Daily Health Policy Report

Thursday, January 10, 2013

Last updated: Thu, Jan 10

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Capitol Hill Watch

Fiscal Cliff


Coverage & Access

Public Health & Education

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

'The Matrix' Meets Medicine: Surveillance Swoops Into Health Care

In this Kaiser Health News piece, Michael L. Millenson writes: "In an inconspicuous control room at the Sioux Falls, S.D., headquarters of the Evangelical Lutheran Good Samaritan Society, nurses keep round-the-clock watch on motion and humidity sensors in the living rooms, bedrooms and bathrooms of elderly men and women in five states" (Millenson, 1/9). Read the story.


This Story: Print | Link to | Top

Capsules: Governors' Group Highlights Health Care In 2013 Outlook; Commonwealth Fund Panel Proposes Options To Slow Health Care Spending

Now on Kaiser Health News' blog, Shefali S. Kulkarni reports on the National Governors Association's outlook for the year ahead: "As governors gear up to deliver their state-of-the-state addresses later this month, the Democratic and Republican leaders of the National Governors Association spoke Wednesday about the broader policy challenges facing all states in 2013 — and sure enough, health care was among the major issues both mentioned" (Kulkarni, 1/10).

Also on Capsules, Alvin Tran reports on a new Commonwealth Fund report on ways to slow health spending: "A group of health policy professionals Thursday called on federal, state and local governments to help slow the relentless growth of health care spending by setting firm limits on those expenditures. The group ... urged each level of government to agree to hold the increases in health spending to the same rate as the growth of the gross domestic product, a measure of the nation's total economy, while also improving health system performance" (Tran, 1/10). Check out what else is on the blog.

This Story: Print | Link to | Top

Political Cartoon: 'Boxed In?'

Kaiser Health News provides a fresh take on health policy developments with "Boxed In?" by Lisa Benson.

Meanwhile, here is today's health policy haiku:


A best actor nod
For five-thirty-five who "act"
Like legislators?
-Anonymous, of course

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.

This Story: Print | Link to | Top

Administration News

Obama Taps White House Chief Of Staff To Head Treasury

News outlets report that although Jack Lew is known as a deficit hawk, he has been a defender of Medicaid and other safety net programs.

The Wall Street Journal: Obama Aide Is Treasury Pick
In 2011, as political leaders were designing the spending reductions that would begin this year if a larger deficit-reduction deal wasn't reached, some Republicans wanted to cut Medicaid, the health-care program for the poor. Mr. Lew bluntly interrupted to say Medicaid was off the table, prompting a GOP aide to hang up the phone, according to a person familiar with the exchange. Several months earlier, during a debate over government funding, the usually even-tempered Mr. Lew stormed out over a dispute with Republicans about what numbers both sides should use as their "base line" for negotiations (Paletta and Hook, 1/10).

The Washington Post: Obama Selects White House Chief Of Staff Jack Lew To Head Treasury
Ideologically, Lew is a deficit hawk, and he thinks Obama should be pursuing an aggressive effort to slow the growth of the federal debt. But he has deep roots in Democratic politics, and in previous negotiations he has passionately resisted efforts to slice the social safety net, particularly Medicaid, the health insurance program for the poor (Goldfarb, Tankersley and Cillizza, 1/9).

The New York Times: Obama's Pick For Treasury Is Said To Be His Chief Of Staff
If Mr. Lew is confirmed in time, his first test as Treasury secretary could come as soon as next month, when the administration and Congressional Republicans are expected to face off over increasing the nation's debt ceiling, which is the legal limit on the amount that the government can borrow. Mr. Obama has said he will not negotiate over raising that limit, which was often lifted routinely in the past, but Republican leaders have said they will refuse to support an increase unless he agrees to an equal amount of spending cuts, particularly to entitlement programs like Medicare and Social Security (Calmes, 1/9).

Also, Health and Human Services Secretary Kathleen Sebelius will stay in her position for the second term --

Politico Pro: Sebelius Stays On As ACA Takes Effect
The announcement that HHS Secretary Kathleen Sebelius will remain in her job all but ensures that Sebelius will be around to oversee the implementation of the biggest pieces of the health law when they kick in next year. The White House announcement Wednesday was hardly a surprise, but it came as a quick follow-up to the news that Labor Secretary Hilda Solis is stepping down. Within minutes of that news, a White House official said Sebelius, VA Secretary Eric Shinseki and Attorney General Eric Holder will all remain in their current jobs. But those were the only details the administration provided, and an HHS spokeswoman said Sebelius would have no further comment (Haberkorn, 1/9).

