces in California governor’s race

http://www.latimes.com/politics/la-pol-ca-john-cox-gavin-newsom-governor-abortion-20180707-story.html#

Abortion debate surfaces in California governor’s race

The nation’s divide over abortion rights is expected to be a telltale flashpoint between the two candidates for California governor who embrace starkly different views on the issue, even though protections for legal access to abortion have been cemented into state law for decades.

Staunchly anti-abortion and endorsed by organizations opposed to abortion, Republican John Cox argued in 2006 that cases of rape and incest should be no exception to a ban on abortion. Democrat Gavin Newsom wants to increase funding and accessibility for abortion and family planning and is strongly backed by Planned Parenthood, a frequent target of the Republican-led Congress and the Trump administration.

“I think anybody who has a rape and incest exception to abortion really hasn’t thought it through. Killing the baby is not going to absolve the crime of rape,” Cox said at the Conservative Political Action Conference in Washington 12 years before he finished in second place in the California primary.

Cox made the comment shortly before announcing an unsuccessful campaign for president. He also said he was “100% and proudly pro-life and I offer no apologies for it.”

With President Trump’s pending appointment to the U.S. Supreme Court rekindling the nation’s longstanding political clash over the issue, advocates on both sides foresee the court shifting to the right and a possible overturning of Roe vs. Wade, the landmark 1973 decision that guaranteed a nationwide right to abortion. Though just speculation ahead of having an actual nominee and confirmation hearings, a change in abortion rights probably would be tossed back into the mire of state politics.

“Depending on who Trump nominates, this issue starts to become an advantage to Democrats,” said Chapman University political scientist Lori Cox Han. “For John Cox, there’s really not any advantage at all.”
Though Cox in 2017 trumpeted his endorsement by the California Pro-Life Council and made his opposition to abortion clear, the issue has not been a major focal point of his campaign for governor. Instead, Cox has portrayed himself more as the conservative antidote to the policies of California Democrats that he says have wrought record poverty and homelessness and unaffordable housing and saddled residents with high taxes, including the recent increase in gas taxes.
It’s unlikely that Newsom or his supporters will let Cox’s past statements on abortion go unmentioned.
Cox has cited his Catholicism and also said his views on abortion were shaped after learning that his father “took advantage” of his mother before marrying her. The couple later divorced.
“She didn’t have the choice of an abortion because it wasn’t legal. If it had been, it might have been an easy decision to terminate me,” Cox wrote in “Politics, Inc.,” a political position paper that was published in 2006. “She didn’t, thank God, and so was born my absolute opposition to abortion on demand.”
Cox, a wealthy businessman from Rancho Santa Fe, also is a strong opponent of the death penalty.
“His personal positions on the death penalty and abortion are well known, but as Governor, he would abide by the law,” Cox campaign spokesman Matt Shupe said in an emailed statement to The Times.
Amy Everitt, director for NARAL Pro-Choice California, said the differences between the two candidates for governor who will be on the November ballot have never been more clear.
“John Cox, who’s never held elected office, has been consistent in one way, and that is as an anti-choice leader,” she said. “His values lie far outside mainstream California values.”
She said the group considers Newsom as someone who has been a strong supporter of abortion rights throughout his political career.
California’s lieutenant governor, formerly the mayor of San Francisco, boasted during the gubernatorial primary campaign about his efforts to raise money for Planned Parenthood to increase access to abortion and other healthcare services for women.

Newsom also has called for the state to increase Medi-Cal reimbursement rates to healthcare providers, including Planned Parenthood, and to provide a permanent $100-million allocation for reproductive healthcare from the money raised by Proposition 56, the tobacco tax increase approved by voters in 2016.

Newsom said California’s next governor needs to be a leader in defending abortion rights throughout the country.
“There’s a deliberative effort to roll back reproductive rights in the country, to attack women, to demean women,” Newsom said during a candidate forum sponsored by NARAL Pro-Choice California in January.
“You need leaders to step into that debate. You need to call it out. You need to explain it. You need to expose it.”
Organizers said Cox was invited to the NARAL event, but that he did not respond. It ultimately featured only Democratic candidates.
California first legalized abortion in 1967, years before the Roe vs. Wade decision, and those protections have since been expanded and solidified through legislative statute and rulings by the California Supreme Court. Those protections include the right for funding for abortions provided to women covered by the Medi-Cal program and the right of minors to obtain an abortion without parental consent.
Still, a California governor who opposes abortion possesses enough executive authority to, at the very least, disrupt access, said Susan Berke Fogel, director of the reproductive health and justice programs at the National Health Law Program in Los Angeles. The governor could appoint an anti-abortion director to the California Health and Human Services Agency and cut funding for state programs that help pay for abortions and provide access to birth control, she said.
The governor also appoints judges, including to the state Supreme Court, and could attempt to reshape the judiciary and subsequent legal decisions regarding abortion rights in California.

