KHN Original Reporting & Guest Opinion
Kaiser Health News reporter Julie Appleby writes: "When Sharon Smith chose an out-of-network specialist to perform a complicated jaw surgery on her teenage son last May, she knew it would cost her more. But she was not expecting a $15,000 difference. Consumers have long complained about the cost of going outside their health plan's network, but Smith encountered a new twist: a growing number of insurers have changed the way they calculate reimbursements to shift more of the expense to patients" (Appleby, 2/9). Read the story.
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Kaiser Health News reporter Mary Agnes Carey talks with Jackie Judd about an Obama administration rule requiring many religious-affiliated groups to cover birth control as part of their insurance coverage. She says that the "White House has reiterated repeatedly that they're open to talking to all parties. ... But they’ve made it clear that they’re not backing down from this guarantee of contraceptive coverage for all women no matter where they work." Watch the video.
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Now on Kaiser Health News' blog, Diane Webber reports: "Two Democratic governors — Gov. Dannel Malloy of Connecticut and Gov. Martin O'Malley of Maryland — tried to tamp down the controversy over contraception coverage at Catholic institutions this week by quoting the same number: 28 states already require insurance coverage of contraception. ... But it’s not the whole story" (Webber, 2/8).
Jordan Rau examines new data on hospital infection rates: "Across the country, one in six hospitals has high rates of one of the most serious kinds of preventable infections — those caused by catheters inserted into large veins, according to new data published by the Centers for Medicare & Medicaid Services" (Rau, 2/9)
Also, Jessica Marcy writes: "Doctors report that they’re not always completely honest with patients, especially when it comes to disclosing a medical mistake, or discussing a difficult prognosis, according to a new survey" (Marcy, 2/8).
In addition, Phil Galewitz reports: "The Obama administration launched a $40 million effort Wednesday to reduce premature births, especially early elective deliveries, but it has no plans to stop Medicaid from paying for those deliveries" (Galewitz, 2/8). Check out what else is on the blog.
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Kaiser Health News provides a fresh perspective on health policy developments with "Bypassing The Mitre?" by Nick Anderson, the Houston Chronicle
Meanwhile, here's today's health policy haiku:
LET IT SNOW?
Uwe in winter
Health spending going down. O!
Bamacare, perhaps?
- Tod Ibrahim
If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.
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Administration News
Speaker John Boehner was among those who promised Wednesday to get rid of the administration's regulation that would require religious employers, such as hospitals, charities and universities, to cover free birth control for employees.
The New York Times: Birth Control Is Covered, And G.O.P. Vows A Fight
Congressional Republicans, seizing on the type of social issue that motivates and unifies their base, stepped forcefully Wednesday into the battle over an Obama administration rule requiring health insurance plans provided by Catholic universities and charities to offer free birth control to women, vowing to fight back with legislation to unravel the new policy (Steinhauer, 2/8).
The Wall Street Journal: GOP Legislators Take Aim At Contraceptive Rule
House Speaker John Boehner (R., Ohio), a Catholic, said in a floor speech that the requirement from the Department of Health and Human Services, part of the health-care overhaul, would force Catholic employers such as hospitals, schools and charities to "provide services they believe are immoral." "If the president does not reverse the department's attack on religious freedom, then the Congress, acting on behalf of the American people and the Constitution we are sworn to uphold and defend, must," he said (Radnofsky and Meckler, 2/9).
Reuters: Obama Birth-Control Rule Stokes Election-Year Fight
Boehner said if the president refuses to rescind the measure, Congress will do so legislatively. But such a bill would have little chance of getting through a divided Congress. While Boehner may secure backing in the Republican-dominated House, he faces problems in the Senate, which is controlled by Obama's fellow Democrats (Ferraro and Spetalnick, 2/8).
Roll Call: House, Senate GOP Leaders Attack Obama Birth Control Rule
In a rare floor speech, the Ohio Republican — who is a practicing Catholic — pulled no punches: “In imposing this requirement, the federal government is violating a First Amendment right that has stood for more than two centuries. And it is doing so in a manner that affects millions of Americans and harms some of our nation’s most vital institutions” (Stanton and Shiner, 2/8).
Modern Healthcare: GOP Vows Action On Birth-Control Rule
House Energy and Commerce Committee Chairman Fred Upton (R-Mich.) said his panel would move quickly to advance legislation that would reverse an HHS decision requiring religious organizations to provide health coverage for contraceptives. The news from Upton's committee came not long after House Speaker John Boehner (R-Ohio) called the requirement an "unambiguous attack on religious freedom" and vowed on the House floor that the lower chamber would work to overturn the requirement if the Obama administration did not do so (Zigmond, 2/8).
The Associated Press: Analysis: Obama Contraceptive Mandate Has A Price
The Obama administration's new mandate that religious organizations pay for their workers' birth control has become a bludgeon for Republican culture warriors, as social issues have surged to the forefront in the presidential campaign. Conservatives who believe religious freedom always trumps gender equity in the public arena are outraged. But so too are Roman Catholic and evangelical moderates who have stuck with President Barack Obama, an abortion rights supporter, because of his 2008 pledge to reduce the abortion rate and find common ground among religious and secular Americans (Zoll, 2/9).
The Hill: Senate GOP Pushes To Shield Faith Groups From Contraception Rule
Senate Republicans are pushing legislation to overturn the Obama administration’s decision that the health plans of faith-based organizations must cover contraception if they serve people of multiple religious backgrounds. Sens. Marco Rubio (R-Fla.), Roy Blunt (R-Mo.) and Kelly Ayotte (R-N.H.) are leading the effort. "This is about whether the government of the United States should have the power to go in and tell a faith-based organization that they have to pay for something that they teach their members shouldn’t be doing," said Rubio (Bolton, 2/8).
San Francisco Chronicle: Bay Area Catholic Clerics Join Contraception Fray
San Francisco's Catholic archbishop has jumped into the latest national culture war, blasting the Obama administration's controversial requirement that employers -- including Catholic hospitals, universities and institutions -- provide birth control and other contraceptive services as part of their health care insurance plans. While the rule is not scheduled to take effect fully until August 2013, that isn't stopping partisans from leaping into battle positions in this election year. The issue is reopening the nation's cultural divide at time when voters care most about the perilous economy (Garofoli, 2/9).
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Officials say Obama remains committed to the HHS regulation, amid indications they are exploring ways to get around religious groups' complaints.