CQ HealthBeat: It's Official: Sebelius Will Remain In The Cabinet
Health and Human Services Secretary Kathleen Sebelius will stay for a second term in the Obama administration, HHS aides confirmed on background late Wednesday afternoon. The confirmation came after President Barack Obama announced that Labor Secretary Hilda Solis will be stepping down. There had been little speculation, though, that Sebelius would leave, given that the agency is deep in the midst of fully implementing the health care law by 2014 and she’s shown no sign of preparing to leave her post (Norman, 1/9).

This Story: Print | Link to | Top

Health Reform

States Continue Efforts To Advance Health Exchanges

States look for creative ways to publicize the online marketplaces where people can shop for and purchase coverage beginning next fall. Meanwhile, Minnesota legislators introduce a measure to set up such a market, and Florida Gov. Rick Scott releases new, much smaller estimates of the cost of expanding that state's Medicaid program.

Politico: States Struggle With How To Sell Their Exchanges
From Pandora radio to those paper coffee cup sleeves to the neighborhood laundromat, states are searching for creative ways to advertise their new health insurance exchanges to people who may not know much about how to get covered next year under the health care law — and who may not like what they've heard (Cunningham, 1/10).

MPR News: With Bill In Hand, Legislators Squeezed For Time To Establish Health Insurance Exchange
As the new legislative session gets underway this week, DFL and Republican lawmakers wasted no time in unveiling a bill to carry out a key part of the federal health care overhaul in Minnesota: establishing a state health insurance exchange. The exchange will provide an online gateway for up to a million Minnesotans to comparison shop for health insurance and enroll in Medicaid beginning Oct. 1. Lawmakers have about 10 weeks to pass a bill and get it on the governor's desk. Gov. Mark Dayton's administration has made great strides in creating a Minnesota insurance exchange: securing more than $70 million in federal funds, mobilizing task forces, signing contracts to build the exchange's technical backbone (Stawicki, 1/10).

MPR News: Minnesota Lawmakers Unveil Bill To Create Insurance Exchange
State lawmakers unveiled a bill Wednesday to create an insurance exchange in Minnesota. The exchange is an online gateway for more than million Minnesotans to shop comparatively for health insurance or enroll in Medicaid beginning Oct. 1. The bill calls for a seven-member board to govern the online marketplace, including choosing which insurance plans can be sold on the exchange. But Julie Brunner of the trade group representing the state's insurers, the Minnesota Council of Health Plans, said insurers don't think a board should be able to limit which plans sell on the exchange. "It should be automatic that if you meet the certification requirements to sell in the exchange, you can sell in the exchange," Brunner said. The bill calls for charging health insurers a 3.5 percent surcharge on premiums for plans they sell on the exchange through 2014 in order to fund the online marketplace (Stawicki, 1/9).

Minneapolis Star Tribune: Work Begins On Minnesota Health Insurance Exchange
Minnesota is taking the first step toward sweeping changes in the way more than a million of its residents and businesses buy health insurance. A bipartisan coalition of lawmakers gathered at the Capitol on Wednesday to introduce long-delayed legislation that will set the groundwork for Minnesota's new health insurance exchanges. The system, a cornerstone of the federal Affordable Care Act, will allow consumers to shop online for their health coverage and choose the plans with the best coverage at the best price. "A year from now, as a result of this legislation, I hope to be able to have Minnesotans buy their health insurance on a device like this or on their home computer," said the chief House sponsor, Rep. Joe Atkins, DFL-Inver Grove Heights, holding his iPad aloft. "The magnitude of this legislation is that 1.3 million Minnesotans are expected to be able to purchase their health insurance online." The health exchanges were mired in partisan gridlock last session (Brooks, 1/9).

California Healthline: New Year's Resolutions: Tasks For California's Exchange In 2013
All the way back in August 2011, HHS awarded California more than $38 million to begin work on its health insurance exchange under the Affordable Care Act. Flash forward to 2013, and the exchange already has cleared the sale of certain health plans and adopted a new name: Covered California. It even has a logo. Earlier this month, California was one of seven states to receive conditional federal approval for its exchange plan, making it a leader in national implementation efforts. … Between 150,000 and 430,000 individuals will have enrolled by next January, officials say, and by the end of 2016 the exchange will include about 4.4 million Californians. Set to cover more than half of the state's 7.1 million uninsured under age 65, the exchange will be a crucial tool for a significant percentage of California residents. 2013 is a critical year for state health officials, who are hoping to sustain the momentum created by the federal approval and have the exchange online by 2014 (Wayt, 1/9).

The Associated Press: Florida Governor Rick Scott Under Fire For Health Care Cost Estimate
Gov. Rick Scott is coming under fire again that he is overstating the potential cost to Florida taxpayers of the federal health care overhaul. Scott on Monday met with Health and Human Services Secretary Kathleen Sebelius to express his concerns about the overhaul. A key part of the overhaul is the optional expansion of Medicaid to cover more of the state's working poor (1/9).