Decades ago, Republican Gov. George Deukmejian made several cuts to the state’s family-planning programs. Fogel doubts a similar move would survive a legal challenge, but that wouldn’t stop an activist anti-abortion governor from trying, and “it would be disruptive,” Fogel said.

Unlike the U.S. Constitution, California’s Constitution includes a clear-cut right to privacy, a legal foundation protecting a woman’s right to choose to have a child or a legal abortion.

Wynette Sills, director of the anti-abortion organization Californians for Life, agrees with Fogel that even if Roe vs. Wade was overturned, abortion would still be legal in the state.
Still, electing Cox to be the next governor would help prevent the Legislature from making abortion even more prevalent in California. Cox, for example, could use his veto power to reject Senate Bill 320, pending legislation that would require health clinics on University of California and California State University campuses to provide drugs prescribed for medication abortion by 2022.

“Reasonable citizens of California will agree that our state Legislature is to the far extreme in promoting abortion,” Sills said. “We are seeking a reasonable and critical balance to the aggressive abortion actions we’re seeing at the Capitol, and John Cox would provide that balance.”

Most Californians consider abortion to be a settled issue in the state, Han said. For years, they have rejected every attempt to chip away as those protections, including voting against statewide initiatives to require greater parental consent for minors seeking abortions.

A 2017 poll by the Public Policy Institute of California found that more than 70% of Californians believe government should not interfere with a woman’s access to abortion, compared with the 27% who wanted the government to pass more restrictions. That view was held across the political spectrum, including by a majority of Republicans, and the overall findings were consistent in surveys going back to 2000.

 

Insurers warn of rising premiums after Trump axes Obamacare payments again

https://www.reuters.com/article/us-usa-healthcare-obamacare/insurers-predict-market-disruption-after-trump-suspends-obamacare-risk-payments-idUSKBN1JY0RI

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Health insurers warned that a move by the Trump administration on Saturday to temporarily suspend a program that was set to pay out $10.4 billion to insurers for covering high-risk individuals last year could drive up premium costs and create marketplace uncertainty.

The Affordable Care Act’s (ACA) “risk adjustment” program is intended to incentivize health insurers to cover individuals with pre-existing and chronic conditions by collecting money from insurers with relatively healthy enrollees to offset the costs of other insurers with sicker ones.

President Donald Trump’s administration has used its regulatory powers to undermine the ACA on multiple fronts after the Republican-controlled Congress last year failed to repeal and replace the law propelled by Democratic President Barack Obama. About 20 million Americans have received health insurance coverage through the program known as Obamacare.

America’s Health Insurance Plans (AHIP), a trade group representing insurers offering plans via employers, through government programs and in the individual marketplace, said the CMS suspension would create a “new market disruption” at a “critical time” when insurers are setting premiums for next year.

“It will create more market uncertainty and increase premiums for many health plans – putting a heavier burden on small businesses and consumers, and reducing coverage options. And costs for taxpayers will rise as the federal government spends more on premium subsidies,” AHIP said in a statement.

It could also encourage more insurers to bow out of Obamacare.

“This is occurring right at the time of year that people (insurers) are making decisions about whether to participate in the exchanges and what premiums to charge if they do,” said Eric Hillenbrand, a managing director at consultancy AlixPartners. “This will affect their thinking on both of those decisions.”

The Centers for Medicare and Medicaid Services (CMS), which administers ACA programs, said on Saturday that months-old conflicting court rulings related to the risk adjustment formula prevent them from making payments.

CMS was referring to a February ruling from a federal court in New Mexico that invalidated the risk adjustment formula, and a January ruling from a federal court in Massachusetts that upheld it.

CMS administrator Seema Verma said in a statement the administration was “disappointed” in the February ruling and that CMS has asked the court to reconsider and “hopes for a prompt resolution that allows CMS to prevent more adverse impacts on Americans.”

But supporters of the ACA criticized the CMS announcement as the latest move by the Trump administration to undermine Obamacare.

“We urge the Trump administration to back off of this dangerous and destabilizing plan, and instead begin working on bipartisan solutions to make coverage more affordable,” said Brad Woodhouse, the executive director of Protect Our Care, a progressive group that supports Obamacare.

The administration has made several other moves in recent years to scale back or halt implementation of certain aspects of the ACA.

Late last year, it said it would halt so-called cost-sharing payments, which offset some out-of-pocket healthcare costs for low-income patients.

It has also scaled back the advertising budget for Obamacare healthcare plans during the open-enrollment period by about 90 percent.

“What you are effectively doing is dismantling pieces of [the ACA] without replacing them,” Hillenbrand said. “It moves us back to some extent to the status quo where people with pre-existing conditions found it very difficult to get insurance.”

Memorial Hermann hit with $1M retaliation suit by former employee

https://www.beckershospitalreview.com/legal-regulatory-issues/memorial-hermann-hit-with-1m-retaliatiImage result for employee lawsuit

A former physician peer review coordinator for Houston-based Memorial Hermann Health System has sued the health system for $1 million, claiming she was fired in retaliation after she refused to reveal confidential information.