Los Angeles Times: Birth-Control Fight Turns Into A Campaign And Fundraising Tool
Amid the rising clamor, administration officials are exploring the possibility of implementing the rule so that religiously affiliated employers could offer supplemental policies, known as riders, for contraception or direct workers to insurance companies that sell such riders. Even if Catholic voters and independents agree with the White House on substance, the administration doesn't want to appear insensitive to the concerns of the Catholic Church. Women's groups would be likely to vigorously oppose any alteration of the rule (Mascaro and Hennessey, 2/8).
Politico: White House Tries To Quell Birth Control Storm
President Barack Obama is groping for a solution to an increasingly ugly election-year controversy over birth control coverage. And Republicans are doing everything in their power to make it as difficult as possible for the White House. ... Polls show the birth control rule is popular, even among Catholics — but the backlash within Washington has been fierce, and the actions of the president’s top advisers Tuesday showed just how worried they are about it (Budoff Brown and Feder, 2/8).
McClatchy: White House: 'Absolutely Firm,' But Willing To Talk, On Birth Control
The White House insisted Wednesday that the president's commitment to contraceptive access for women is "absolutely firm," even as Republicans from Capitol Hill to the presidential campaign trail assailed the policy as an attack on religious liberty. … A new law taking effect this year requires most private insurers to pay for birth control. Religious groups have been given an extra year to comply. At the White House, Press Secretary Jay Carney said the administration wants all American women — no matter where they work — to have access to the same health care coverage and the same preventive care services. That includes contraception without a co-payment (Bolstad and Clark, 2/8).
The Washington Post: Boehner Vows Action To Overturn Obama Administration Rule On Birth Control
White House officials, along with dozens of liberal religious leaders and several leading Democratic lawmakers, defended the policy Wednesday, describing it as a crucial protection for women who deserve birth-control coverage no matter where they work. The White House also publicized a support letter signed by 600 doctors and medical students. Nearly two dozen leaders of organizations including Catholics for Choice and the Central Conference of American Rabbis issued a statement saying the policy will "safeguard individual religious liberty" while helping "improve the health of women, their children, and families" (Wallsten and Aizenman, 2/8).
Politico: Joe Biden, Bill Daley Warned Of Contraceptive Backlash
Two top advisers to President Barack Obama — both Catholics — warned him of the potential for controversy over his decision to require religious organizations to cover contraceptives in their health insurance plans. Vice President Joe Biden and former White House chief of staff Bill Daley both told the president that the decision would be cast as a government intrusion on religious freedom and that it could alienate Catholic voters in swing states, Bloomberg reported Wednesday (Epstein, 2/8).
NPR: 'Congress Will Act': Fight Over Birth Control Coverage Moves To The Hill
Republicans won't pass their legislation to overturn the mandate without a fight. "There are religions that believe divorce is a sin," said Sen. Jeanne Shaheen, D-N.H. "Should these institutions be exempt from our labor laws and be allowed to discriminate based on marital status? Of course not, and this is no different." In fact, pointed out Sen. Barbara Boxer, D-Calif., many women don't even use prescription contraception in ways that violate the church's teachings. "A full 14 percent of women who use birth control pills — that is 1.5 million women — use them to treat serious medical conditions, not to prevent pregnancies," she said (Rovner, 2/8).
CQ HealthBeat: Religious Leaders Back Obama On Contraception Rule
The Obama administration drew support on Wednesday from 20 religious groups praising a decision to require that hospitals and universities with religious affiliations offer health insurance plans with free contraceptive coverage to their employees. While the move has drawn a firestorm of objections from Catholics and Republicans in recent days, the organizations that signed a public statement said they are "mainstream" leaders in religion who agree with the administration (Norman, 2/8).
The Hill: Obama Administration Struggles To Contain Uproar Over Birth-Control Rule
The White House struggled Wednesday to contain the growing uproar over its birth-control mandate, with Democrats peeling off one by one in what has become an increasingly divisive election-year controversy. Pressure to roll back the new contraception policy mounted quickly as the day wore on, driven by divisions among Democrats, mixed messages from President Obama’s advisers and a constant drumbeat from the GOP (Parnes and Baker, 2/8).
Kaiser Health News: Two Democratic governors — Gov. Dannel Malloy of Connecticut and Gov. Martin O’Malley of Maryland — tried to tamp down the controversy over contraception coverage at Catholic institutions this week by quoting the same number: 28 states already require insurance coverage of contraception. ... But it's not the whole story" (Webber, 2/8).
Health On The Hill: Backlash Grows Over Contraception Rule In Health Law
KHN's Mary Agnes Carey talks with Jackie Judd about an Obama administration rule that would require many religious-affiliated groups to cover birth control in their insurance plans. Watch the video or read the transcript.
The Associated Press: White House Attacks Romney On Birth Control
The White House is taking on GOP presidential hopeful Mitt Romney over his criticism of President Barack Obama's birth control coverage mandate. Press secretary Jay Carney says Romney is an "odd messenger" to be attacking Obama over the issue. ... Carney says a virtually identical policy is in place in Massachusetts, where Romney served as governor, and that it's ironic for Romney to criticize Obama over it (2/8).
CBS News: Romney Fires Back At White House, Aims At Santorum
Romney returned fire at President Obama's press secretary Jay Carney. ... "Well, you know, Mr. Carney needs to check his history and that is that that provision was put in Massachusetts before I was governor, and then when I was governor I tried to have it removed in our health care plan," Romney told reporters. "So in the working on our health care plan I worked very hard to get the legislature to remove all of the mandated coverages, including contraception. So quite clearly, he needs to understand that was a provision that got there before I did and it was one that I fought to remove" (Kaplan, 2/8).
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Sens. Robert Casey and Joe Manchin, Rep. John Larson and Obama adviser Tim Kaine are breaking with the White House on the contraception controversy.
The Washington Post: Tim Kaine Splits With Obama On Birth Control Rule For Religious Groups
Former Virginia governor Timothy M. Kaine criticized the Obama administration's new policy requiring some religious institutions to provide coverage for prescription contraceptives, a rare instance of disagreement between the Senate candidate and his close political ally. ... "I think the White House made a good decision in including a mandate for contraception coverage in the Affordable Care Act insurance policy, but I think they made a bad decision in not allowing a broad enough religious-employer exemption," Kaine said, according to a transcript of his remarks provided by his campaign (Pershing, 2/9).
USA Today: Obama Mandate On Birth Control Coverage Stirs Controversy
Republican leaders have been joined by a few Democrats — such as Sens. Robert Casey of Pennsylvania and Joe Manchin of West Virginia and House Democratic Caucus Chairman John Larson of Connecticut — in calling for changes in the policy (Wolf and Grossman, 2/8).