Health News Florida: New Report Slashes Cost Estimate On Medicaid Expansion
After two days of heavy criticism, Gov. Rick Scott’s administration released a new, much smaller estimate of the cost of expanding Florida Medicaid late Wednesday night. The new report pegs the price tag at about $3 billion. At the most, if all those eligible signed up, it would cost the state $5 billion over a decade, the new report says. That is less than one-fifth the cost that Scott has been citing. Over the same time span, the expansion would bring in about $30 billion in federal funds, the new analysis says, enough to cover 910,000 uninsured low-income Florida adults. In other words, Florida would get about $10 in federal funds for every $1 it put into the expansion, the new estimate says (Gentry, 1/10).

The Associated Press: Fla. Agency Drops Cost Of Health Care Overhaul
Just two days ago, Florida Gov. Rick Scott was in Washington declaring that the potential cost of the federal health care overhaul to state taxpayers would be as much as $26 billion. But on Wednesday, Scott's own health care agency released new cost estimates of as little as $3 billion over the next decade (Fineout, 1/9).

The Associated Press: New Mexico To Expand Medicaid Program
Republican Gov. Susana Martinez says New Mexico will follow provisions of a federal health care law to expand the state's Medicaid program to potentially provide medical services to 170,000 low-income adults. New Mexico will join at least 15 other states and the District of Columbia in broadening eligibility for the health care program under terms of a health care overhaul championed by President Barack Obama (Massey, 1/9).

Meanwhile, here are reports on ACOs and health insurance co-ops --

WBUR: Common Health: Beth Israel Deaconess Goes ACO; What Does That Mean?
Does "ACO" mean anything to you yet? Well if you want to do more than nod and smile the next time you’re around a lot of doctors, read the next couple of paragraphs. Hospitals that plan to stay in business in Massachusetts are either creating or joining Accountable Care Organizations (ACOs). Today we have a new one of these large “all care under one umbrella” groups: The Beth Israel Deaconess Care Organization (BIDCO) includes the hospital, its physicians’ group and two affiliated hospitals. BIDCO is in talks with Cambridge Health Alliance, Signature Healthcare in Brockton and a few other organizations about joining. Dr. Kevin Tabb, who runs the hospital (Beth Israel Deaconess Medical Center), says ACOs offer a new and better way to deliver and pay for care (Bebinger, 1/9).

St. Louis Beacon: Plans To Set Up Health Insurance Cooperative In Missouri Is In Limbo
Buried in the Affordable Care Act is a provision to give individuals and small businesses in all states the option of buying their health insurance from a nonprofit cooperative. Missouri might have missed the boat because funding for low-interest federal loans to set up co-ops has been eliminated for now as part of the fiscal cliff negotiations. The health-reform law provided seed money to add a co-op insurance option to insurance exchanges in all 50 states. The federal government already has approved about $1.9 billion in loans for co-ops in 24 states, including $160 million for one in Illinois. Missouri was among states awaiting funding when Congress eliminated the remaining $1.4 billion for the co-op loan program (Joiner, 1/10).

And in other news -

The Washington Post: Leading HHS: Staying Focused On The Goal Requires Teamwork, Innovation And Inspiration
As deputy secretary of the Department of Health and Human Services (HHS), Bill Corr is responsible for the operations of the government's largest civilian department. He most recently served as executive director of the Campaign for Tobacco-Free Kids and previously served for 12 years as counsel to the U.S. House of Representatives' Subcommittee on Health and the Environment. Corr spoke with Tom Fox, who is a guest writer of the Washington Post's Federal Coach blog and vice president for leadership and innovation at the Partnership for Public Service. Fox also heads up the Partnership's Center for Government Leadership (Fox, 1/9).

This Story: Print | Link to | Top

Capitol Hill Watch

Capitol Hill Health Policy News: Fact-Checking Pelosi On Medicare; Senior GOP Health Adviser To Leave House; Redefining Rural Doctor Access

A selection of stories revolving around Capitol Hill, including an effort to expand mental health care.

The Washington Post's The Fact Checker: Nancy Pelosi's Claim That The GOP Would Raid Medicare For Tax Cuts
We are reluctant to re-litigate the rhetoric of the 2012 presidential campaign, but this comment by Rep. Nancy Pelosi about the House GOP budget jumped out at us. We had frequently written during the campaign about the misleading claim by Mitt Romney that President Obama had gutted more than $700 billion from Medicare to fund Obamacare. And yet here was Pelosi claiming Republicans had used the "same money" to fund a tax cut, compared to Democrats, who she said had used the $700 billion to "increase benefits to seniors" (Kessler, 1/10).