In the lawsuit, pending in Harris County (Texas) District Court, Gertrude Johnson alleges that beginning in 2018 Memorial Hermann asked her to reveal confidential and protected information related to the health system’s surgeons’ peer review grades. She was allegedly asked to disclose the information during “filter committee” meetings, which are open meetings that are not confidential.

Ms. Johnson told several health system officials she believed disclosing the information to the filter committee would violate Texas and/or federal law. Despite her concerns, the health system allegedly required Ms. Johnson to share the information.

Ms. Johnson alleges she was fired in May 2018 for reporting her concerns about disclosing the confidential information. Although health system officials allegedly told Ms. Johnson her position had been eliminated, she claims Memorial Hermann planned to fill her position again in July 2018. Ms. Johnson alleges Memorial Hermann “created a pre-textual basis for the termination to hide its true intent.”

A Memorial Hermann spokesperson told Becker’s Tuesday morning that the health system had not been served with the lawsuit and had no comment on the pending litigation.

 

Geisinger slashes opioid prescriptions by 50% since 2014, saving $1M per year

https://www.beckershospitalreview.com/opioids/geisinger-slashes-opioid-prescriptions-by-50-since-2014-saving-1m-per-year.html

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Danville, Pa.-based Geisinger Health System has cut opioid prescriptions in half since 2014, saving the health system an average of about $1 million annually, according to The Sentinel.

Here are four things to know:

1. Geisinger told The Sentinel it has managed to slash opioid prescriptions from 60,000 to 31,000 on average per month since 2014, in part by focusing on a pain reducing regimen consisting of physical therapy and changes in patients’ diet and behavior. Exceptions are made for some patients, such as those in oncology, according to the report. Patients who do receive opioid prescriptions receive a seven-day maximum supply.

2. The reduction also stemmed from the health system’s shift to electronic prescribing, which began in August 2017. Geisinger’s analytics and IT teams developed an electronic provider dashboard to identify and track the highest prescribing physicians and discuss the latest research in prescribing practices with them before addressing clinicians systemwide.

“As we put [the data] in front of [clinicians], the typical response we received was, ‘Wow, I didn’t know I was prescribing that much,'” Mike Evans, vice president and chief pharmacy officer for Geisinger, told The Sentinel.

3. Mr. Evans said the health system plans to end paper prescribing of opioids this summer. He also acknowledged the importance of cybersecurity measures to prevent potential hacking.

4. John Kravitz, CIO of Geisinger, told The Sentinel the health system’s efforts to curb opioid prescribing have cost less than $500,000 but have saved the system an estimated $1 million annually.

To access the full report, click here.

 

 

About 30 New Lawsuits Await Supreme Court Input in High-Stakes DSH Payments Case

https://www.healthleadersmedia.com/finance/about-30-new-lawsuits-await-supreme-court-input-high-stakes-dsh-payments-case

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In latest filing, HHS argues there’s a broader principle at play than the potential reimbursements totaling up to $4 billion.

As the U.S. Supreme Court prepares to consider this fall whether to take up a case implicating potentially billions of dollars in Medicare payments, hospitals that provide high rates of uncompensated care are lining up to ask the federal government for their piece of the pie.

The D.C. Circuit Court ruled less than a year ago that Health and Human Services violated the Medicare statute by failing to conduct a notice-and-comment rulemaking process when it implemented a policy affecting disproportionate-share hospital (DSH) reimbursements. Since then, providers have filed about 30 lawsuits in the D.C. District Court raising similar claims, according to a filing submitted Thursday to the Supreme Court on HHS Secretary Alex Azar’s behalf.

Some of the suits include dozens of plaintiffs. Most of them have been stayed pending the Supreme Court’s next move.

“The monetary stakes and hospitals’ legal sophistication will likely lead to future cases raising similar issues being litigated in the District of Columbia, where the decision below constitutes binding precedent,” Solicitor General Noel J. Francisco wrote in the filing, arguing that the Supreme Court should take the case so HHS may argue that the appellate court’s decision should be overruled.


The respondents—who argued the Supreme Court should deny the HHS request and let the Circuit Court decision stand—include just nine hospitals, but their claims for a single year total $48.5 million in additional reimbursement. Considering that about 2,700 hospitals receive DSH payments, the financial stakes surrounding this case are clearly quite high.

Although the appellate court sided with the hospitals’ claim that HHS broke the law by skipping notice-and-comment rulemaking, the latest HHS filing argues that the ruling was faulty and that there’s a broader issue at play.

The respondents both “miss the point and are wrong” about the legal standard, the HHS filing states.

“They miss the point because the logic of the decision below would apply to any context in which the agency gives its contractors interpretive instructions about making initial reimbursement decisions,” the filing states, noting that providers have the option to challenge initial cost-reporting determinations.

In other words, if HHS is required to engage in notice-and-comment rulemaking to calculate DSH reimbursements, then it must be required to do the same in other matters that would make running Medicare and other programs unworkable, HHS argues.

The Supreme Court is set to consider in a conference September 24 whether to take up the case.