Politico: John Larson to White House: Contraception Rule Needs More Work
Rep. John Larson, the House's fourth-ranking Democrat, is raising concerns with the Obama administration about its requirement that certain religious-affiliated institutions cover contraceptives in their insurance plans even if it violates their religious beliefs. Larson joins a small but growing chorus of Democrats who have raised concerns about the decision, which congressional Republicans and religious groups say is a war on religious freedom (Haberkorn and Bresnahan, 2/8).
National Journal: Obama Facing Breaks From Base On Contraceptive Mandate
In the meantime, here's a closer look at how members of the president's own party running for the Senate in 2012 have been navigating the issue this week: Former Democratic National Committee Chairman Tim Kaine: The key Democratic break with Obama came from his close ally and former DNC chairman Tim Kaine, running for the Senate in a hotly-contested battleground. Kaine, whose Catholic devotion is a major part of his biography, said he favored additional religious exemptions for Catholic employers. … Sen. Bob Casey, D-Pa.: Casey, who opposes abortion rights, sent a letter to Obama last week urging him to "correct this decision" (Sullivan and Brennan, 2/9).
Politico: High-Profile Catholic Dems Bail On Obama On Contraceptives
President Barack Obama’s contraceptives edict has handed Republicans an election-year gift. But now, the president may have a problem with his own party, too. A handful of high-profile Catholic Democrats are bailing on the president and joining the GOP chorus of critics. They’re arguing that the rule needs to be significantly softened if not, as Republicans want, scrapped altogether. At this point, the Democratic defectors are few in number but tall in stature. They include two swing-state pols on the November ballot — Obama's former DNC chairman, Tim Kaine, who's running for Senate in Virginia, and Pennsylvania Sen. Bob Casey — as well as House Democratic Caucus Chairman John Larson (Wong, 2/8).
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Campaign 2012
Rick Santorum again assails Mitt Romney's health care credentials. But, Santorum's presidential bid is itself finding some controversy for the candidate's ties to hospital chain Universal Health Services, where he was once a director.
The New York Times: Romney Faces Rebels On The Right And Softness In The Middle
Michael Biundo, Mr. Santorum's campaign manager, said it was time to highlight Mr. Romney's weaknesses with movement conservatives. He said Mr. Romney's record as the governor of Massachusetts — particularly the health care program that is similar to the national plan signed into law by Mr. Obama — would make him an imperfect Republican standard-bearer (Zeleny, 2/8).
Los Angeles Times: Republican Presidential Field Still Lacks A Unifier
Appearing early Wednesday on CNN, the former Pennsylvania senator pushed back against Romney's election night assertion that the Republican presidential contest amounts to a choice between a business-world outsider and a Washington insider. "Mr. Outsider was for a government takeover of health care, was for a government takeover of the private sector — the Wall Street bailout — and for a takeover of industry and energy with cap and trade," Santorum said. "So, Mr. Private Sector was Mr. Big Government" (Barabak, 2/8).
Boston Globe: Santorum's Bid Fueled By 2 Wealthy Contributors
The company whose employees gave the most money to Santorum’s campaign - $19,500 – was the hospital chain Universal Health Services, according to the Center for Responsive Politics' OpenSecrets blog. Santorum was a director of the organization, which Bloomberg reported was sued by the federal government in 2010 over allegations of Medicare fraud (Schoenberg, 2/9).
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Medicare
News about SGR funding negotiations, other Medicare developments from around the country.
Modern Healthcare: Republicans Await Dems' Options For Funding SGR Fix
Republicans expect to receive on Thursday a list of Democratic options to pay for a large tax-cut extension measure that includes a freeze in scheduled cuts to Medicare physician pay rates. However, at least one Republican expects negotiations on the legislation to make little progress before a law freezing current policy in place expires at the end of the month (Daly, 2/8).
CQ HealthBeat: One In Four Medicare Users Would Pay Surcharges by 2035 Under GOP, Obama Plans
Under pending proposals by House Republicans and the White House, one in four Medicare enrollees by 2035 would be on the hook for monthly premium surcharges now paid only by beneficiaries with very high incomes, says a new study. A Medicare enrollee today who makes as little as $47,000 a year is among the one in four Medicare beneficiaries with the highest annual incomes, notes the study by the Kaiser Family Foundation (Reichard, 2/8).
(St. Paul) Pioneer Press: Medicare’s Lower-Cost Drug Use In Minnesota Touted
If Medicare beneficiaries across the country used low-cost medications at the same rate as some patients in Minnesota, the government insurance program and seniors would have saved $4.5 billion during 2008 without any negative health effects. That's the take-home message from a study being published today in the New England Journal of Medicine that adds to Minnesota's reputation as being home to some of the thriftiest health care in the country. Researchers found that average per-person drug spending in Minnesota cities such as Rochester and St. Cloud was $2,413 compared with just over $3,000 in high-cost areas like south Texas (Snowbeck, 2/8).
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Quality
Most physicians paint overly optimistic prognoses for their patients, and many have withheld information concerning their medical mistakes and financial relationships with drug companies and device manufacturers, according to a national survey published in Health Affairs.
The Associated Press: Study Finds MDs Not Always Honest With Patients
Trust your doctor? A survey finds that some doctors aren't always completely honest with their patients. More than half admitted describing someone's prognosis in a way they knew was too rosy. Nearly 20 percent said they hadn't fully disclosed a medical mistake for fear of being sued. And 1 in 10 of those surveyed said they'd told a patient something that wasn't true in the past year. The survey, by Massachusetts researchers and published in this month's Health Affairs, doesn't explain why, or what wasn't true (Neergaard, 2/9)
Boston Globe: Survey Shows Where Doctors Shade The Truth
Most physicians paint overly optimistic prognoses for their patients, and many have told lies or withheld information concerning their medical mistakes and financial relationships with drug companies and device manufacturers, according to a national survey conducted by researchers at Massachusetts General Hospital. The 2009 survey of nearly 1,900 doctors, published yesterday in the journal Health Affairs, shows that many doctors do not adhere to the standards of medical societies and accreditation groups, which have long required doctors to be open and honest with their patients (Kotz, 2/9).
The Baltimore Sun: Do Doctors Lie To Patients?