The Hill: Mont. Senators Challenge HHS Redefining 'Frontier'
Montana Sens. Max Baucus (D) and Jon Tester (D) have asked the U.S. Department of Health and Human Services (HHS) to reconsider its decision to change the definition of "frontier" from population density to a community's distance from a major city. The senators sent a letter to HHS’s Office of Rural Health Policy on Monday explaining how the change would negatively affect small towns in rural areas get access to doctors and services. ... Rural areas receive grants from HHS to fund community health centers in lower-populated places — Tester and Baucus fear that a change in the definition of "frontier and remote" could mean less money for communities in their state (Cox, 1/9).

The Associated Press: Al Franken Seeks To Expand Mental Health Care
Federal funding for mental health programs in prisons and jails would expand under a bill unveiled Wednesday by Sen. Al Franken. The Minnesota Democrat's bill would continue federal funding for courts that divert the mentally ill from prison into treatment and increase training for police officers in handling people with mental health issues (1/9).

Politico Pro: Cohen Leaves House Post To Open Consulting Firm
A top Republican health care policy expert on Capitol Hill is leaving his position with plans to open a new health care consulting business. Howard Cohen, chief health counsel on the House Energy and Commerce Committee, left the Hill on December 31, he told POLITICO. Cohen, who worked on Energy and Commerce for two years, following a 10-year stint on the Hill in the 1990s, said he's looking forward to working on health care policy from a wider perspective, including from the states and industry (Haberkorn, 1/9).

This Story: Print | Link to | Top

Fiscal Cliff

Fiscal Cliff Boosts Clinical Data Registries, But Cuts Some Health Care Payments

CQ HealthBeat reports on a provision of the fiscal cliff law intended to encourage physicians to submit data to registries that could be a tool to promote better quality care. The Medicare NewsGroup analyzes another provision that changes how payments are calculated for end stage renal disease drugs.

CQ HealthBeat: Fiscal Cliff Deal Seen Boosting Use Of Clinical Data Registries
Cardiologists, thoracic surgeons, gastroenterologists and oncologists are likely to take advantage of a new provision of the fiscal cliff law intended to spur doctors to submit more data to registries that could be a powerful tool to promote more efficient, higher quality care. That's the view of Kavita Patel, a Brookings Institution scholar who is a leading researcher on the topic of clinical data registries, which collect information on the characteristics of patients, patterns of care and the outcomes of medical treatments. One example of the power of registries: A Duke University research team discovered by analyzing data in a registry maintained by an arm of the American College of Cardiology that more than 20 percent of patients who received implants of costly cardiac defibrillators should not have gotten them (Reichard, 1/9).

The Medicare NewsGroup: Fact/Fiction: The Fiscal Cliff Deal Will Cut Payments For Illnesses That Disproportionately Impact Minorities
Rep. Marcia L. Fudge (D-Ohio) said in a written statement, following the passage of the American Taxpayer Relief Act of 2012, that the Band-Aid used to avoid cuts to physicians from the Sustainable Growth Rate (SGR), or "doc fix," was "paid for by cutting provider payments for treating illnesses disproportionately impacting minorities, including end stage renal disease and diabetes." ...This is fact (Solana, 1/8).

This Story: Print | Link to | Top


HHS IG: Still Not Many Medicare Advantage Fraud Probes Despite 2007 Investigation

HHS says there aren't many investigations into fraud and abuse perpetrated by the nation's Medicare Advantage providers despite recent investigations that concluded four plans got nearly $600 million more in payment than they should have in 2007.

Modern Healthcare: Amid Concerns About Overpayments, HHS Notes Small Number Of Medicare Advantage Probes
HHS' inspector general's office says the $124 billion Medicare Advantage program is the focus of very few investigations from fraud-hunters -- a conclusion that comes on the heels of a string of audits alleging hundreds of millions of dollars of questionable payments in the program. HHS officials last year published the results of long-running investigations into four Medicare Advantage plans, concluding that the plans had received nearly $600 million more than they should have in 2007 by claiming that patients were more medically complex than they were. All four companies denied the allegations, but the inspector general's office is continuing with probes of an untold number of the other 170 or so Medicare Advantage companies working for the CMS (Carlson, 1/10).

Elsewhere, 2013's changes to Medicare are coming into focus --

The Medicare NewsGroup: New Services For Beneficiaries, Tweaked Payment Policies For Providers In 2013
Medicare policy is constantly evolving, and 2013 is no exception. Beneficiaries will see new preventative services, and some providers will see new taxes and others tweaked payment policies. This interactive slideshow highlights many of the latest changes to the program (Sjoerdsma, 1/9).