Researchers from Harvard Medical School and the Mongan Institute for Health Policy at Massachusetts General Hospital in Boston surveyed 1,891 physicians nationwide and one-tenth said they had told a patient something untruthful in the last year. Nearly 20 percent of physicians surveyed said they had not fully disclosed an error to a patient in the previous year because they feared a malpractice case. Doctors feared lawsuits even though research has shown prompt disclosure cuts down on malpractice cases (Walker, 2/8).
WBUR's CommonHealth blog: Doctors Not Always Open, Honest With Patients, Survey Finds
Specifically, about one-third of the survey respondents didn’t completely agree with disclosing serious medical errors to patients because they feared a malpractice case; two-fifths did not completely agree that they should disclose their financial relationships with drug companies to patients; and over one-tenth said in the past year, they’d actually told patients something that wasn’t true (Zimmerman, 2/8).
Kaiser Health News: Study: Some Physicians Not Always Honest With Patients
A vast majority of physicians said they embraced the American Board of Internal Medicine Foundation’s Charter on Medical Professionalism which calls for fully informing patients about the risks and benefits of interventions. But more than a third said they did not completely agree it was necessary to disclose “all serious medical errors to affected patients” (Marcy, 2/8).
Medscape: Honesty Is a Sometimes Policy for Many Physicians
To medical ethicist Linda Emanuel, MD, PhD, at Northwestern University in Evanston, Illinois, the survey results represent a "welcome wake-up call" for her profession. ... In their article, Dr. Iezzoni and co-authors report that honesty and openness among physicians vary on the basis of demographic factors, specialty, and practice setting. Women and underrepresented minorities in medicine are more likely to follow the principles laid out in the Charter on Medical Professionalism (Lowe, 2/8).
Journal of the American Medical Association: Survey: Some Physicians Not Always Honest or Frank With Patients
Not all physicians are as truthful or open in their communications with patients as the latter may expect, behavior that is in conflict with at least some of the tenets of the Charter on Medical Professionalism, according to new findings appearing today in Health Affairs. The Charter on Medical Professionalism, which is endorsed by more than 100 professional groups worldwide and the US Accreditation Council for Graduate Medical Education, requires openness and honesty in physicians’ communication with patients (Mitka, 2/8).
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Public Health & Education
The Washington Post: Komen's Nancy Brinker Says She Made Mistakes In Planned Parenthood Case
In her first public statement since her organization reversed a decision to stop donating to Planned Parenthood, Nancy Brinker, the founder of Susan G. Komen for the Cure, said that “I made some mistakes” in the case, which swelled into a massive controversy. Brinker, in a letter to Washington Post columnist Sally Quinn, also noted that many commentators had blamed “culture wars” for the intensity of the criticism over the foundation’s cutoff of funding (2/9).
Politico: Nancy Brinker: 'I Made Some Mistakes'
Nancy Brinker, the founder of Susan G. Komen for the Cure, has admitted in her first public comments since the organization reversed its contentious decision to stop funding Planned Parenthood, that she "mishandled" the recent controversy and "made some mistakes." In a note sent Wednesday night to Sally Quinn of The Washington Post in response to an open letter from Quinn, Brinker wrote, "Sally, you know that we would never, ever, leave women unserved, especially the low-income, uninsured and underinsured women who are relying on us more than ever in an uncertain economy" (Lee, 2/9).
Meanwhile, Reuters examines the foundation's spending priorities -
Reuters: Insight: Komen Charity Under Microscope For Funding, Science
The Susan G. Komen for the Cure charity defines its mission as finding a cure for breast cancer. In recent years, however, it has cut by nearly half the proportion of fund-raising dollars it spends on grants to scientists working to understand the causes and develop effective new treatments for the disease. While the absolute dollar amount of those grants has steadily grown, it has not kept pace with the surge in donations Komen has received, a Reuters analysis of the group's financial statements shows (Begley and Roberts, 2/8).
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Kaiser Health News' Capsules blog: HHS Seeks To Cut Preterm Births
The Obama administration launched a $40 million effort Wednesday to reduce premature births, especially early elective deliveries, but it has no plans to stop Medicaid from paying for those deliveries (Galewitz, 2/8).
KQED's State of Health blog: New Federal Plan to Reduce Early Elective Births
Data show that delivering early without a valid medical reason increases the risk of complications to babies, including breathing and feeding problems and blood infections. According to HHS, up to 10 percent of all deliveries are scheduled during weeks 37 and 38 without a medical reason (Bazar, 2/9).
Modern Healthcare: HHS Aims To Curb Pre-Term Births
The Center for Medicare & Medicaid Innovation will award about $40 million in grants to test approaches that can help reduce the rising number of pre-term births in the U.S... The new “Strong Start” initiative will focus on preventing pre-term births and also on reducing early elective deliveries that can result in a variety of health problems for mothers and infants (Zigmond, 2/8).
CNN: New Initiative Targets Preterm Births/Elective Deliveries
According to the American College of Obstetricians and Gynecologists, during the last 20 years, premature births have risen 36 percent. ... March of Dimes President Jennifer Howse calls the initiative the single most important step towards preventing prematurity to date. "Working together to eliminate medically unnecessary early deliveries will reduce the emotion and financial burden of prematurity for thousands of families" (Young, 2/8).
CQ HealthBeat: CMS Aims to Reduce Premature Births Through New Grants
[The program] will test three approaches, including group prenatal care, case management at birth centers and coordinated services at maternity care homes (Bristol, 2/8).
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Women's advocacy group seeks wider access to Plan B contraceptive, while study reports lowest teen pregnancy rate in decades.
Bloomberg: Plan B Contraceptive Access Limits Spur New U.S. Court Action Against FDA
A reproductive rights group asked a federal judge to reopen a lawsuit over access to the emergency contraceptive Plan B, claiming the Food and Drug Administration acted in “bad faith” when it placed restrictions on the drug. The Center for Reproductive Rights, in a filing today in federal court in Brooklyn, New York, said reopening its 2005 case was the most efficient way for the group to overturn the FDA’s age restraints on the drug. The group urged the court to order the agency to make Plan B available within 30 days without a prescription or age restrictions (Schoenberg and Frier, 2/8).
The Atlanta Journal-Constitution: Teen Pregnancy Rate Hits 40-Year Low
The U.S. teen pregnancy rate has reached a 40-year low, a new study finds. The study, by the Guttmacher Institute, found that the pregnancy rate declined 42 percent from its peak in 1990, according to the study released Wednesday. The teen pregnancy rate in 2008 was 68 per 1,000 girls age 15-19, down from 117 per 1,000 in 1990. That means about 7 percent of girls in that age group became pregnant that year (Provano, 2/8).