This Story: Print | Link to | Top

Coverage & Access

Report: U.S. Could Save $2T Over A Decade By Encouraging Cost-Effective Care

A new report from the Commonwealth Fund says the federal government could save $2 trillion on health care costs over a decade it if accelerates provider adoption of more-effective care.

Reuters: U.S. Could Save $2 Trillion On Health Costs -- Study
The United States could save $2 trillion in health care spending over the next decade, if the U.S. government used its influence in the public and private sectors to nudge soaring costs into line with economic growth, a study released on Thursday said. Compiled by the nonpartisan Commonwealth Fund, the study recommends holding the $2.8 trillion U.S. health care system to an annual spending target by having Medicare, Medicaid, other government programs and private insurers encourage providers to accelerate adoption of more cost-effective care (Morgan, 1/10).

Kaiser Health News: Capsules: Commonwealth Fund Panel Proposes Options To Slow Health Care Spending
The group, assembled by the Commonwealth Fund, a nonprofit research group, urged each level of government to agree to hold the increases in health spending to the same rate as the growth of the gross domestic product, a measure of the nation's total economy, while also improving health system performance (Tran, 1/10).

This Story: Print | Link to | Top

Public Health & Education

Boston Declares Flu Emergency As Viruses Spread Across The Nation

Boston officials report 700 cases of flu, 10 times more than last year.

The New York Times: Flu Widespread, Leading A Range Of Winter's Ills
The country is in the grip of three emerging flu or flulike epidemics: an early start to the annual flu season with an unusually aggressive virus, a surge in a new type of norovirus, and the worst whooping cough outbreak in 60 years. And these are all developing amid the normal winter highs for the many viruses that cause symptoms on the "colds and flu" spectrum (McNeil Jr. and Seelye, 1/9).

USA Today: 700 Cases Of Flu Prompt Boston To Declare Emergency
The Boston declaration is meant to drive home the message about the danger of flu and the necessity of getting vaccinated, said Nick Martin, communications director at the city Public Health Commission. … The hospitals in Boston have been overwhelmed, said Jim Heffernan, chief of primary care at Boston's Beth Israel Deaconess Medical Center. His hospital is full, he said, the emergency room "overflowing because there aren't enough places to put people. It just snowballs" (Weise and Eversley, 1/10).

Reuters: Boston Declares Health Emergency Amid U.S. Flu Outbreak
In Illinois last week, large numbers of sick people overwhelmed some hospitals, and 24 facilities had to turn away some sick people, more than triple the seven hospitals that turned patients away in the same week last year. ... In North Carolina, flu activity has been recorded at the highest levels in a decade with 14 deaths. Many hospitals there have tightened restrictions on visitors. ... Public health officials urged people to stay home from work or school if they become ill, but not necessarily to rush to the hospital, particularly if they are between the ages of 5 and 65 and otherwise healthy (Malone, 1/9).

Boston Globe: Mayor Menino Declares Public Health Emergency In Boston Because Of Flu Outbreak 
The good news is that the strains of flu virus in circulation this year were anticipated, and 91 percent of the viruses found in testing this year are well-matched to the vaccine, said Kevin Cranston, director of the DPH Bureau of Infectious Disease. There are ample supplies of the shot, he added. ... Since seniors face a higher likelihood of developing pneumonia and other life-threatening flu complications, one nursing home in the area has taken the drastic step of asking family members not to visit until flu rates subside (Kotz and Conaboy, 1/9).


This Story: Print | Link to | Top

U.S. Trails 16 Other Affluent Countries In Life Expectancy, Health Status

A National Academy of Sciences report looked at a wide variety of health measures.

NPR: U.S. Ranks Below 16 Other Rich Countries In Health Report
It's no news that the U.S. has lower life expectancy and higher infant mortality than most high-income countries. But a magisterial new report says Americans are actually less healthy across their entire life spans than citizens of 16 other wealthy nations (Knox, 1/9).

The Wall Street Journal: Americans Die Younger Than Peers
Americans die younger and have more illnesses and accidents on average than people in other high-income countries—even wealthier, insured, college-educated Americans, a report said Wednesday. ... The study by the federally sponsored National Research Council and Institute of Medicine found the U.S. near the bottom of 17 affluent countries for life expectancy, with high rates of obesity and diabetes, heart disease, chronic lung disease and arthritis, as well as infant mortality, injuries, homicides, teen pregnancy, drug deaths and sexually transmitted diseases (Radnofsky, 1/9).