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Coverage & Access
More insurers are shifting a growing amount of the cost of providing care to patients, Kaiser Health News reports. In other insurer news, UnitedHealth will overhaul how it pays doctors, and Washington's state insurance commissioner is asking for permission to consider insurer surpluses when mulling proposed insurance rate increases.
Kaiser Health News: Consumers Hit By Higher Out-of-Network Medical Costs
Kaiser Health News reporter Julie Appleby writes: "When Sharon Smith chose an out-of-network specialist to perform a complicated jaw surgery on her teenage son last May, she knew it would cost her more. But she was not expecting a $15,000 difference. Consumers have long complained about the cost of going outside their health plan's network, but Smith encountered a new twist: a growing number of insurers have changed the way they calculate reimbursements to shift more of the expense to patients" (Appleby, 2/9).
The Wall Street Journal: New Way To Pay Doctors
Efforts to change how Americans pay for health care are gathering momentum on a national scale as UnitedHealth Group Inc., the largest U.S. health insurer, becomes the latest carrier to say it is overhauling its fees for medical providers. ... Under the new plan the carrier is rolling out, part of medical providers' compensation could be tied to goals such as avoiding hospital readmissions and ensuring patients get recommended screenings (Wilde Mathews, 2/9).
The Seattle Times: 3 Big Health Insurers Stockpile $2.4 Billion As Rates Keep Rising
Most publicly traded companies sitting on a pile of cash face a lot of sharp questions from shareholders, often accompanied by demands to fork it over as dividends. Nonprofit health-insurance companies in Washington don't have shareholders. But they are facing demands for the $2.4 billion they've amassed while handing steep rate hikes to customers. State Insurance Commissioner Mike Kreidler is again asking lawmakers to give him the power to consider a nonprofit health insurer's surplus before he agrees to any rate increase (Ostrom, 2/8).
The Sacramento Bee: Over-The-Counter Remedies To Consider
Many people in the United States have no health insurance, and many more are underinsured or have very high deductibles, which require them to pay significant amounts of cash for medical services before any insurance coverage kicks in. As our current health care crisis continues to unfold, more people will be using the Internet to make their own diagnoses and figure out their own treatment plans before considering entering the medical system. In this light, let's look at some common medical concerns, along with some over-the-counter remedies you can try to help you feel better without having to make a trip to the doctor (Judge and Barish-Wreden, 2/9).
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Health Information Technology
According to a Brookings Institution study, the development of state health information exchanges has been slowed by governance, financing and policy issues.
Modern Healthcare: Brookings Report: Barriers Limit State Health Information Exchanges
The current governance, financing and policy barriers limit state health information exchanges from reaching their full potential, the Brookings Institution said in a report. The authors found that state exchanges have been successful in "establishing organizational frameworks, building technology-based connections and bringing relevant groups to the table for discussion," according to the Feb. 8 report (Lee, 2/8).
CQ HealthBeat: Electronic Health Information Exchange Poised For Major Growth, Experts Say
While progress has been slow on sharing patient health information electronically, experts said Wednesday that new payment and service delivery models could drive rapid adoption in the next several years. “We want to see exchanges take off this year,” said Claudia Williams, director of the State Health Information Exchange for the Health and Human Services Office of the National Coordinator for Health Information Technology (Bristol, 2/8).
The Hill: Report Draws Lessons Of States’ Experience With Sharing Health Information
The report looked at five states — Indiana, Massachusetts, New York, Tennessee and California — that have created state-level health information exchanges. ... For the exchanges to be effective, the report concludes, "policymakers must present a clear vision, achieve consensus on key objectives, overcome organizational and market fragmentation, and work effectively with a range of different constituencies" (Pecquet, 2/8).
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State Watch
Georgia Health News: Task Forces To Discuss Report On Medicaid
State officials are creating two task forces to gather input on a consulting firm’s report on the future of Georgia’s Medicaid and PeachCare programs. One task force will involve medical provider groups, including representatives of hospital and physician organizations. The second grouping will review the Navigant report’s recommendation to revamp services for the ‘‘aged, blind and disabled’’ populations (Miller, 2/8).
The Associated Press/Boston Globe: Governor Proposes Medicaid Changes
[Connecticut] Governor Dannel P. Malloy’s new budget proposes to raise the eligibility threshold for low-income adults to apply for health insurance through Medicaid. It would to raise the current $1,000 asset limit for low-income adults applying for Medicaid to $25,000. The new proposed asset limit does not include a person’s primary residence or single vehicle. Officials project that the proposed plan could save $30 million annually (2/9).
The Connecticut Mirror: Malloy To Add Funds To Private Human Service Providers, Nursing Home 'Right-Sizing'
The health and human services portions of Malloy's proposed budget adjustments include money to support an effort to move people out of nursing homes, fund nursing homes that consider providing long-term care to people leaving prisons and state institutions, add three childhood vaccines to the state's program and offer the first funding boost in five years to private human services providers (Levin Becker, 2/8).
Reuters: U.S. Rejects California Health-Care Copayment Plan
The government blocked an effort on Monday by California to reduce its health-care spending by requiring those enrolled in its Medi-Cal program for the needy to make copayments for medical services. The Centers for Medicare & Medicaid Services informed California by letter that it was "unable to identify the legal and policy support" that would allow the state to require copayments to Medi-Cal under the Social Security Act (2/8).
California Healthline: Same Providers In Healthy Families And Medi-Cal?
Yesterday's distribution of a summary of new Healthy Families data by the state Department of Health Care Services caused some advocates to scratch their heads. ... The new data indicate most providers and health plans in the Healthy Families program also serve Medi-Cal beneficiaries. DHCS director Toby Douglas said the health plans of the two programs "are all pretty much the same except for Blue Shield" (Gorn, 2/9).
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Hospitals in Atlanta, Wisconsin and New York are consolidating or partnering more closely with others in a bid to reduce costs and save themselves. In other hospital news, small California hospitals market back surgery to patients and a Minnesota hospital faces a "patient abuse" crisis.
The Atlanta Journal-Constitution: Atlanta Medical Center, South Fulton Medical Center Seek Consolidation
Atlanta Medical Center and financially ailing South Fulton Medical Center announced Wednesday that they will seek state permission to consolidate the two hospitals. Both hospitals are owned by the Tenet Healthcare Corp. … Consolidations in Atlanta's hospital market are now common, as stand-alone facilities find it difficult to survive in today's health care marketplace (Teegardin, 2/8).
Modern Healthcare: Atlanta-Area Hospitals Seek Consolidation
A consolidation agreement may be on the horizon for two Atlanta-area hospitals. According to a joint news release, 403-bed Atlanta Medical Center and 180-bed South Fulton Medical Center, East Point, Ga., are in discussions with officials from the state's community health department "to determine the most viable option and to secure all necessary approvals" for such a deal (McKinney, 2/8).
Modern Healthcare: Ministry Health Buys Out Partner In Wis. System
Affinity Health System in Wisconsin's Fox Valley has converted from a jointly sponsored three-hospital system into an entity controlled by a single Roman Catholic hospital operator with the goal of becoming an accountable care organization. ... [Ministry Health Care President and CEO Nick] Desien said the move to sole-sponsorship of Affinity was motivated in part by changes included in the health reform law, including transitions to bundled payments and population-based health care, which favor efficiency and larger organizational structures (Carlson, 2/8).
Modern Healthcare: NuHealth Seeks To Downsize, Boost Affiliation With North Shore-LIJ
NuHealth System said it will seek $30 million and antitrust clearance from the state of New York to downsize its hospital and affiliate more closely with North Shore-Long Island Jewish Health System.. .. NuHealth, which includes 481-bed Nassau University Medical Center in East Meadow, N.Y., has struggled with pension costs, Medicaid cuts, less support from local government and rates from managed care, according to a statement from the hospital (Evans, 2/8).
The Wall Street Journal: In Small California Hospitals, The Marketing Of Back Surgery
Tri-City Regional Medical Center [is] a hospital that has developed a thriving business doing back surgery on workers' compensation patients. It built up this business rapidly. For an operation known as spinal fusion, which joins two or more vertebrae, the small hospital billed workers' compensation insurers $65 million in 2010, up from less than $3 million three years earlier, state hospital discharge data show (Carreyrou, McGinty and Millman, 2/9).
Boston Globe: Mass. Releases Data On Hospital Infections
Massachusetts public health officials have called together patient safety leaders to determine why hospitals reported a high rate of surgical infections among women who received vaginal hysterectomies over the past two years... By providing data on "health care-associated infections" for each hospital in an easy-to-read format, Department of Public Health officials said they want to reach a new audience: consumers and policy makers. Past reports have been geared more to hospital leaders (Kotz, 2/9).
Minneapolis Star Tribune: Dayton Cites 'Crisis' At St. Peter Hospital
Gov. Mark Dayton said on Wednesday that "there is a crisis of patient abuse'' at the Minnesota Security Hospital in St. Peter, a hospital that has been battered in recent months by management turmoil, resignations of psychiatric staff and incidents of inhumane care. Concluding an unusual firsthand tour of the hospital's psychiatric wards, Dayton said he endorsed the controversial efforts adopted recently by administrators to end unchecked patient seclusion and restraint practices. During a two-hour visit, Dayton also met with about 300 employees, many of whom, he said, voiced confusion over the hospital's patient-care philosophy after years of mixing strict discipline with isolation in a prison-like setting (McEnroe, 2/8).
Houston Chronicle: Hospital Exec Charged In $116 Million Medicare Scam
An executive of Riverside General Hospital was arrested and charged Wednesday in a $116 million Medicare scheme involving kickbacks to patient recruiters and the owners of homes for the elderly and disabled in exchange for steering residents to Riverside's mental health clinics. Mohammad Khan, 63, is identified in the indictment as an administrator "who managed and controlled the day-to-day operations of the hospital's (clinics)," where he is accused of also plying supposed patients with cigarettes, food and coupons redeemable at the hospital's "country stores" in order to entice them to therapy. Khan, who began working for Riverside General Hospital in Houston's Third Ward, is known as "Dr. Khan" by his co-workers even though it appears he is not licensed to practice medicine in Texas (Langford, 2/8).
Minnesota Public Radio: Allina Name Change Reflects Focus On Patients' Health
Allina Hospitals and Clinics, one of Minnesota's major medical systems, is changing its name to represent a move toward keeping people healthy rather than just treating illnesses, according to officials. CEO Ken Paulus said the new name — Allina Health — is a major shift that's intended to challenge Allina's employees to think about patients' overall health (Stawicki, 2/8).
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Des Moines Register: Does Iowa Need An HPV program? Senate Subcommittee Says Yes
Iowa's health department would launch a $250,000 public awareness program about the human papillomavirus vaccine under a bill approved today by a Senate subcommittee. ... Senate Study Bill 3097 would allocate $250,000 for the program, which includes vaccinations for low-income women between the ages 19 and 26 who have no other health coverage. The bill was approved today by a Senate Human Resources subcommittee and now heads to the full committee for further consideration (Clayworth, 2/9).
The Baltimore Sun: State Workers To Get New Pharmacy Plan
More than 200,000 Maryland state employees, retirees and dependents will switch to a new pharmacy plan as a result of the Board of Public Works' decision Wednesday to award the $2.4 billion contract to a St. Louis-based company. When the transition take place in May, plan members will no longer be able to fill prescriptions at one of Maryland's 58 Walgreens stores. The chain is not part of the network operated by the new provider, Express Scripts Inc. (Dresser, 2/8).
MSNBC/Associated Press: Md. Awards $1.1 Million For Community Health Care
The Maryland Community Health Resources Commission is awarding $1.1 million to improve access to medical and dental care statewide. Lt. Gov. Anthony Brown announced the 15 awards Wednesday. Baltimore city tops the list, with three grants totaling $183,000. The largest is $109,000 to Catholic Charities' Esperanza Center. The center provides services to new immigrants. The biggest single grant of $140,000 is to the Community Clinic Inc. in Montgomery County. It serves people who are uninsured or under-insured (2/9).
WBUR: Report: Health Care Changes Saving Money For Cities
A report suggests that Massachusetts cities and towns are on track to exceed the estimated $100 million in statewide savings during the first year of new municipal health care rules. ... The law gives municipalities more flexibility to make changes to public employee health insurance outside of the collective bargaining process (2/8).
Health News Florida: Consumer Seats At Risk
One of the consumer seats on each of Florida’s medical boards would be taken away and given to a physician assistant under bills pending in House and Senate budget committees. The change would leave just two consumers on the 15-seat Board of Medicine and just one on the seven-member Board of Osteopathic Medicine (Gentry, 2/8).
Kansas Health Institute News: KHIE Board Approves First Budget Amid Questions About Future Funding The board responsible for overseeing health information exchange in Kansas today approved its first operational budget despite still-unanswered questions about how much money it has left and how those dollars should be spent.The Kansas Health Information Exchange, Inc. board approved a $665,456 budget for recurring expenses this year and an additional $120,000 for consulting and outsourced services (Cauthon, 2/8).