Reuters: Obesity, Lack Of Insurance Cited In U.S. Health Gap
The United States also has a higher infant mortality rate than the other countries, with 32.7 deaths per 100,000, the report showed. Most similar countries have infant mortality rates between 15 and 25 deaths per 100,000. ... The U.S. healthcare system is a patchwork of private insurance often provided through an employer as well as public programs aimed at the elderly, disabled and poor. Tens of millions of Americans are left with no insurance to help pay for care (Heavey, 1/9).

PBS NewsHour: Americans Far Less Healthy, Die Younger Than Global Peers, Study Finds
Matthias Rumpf of the Organization for Economic Co-operation and Development -- a group that conducts similar research -- agreed with the findings, though he added that lack of primary care access also directly affects the U.S. life expectancy rate (McHaney, 1/9).

This Story: Print | Link to | Top

State Watch

Governors Urge Feds To Give Them Bigger Health Care Voice

Democratic and Republican leaders of the National Governors Association asked for greater flexibility from the federal government on health law implementation.

CQ HealthBeat: Governors Want A Place At The Table On Health Care Policy
The Democratic and Republican leaders of the National Governors Association hit hard on health in the organization's first-ever "State of the States" address on Wednesday, saying that the federal government must be flexible and partner with states as the health care law is implemented. With the overhaul law going into full effect in 2014, attention increasingly will be paid to state decisions on health insurance exchanges, Medicaid expansion, insurance rate review and more. At the same time, governors have been pushing for a higher-profile role in many Washington fiscal discussions, including on health care policy (Norman, 1/9).

Kaiser Health News: Capsules: Governors' Group Highlights Health Care In 2013 Outlook
As governors gear up to deliver their state-of-the-state addresses later this month, the Democratic and Republican leaders of the National Governors Association spoke Wednesday about the broader policy challenges facing all states in 2013 -- and sure enough, health care was among the major issues both mentioned" (Kulkarni, 1/10).

This Story: Print | Link to | Top

Mass. Abortion Clinic 'Buffer Zone' Law Upheld By Federal Appeals Court

In Massachusetts, a federal appeals court has upheld a 2007 state law that makes it a crime to loiter within 35 feet of an abortion clinic, despite First Amendment challenges from anti-abortion advocates.

The Wall Street Journal's Law Blog: Appeals Court Rejects Challenge To Abortion Clinic 'Buffer Zone'
A federal appeals court upheld a Massachusetts law that creates a buffer zone around abortion clinics, rejecting an interesting First Amendment challenge that took inspiration from the Supreme Court's 2010 campaign-finance ruling in Citizens United v. Federal Election Commission. Wednesday's ruling marked the second time in recent years the Boston-based U.S. Court of Appeals for the First Circuit backed the 2007 law, which makes it a crime to linger within a 35-foot radius around the entrances, exits and driveways of abortion clinics (Palazzolo, 1/9).

The Associated Press: Court Upholds Mass. Abortion Clinic Buffer Law
A federal appeals court has again upheld the buffer zone law for Massachusetts abortion clinics, saying that the regulation protects the rights of patients while, at the same time, allowing others to express their opinions. "Few subjects have proven more controversial in modern times than the issue of abortion," the US Court of Appeals for the First Circuit said in its ruling on Wednesday. "The nation is sharply divided about the morality of the practice and its place in a caring society. But the right of the state to take reasonable steps to ensure the safe passage of persons wishing to enter health care facilities cannot seriously be questioned" (Finucane, 1/9).

This Story: Print | Link to | Top

Anthem Proposes Double-Digit Rate Hikes In Calif., Prompting Insurance Commissioner Outcry

California Insurance Commissioner Dave Jones is calling a recent double-digit rate hike proposal and reinsurance fee by Anthem Blue Cross in his state "unreasonable," though he doesn't have much power to change it.

Marketplace: Are Insurers Hiking Rates Despite Health Care Reform
California's insurance commissioner, Dave Jones, is upset about the latest rate hikes for health insurance. And he's using the only real power he's got: Stepping up to a podium and scolding the insurance companies. In particular, he has called out Anthem Blue Cross of California for an 11 percent premium increase for some customers. But Anthem's double-digit rate hike is consistent with new 2013 rates being rolled out all over the country. Not exactly what the architects of health care reform had in mind. "We are seeing an unexpected spurt of premium increases for small employers and people who obtain policies directly from the insurance company," says Robert Field, a professor of law and health policy at Drexel University. Insurance companies are claiming the rate increases are due to higher health care costs. But Field, who notes that health care costs are leveling off, is skeptical (Horwich, 1/9).

California Healthline: Anthem, Jones Spar Over Premium Rate Hikes, Reinsurance Fee
California Insurance Commissioner Dave Jones [Tuesday] said a recent rate submission by Anthem Blue Cross was "unreasonable" and took particular issue with Anthem's plans to charge a reinsurance fee which Jones said forces small businesses to pay for a 2014 fee a year early, in 2013. Anthem Blue Cross officials said Jones' numbers are off and that the reinsurance fee is a benign and standard business practice which has been used for many years without complaints from government or advocates (Gorn, 1/9).