The Lund Report (an Oregon news service): Fast Track Legislation Scrapped, Lacking Political Support
The managed care plans that are currently providing services to Oregon Health Plan members appear to have lost their bid to create what’s known as "fast track," legislation, giving them the ability to turn into coordinated care organizations (CCOs) by July. ... These CCOs are the backbone of the transformation reform under way and are expected to begin integrating the physical, mental and dental health care of 600,000 people on the Oregon Health Plan (Waldroupe, 2/9).
The Sacramento Bee: Job Cuts Leave More California Residents In Medical Debt, UCLA Study Says
The Great Recession has left more California families with mounting medical debt and a tenuous grip on the insurance needed to afford care, a new UCLA study revealed. Some 2.6 million non-elderly California residents carried medical debt in 2009, about 400,000 more than in 2007, according to the report released Monday by the UCLA Center for Health Policy Research. Recession was the prime suspect, as job cuts forced more Californians onto the unemployment line, stripping their employer-supplied health benefits in the process (Smith, 2/8).
California Healthline: State Choices on Essential Benefits May Become More Complicated
Besides California, 21 other states approved laws in 2011 mandating various health services to be covered by health plans, according to research by the National Conference of State Legislatures. Now, this year, the queue of proposed mandates might be even longer in California, as advocates push for coverage and health officials lay the groundwork for implementing the Affordable Care Act (Gorn, 2/8).
Denver Post: Decaying Statistics Prompt A Renewed Dental-Health Push By Colorado And Private Officials
One of Matthew's 6-year molars has a cavity eating through enamel that never formed quite right. He'll have an appointment with the drill in a week or two. And Matthew has just joined a set of stubborn statistics that have prompted a renewed dental-health push by state and private officials: Fifty-seven percent of Colorado third-graders had cavities in the latest survey in 2007, exactly the same number as in 2004, despite years of effort (Booth, 2/9).
Boston Globe: DeLeo Rejects Patrick’s Tax Proposals
House Speaker Robert A. DeLeo rejected yesterday Governor Deval Patrick’s proposal to raise $260 million in new revenue with various taxes and fees, including a tax on candy and soda, an increase in cigarette taxes, and a new deposit requirement for bottled water. DeLeo, delivering his annual address laying out his priorities for the year, renewed his argument that business leaders need predictability and consistency in the tax code (Bierman, 2/8).
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Weekend Reading
Every week, Jessica Marcy searches for interesting in-depth reading.
The Daily Beast: How Karen Handel's Komen Resignation Boosts Her Political Prospects
Even if you put politics and ideology completely aside, Karen Handel had to resign from Susan G. Komen for the Cure. It's hard to think of the last time an employee did so much damage to such a respected brand in so little time. ... But while Komen will sustain long-term damage, Handel probably will be just fine. Yes, she's lost her position as Komen's vice president for public policy. But Handel has long had political aspirations, and she's now a right-wing cause célèbre. When she ran for the Georgia Republican gubernatorial nomination two years ago, she was attacked for being insufficiently anti-abortion. That's unlikely to happen again. "It's kind of hard to criticize her now," Joel McElhannon, a Georgia-based GOP strategist, told the Associated Press (Michelle Goldberg, 2/8).
TIME: New Criteria May Change Alzheimer's Diagnosis
Recently revised guidelines for diagnosing Alzheimer's disease would reclassify nearly all patients who are currently diagnosed with mild or very mild Alzheimer’s as having mild cognitive impairment (MCI), a new study finds. The change may be confusing for doctors and misleading for patients and their families, says Dr. John Morris, a neurologist at Washington University in St. Louis. Reporting in the journal Archives of Neurology, Morris finds that 99.8 percent of patients now diagnosed with very mild Alzheimer's dementia would actually be considered to have MCI, according to the latest guidelines. Among patients with mild Alzheimer's, 92.7 percent would be reclassified as having MCI (Alice Park, 2/8).
KHN summarized other news coverage on Alzheimer's this week: Obama Administration Pledges $156 Million For Alzheimer's Research And Care (2/8).
American Medical News: The Limits Of Treating Loved Ones
It was a busy day for the cardiologist. Between juggling patients, he received a phone call from his mother. She said she had heartburn and complained that none of the usual over-the-counter medications had helped. So the cardiologist quickly called in a prescription for her for an acid blocker and went back to seeing patients. Later that afternoon, his mother called again -- this time from an emergency department. The doctors there said she had a heart attack. ... Professional ethics policies have long warned about the perils of physicians treating themselves or family members. ... Yet medical board officials say such rules are commonly violated by well-meaning physicians, either knowingly or unknowingly (Carolyne Krupa, 2/6).
Scientific American Mind: Thinking About Mortality Changes How We Act
The thought of shuffling off our mortal coil can make all of us a little squeamish. But avoiding the idea of death entirely means ignoring the role it can play in determining our actions. Consider the following scenario: ... It's the middle of the night when you are suddenly awakened from a deep sleep by the sound of screams and the choking smell of smoke. ... [S]ome thoughts of death shore up our beliefs, and other types of reflection make us reexamine them. Which kind leads to a better life? For their experiment, Blackie and Cozzolino recruited volunteers aged 17 to 76 and primed them in different ways (Wray Herbert, 2/6).
The New Yorker: Out The Window
Today is January, midmonth, midday, and mid-New Hampshire, and the writer sits in his blue armchair looking out the window. He is eighty-three. He teeters when he walks, he no longer drives, he looks out the window and watches birds come to his feeder. … The cow barn forty yards away was built in 1865, and he gazes at it every day of the year. His mother turned ninety in the Connecticut house where she had lived for almost sixty years, and she spent her last decade looking out the window. She died in a nursing home one month short of ninety-one. A year later, Jane, the writer's wife, at forty-seven, was dying of leukemia (Donald Hall, 1/23).
Newsweek/Chicago Tribune: Life With Trig: Raising A Special-Needs Child
Families of children with special needs are bonded by a shared experience of the joys, challenges, fears, and blessings of raising these beautiful children whom we see as perfect in this imperfect world. ... When I discovered early in my pregnancy that my baby would be born with an extra chromosome, the diagnosis of Down syndrome frightened me so much that I dared not discuss my pregnancy for many months. All I could seem to muster was a calling out to God to prepare my heart for what was ahead. My prayers were answered beyond my shallow understanding of what true joy could be (Sarah Palin, 2/9).
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Editorials and Opinions
The Wall Street Journal: The Real Trouble With The Birth-Control Mandate
Critics are missing the larger point. Why should the Department of Health and Human Services (HHS) decree that any of us must pay for "insurance" that covers contraceptives? ... Insurance is a bad idea for small, regular and predictable expenses. There are good reasons that your car insurance company doesn't add $100 per year to your premium and then cover oil changes, and that your health insurance doesn't charge $50 more per year and cover toothpaste (John H. Cochrane, 2/9).
The New York Times: Tales From The Kitchen Table
Catholic dogma holds that artificial contraception is against the law of God. The bishops have the right — a right guaranteed under the First Amendment — to preach that doctrine to the faithful. They have a right to preach it to everybody. Take out ads. Pass out leaflets. Put up billboards in the front yard. The problem here is that they’re trying to get the government to do their work for them. They've lost the war at home, and they’re now demanding help from the outside (Gail Collins, 2/8).
The New York Times: Whose Conscience?
This aggressive claiming of the moral high ground is close to drowning out the regulation’s supporters, inside and outside of the Obama administration. ... While the policy grounds are fully persuasive – the ability to prevent or space pregnancy being an essential part of women’s health care, one that shouldn’t be withheld simply because a woman’s employer is church-affiliated – the purpose of this column is to examine the conscience claim itself, directly, to see whether it holds up (Linda Greenhouse, 2/8).
The New York Times: Sex And The Secularists
Roughly one in six patients in the United States are cared for in a Catholic hospital. Millions of those patients are not Catholic. So why should they be denied birth control, which doctors and social scientists say is a proper tool for healthy living? It gets even trickier when religious institutions take government money, and dole out policies at odds with the Constitution’s establishment clause. There must be a third way (Timothy Egan, 2/8).
Milwaukee Journal Sentinel: Find Compromise For Rule On Birth Control Coverage
Some accommodation should be made for employees of religious institutions. Perhaps a compromise could be crafted that would allow women at exempted workplaces to obtain inexpensive birth control or would provide referrals to an insurance provider who provides birth control coverage (2/8).
The Detroit Free Press: Insurance Mandate For Birth Control Attacks Religious Liberty, Should Be Defeated
Nearly three years after President Barack Obama called for the protection of conscience rights at the University of Notre Dame, not only has he failed to honor his words, last month he authorized perhaps the most egregious and sweeping intrusion into the religious liberty and conscience rights of every American citizen. ... The mandate has rightly elicited a vociferous national response (Paul A. Long, 2/9).
The Washington Post: Virginia GOP Shows Its Hypocritical Side On Abortion
Virginia Republicans, always quick to condemn overreaching government intrusions into people's lives, are themselves becoming the High Priests of the Nanny State. In driving a singularly obnoxious abortion measure through the state legislature — one that substitutes their own medical expertise for that of doctors — they are setting new standards for official arrogance and meddling (2/8).
Arizona Republic: Abortion Opponents Lack Follow-Up
I understand the genuine moral convictions of those who oppose the availability of abortions. What I've never understood ... is the lack of follow-up. Legislators seem to have less concern for a child brought into the world than for a puppy brought home from the pound. When a parent finally caves in to a child's demand for a dog, there is often a long lecture about "responsibility." ... But always there is an understanding that you, the parent, will take up those duties if the child fails. ...That doesn't happen with babies (EJ Montini, 2/9).
Los Angeles Times: 'Obamacare' Insurance Exchanges: Let's Get Going
Should (state legislators) start working on an exchange, or count on the law being repealed by the Supreme Court or by a new Republican-controlled Congress and White House in 2013? The answer is that each state should set up an exchange regardless of how its lawmakers feel about "Obamacare," because it would help ameliorate the very real problems consumers face in the health insurance market (2/8).
New Orleans Times-Picayune: Bobby Jindal's Health Care Vision Put To The Test
Though he is not giving speeches about it, Gov. Bobby Jindal has taken on his greatest challenge to make his brand of government work, as he privatizes a large part of the Medicaid system while the network of state hospitals, already facing an uncertain future, closes clinics, terminates programs and lays off hundreds of employees to meet steep mid-year budget cuts (John Maginnis, 2/8).
The Atlanta Journal-Constitution: Local Affiliate Offers Perspective
We disagreed with the premise that an organization cannot apply for funding while under investigation. We believed this to be a nebulous and open-ended criterion for funding that would require Komen to make judgment calls about organizations before any finding of wrongdoing. This type of prejudgment would have made the Komen organization vulnerable to criticism that it was making funding decisions based on political factors, which simply cannot be allowed (Karen Bragman and Kelly Dolan, 2/8).
The Seattle Times: Women Refused To Indulge Abortion Politicking In the Komen/Planned Parenthood Controversy
I think Komen's decision went nuclear because women don't want to be forced to favor the work of one group over the other. Women rely on both organizations for different aspects of their future; both provide services desperately needed by people with no other option. What is so maddening is that Komen, by creating a phony excuse to dump Planned Parenthood, forced women to take a side and they vehemently didn't want to (Joni Balter, 2/8).
The Seattle Times: End The Sweetheart Deals, Overhaul Public School Health Benefits
Taxpayers and school-district employees stand to gain from creation of a state board to oversee a statewide risk pool for K-12 public-school employees' health benefits. The current labyrinth has 295 school districts and nine educational service districts negotiating with individual unions for private insurance plans. Expensive administrative inefficiencies are obvious, but the system offers little transparency for taxpayers, scant opportunity for oversight and vast differences in coverage and benefits (2/8).
New England Journal of Medicine: The Value of Federalism in Defining Essential Health Benefits
Health and Human Services Secretary Kathleen Sebelius surprised the health care community when, on December 16, 2011, she announced that there would not be one single national definition for [essential health benefits] ... But in this environment of uncertainty, with sizable preexisting local variability in insurance markets and substantial disagreement surrounding the fundamental value of sharing risk, embracing federalism in defining the EHBs is not just good politics — it is good policy (Alan Weil, 2/8).
New England Journal of Medicine: Fair Enough? Inviting Inequities in State Health Benefits
The Obama administration scored a political point in December with its bulletin on essential health benefits, appeasing critics of the Affordable Care Act (ACA) by giving states the right to determine what those benefits should be. The proposal is politically savvy. But is it fair? ... Unceasing effort to standardize comprehensive health coverage and reach a gold standard of care is essential to attaining this goal (Jennifer Prah Ruger, 2/8).
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