This Story: Print | Link to | Top

State Roundup: Advocates Watching Calif. Budget For Medi-Cal Cuts

A selection of health policy news from California, Michigan, Kansas, New Jersey, New York, Arizona, Virginia and Georgia.

Los Angeles Times: Through New Budget, Brown Maps Out Sweeping Change In California
Brown's proposed budget will outline his plans for expanding health coverage under the new federal health care law, which is set to require increased coverage beginning in January 2014. The law will put hundreds of thousands of new enrollees into California's public insurance program, but the governor has raised concerns about what that will cost. In addition, Brown has said the state may reduce the roughly $2 billion it gives to counties to care for the uninsured, amid objections from advocates and county officials (York and Megerian, 1/9).

California Healthline: Health Proponents Watching Budget For Medi-Cal Provider Rate Cut
Governor Jerry Brown today will release his plan to fix a projected $1.9 billion deficit in the state's budget. Despite the recently rosier financial outlook for the state, many in the California health community still hold concerns that those new cuts may come out of the hide of health care. "It sounds like education is going to be made whole, it sounds like prisons are going to be made whole, so yes, we're fearing further cuts to health care," said Francisco Silva, general counsel for the California Medical Association. "There is still a $1.9 billion deficit, after all." Silva was discussing the possible inclusion in the budget of a 10 percent Medi-Cal provider rate reimbursement cut that was approved by the state Legislature but has not gone into effect because it's being challenged in court (Gorn, 1/10).

Detroit Free Press: Michigan Attorney General Bill Schuette To Appeal Ruling On Same Sex Health Care Benefits Policy
Attorney General Bill Schuette said he will appeal to the Michigan Supreme Court an opinion that upholds the Michigan Civil Service Commission's policy granting health care benefits to same-sex partners of state employees, a spokeswoman said Wednesday. Schuette, a Republican, challenged the policy, saying it violated a 2004 Michigan constitutional amendment passed by voters which defined marriage as the union of a man and a woman. Courts have ruled that extending health benefits specifically to same-sex partners would violate that provision. As a result, the Civil Service Commission, along with several Michigan universities and some local governments, have crafted policies in another way -- by extending benefits to housemates who are not immediate family members (Egan, 1/10).

Kansas City Star: KC Council Committee Endorses Extension Of Health Care Levy
Property taxes are never an easy sell, but a Kansas City Council committee hopes voters will approve a nine-year extension of the city’s indigent health care levy. The council's Finance and Governance Committee supported a measure Wednesday that would put the property tax before voters in April. The full council will vote Jan. 17 on the ballot language. ... Critics have questioned the rationale of extending the tax another nine years when implementation of Obamacare is so likely to change the dynamics of insuring the poor. But even if Obamacare is fully implemented in coming years, Kansas City safety net providers said it still won’t cover all health care costs for the working poor. That’s why they’re seeking another nine-year renewal of a health care property tax that Kansas City residents first approved in 2005 (Horsley, 1/9).

The Associated Press/Washington Post: NJ Gov. Christie Says He's Willing To Discuss Tougher Gun Laws Along With Mental Health Issues
New Jersey Gov. Chris Christie said Wednesday that he's willing to have a conversation about stricter gun laws, but says policymakers also must address the mental health system, improve access to drug treatment and look at the impact of violent video games (1/9).

The Hill: Officials: Sandy Damage To NYC Hospitals Topped $800 Million
Hurricane Sandy caused $810 million in damage to New York City hospitals, officials estimated Tuesday. Alan Aviles, president of the New York City Health and Hospitals Corporation (HHC), said the figure includes the costs of storm response, repairs, revenue loss and permanent reconstruction work to soften the blow of future disasters. The largest portion of the $810 million estimate covers permanent reconstruction needs, including projects to relocate mechanical gas systems out of hospital basements, retrofit elevators and recreate flood walls. Sen. Charles Schumer (D-N.Y.) toured parts of the Coney Island Hospital, which suffered extensive damage in the October storm, on Tuesday (Viebeck, 1/9).

The Arizona Republic: Arizona Foster-Care Vaccination Rule Clarified
State officials have clarified a rule that required parents to immunize their own children as a condition of caring for foster or adoptive children, saying families whose children have a medical reason to forgo vaccinations can become licensed. The policy was sent Tuesday to the agencies that train and oversee foster parents. It means would-be adoptive parents who choose not to fully immunize their own children won't be automatically disqualified as foster parents (Reinhart, 1/9).

HealthyCal: Maternal Mortality Increases, Disparities Persist
A recent report from the California Health Care Foundation shows that the maternal mortality rate in California has increased significantly since the late 1990s. Furthermore, the same report shows a wide disparity in maternal mortality between African American women and the rest of the population (Fulton, 1/9).

Richmond Times-Dispatch: Va. Officials Meet To Discuss Health Care Workforce Issues
Sixty-one percent of Virginia pharmacists are women, 92 percent of registered nurses in Virginia are satisfied with their jobs, and the median annual salary for dental hygienists in the state is between $50,000 and $60,000. These are some of the facts being collected by the Virginia Department of Health Professions in surveys completed or under way of an estimated 350,000 health professionals licensed and regulated by the state. The data are being used to identify health care workforce issues, such as the need to train more particular providers or to expand what some providers are allowed to do as part of their practice. “We currently have 20 different professional surveys in place and running, so we will be getting lots more data,” said Elizabeth Carter, director of the Healthcare Workforce Data Center at the state Department of Health Professions (Smith, 1/9).

Kansas Health Institute: Governor To Announce Mental Health Initiative
Gov. Sam Brownback is expected to announce what his office is calling a "new mental health initiative" during an early afternoon press conference Thursday at Wyandot Center, the community mental health center in Kansas City. Accompanying the governor will be Kansas Department for Aging and Disability Services Secretary Shawn Sullivan. Several sources familiar with the initiative told KHI News Service that it was in response to the recent shooting deaths of 20 children and six adults at Sandy Hook Elementary School in Newtown, Conn. (Ranney, 1/9).

Kansas Health Institute: Kansas Earns Low Grade For Preventing Tooth Decay Among Children
A new report that gives Kansas a barely passing grade for preventing tooth decay among children does not reflect recent improvements, according to the head of the state’s leading oral health advocacy group. The report by the Pew Center for the States gives Kansas a grade of 'C' for its efforts to prevent cavities in children through the use of dental sealants -- clear plastic coatings that serve as barriers to bacteria. But Tanya Dorf Brunner, executive director of Oral Health Kansas, said the state actually is doing better than that (McLean, 1/9).

Georgia Health News: Ga. Hospitals In Middle Of Pack On Quality Bonuses
Slightly more than half of Georgia hospitals are receiving individual bonuses from Medicare for the quality of their services, a new analysis has found. Medicare last month announced bonuses and penalties for nearly 3,000 U.S. hospitals as it links almost $1 billion in payments to the quality of care given to patients. The state’s average of 51 percent of hospitals getting bonuses -- and 49 percent getting penalties -- tracks roughly with the national average of 52 percent and 48 percent, respectively, the Kaiser Health News analysis shows. It’s part of a move by government and private insurers toward rewarding medical providers based on their quality of care, not the quantity of services (Miller, 1/9).

This Story: Print | Link to | Top

Weekend Reading

Longer Looks: A Key Hagel Mission Is To Cut Military Health Costs

Every week Shefali S. Kulkarni selects interesting reading from around the Web.

The New Republic: Can Chuck Hagel Cure the Military's Health Care Problem?
As (David) Brooks and (Paul) Wolfowitz and many others have shown, it's easy to frame our messy fiscal conundrum in these simple terms of guns vs. butter, or rather, guns vs grandma's buttery-yellow, super-pricey heart medication. But there's an important detail that gets lost in this apposition: namely, that the most immediate threat to the military budget from rising health care costs is arguably the ballooning cost of the military's own health care programs. The cost of paying for the health care of nearly 10 million home-base military, their families, retirees and dependent survivors has nearly tripled over the past decade, from $19 billion to $53 billion, making it a major factor in the overall surge in the Pentagon's base budget to $525 billion (Alec MacGillis, 1/9).

ProPublica: What a New Doctor Learned About Medical Mistakes From Her Mom's Death 
[Dr. Elaine] Goodman had just finished her first year of medical school when she found herself spending months at the bedside of her 63-year-old mom, who was battling breast cancer in the hospital. One morning she arrived to find her mother’s face and hands bloodied. Hallucinating and disoriented, her mom had yanked the cranial staples inserted during a recent procedure from her head. ... She suffered frequent falls and preventable side effects from drugs. And she narrowly missed having an unnecessary brain operation and getting an incorrect drug. "It was really eye opening for me to see the reality of how difficult it was to keep her safe in the hospital," Goodman said (Marshall Allen, 1/9).

The Daily Beast: The Best Way To Reform Health Care—And Cut The Deficit
[T]here's one way that Obama can keep deficit hawks happy without sacrificing entitlements. It's the least painful way to lower health-care costs, because it actually increases quality. It's bipartisan, because it adopts deregulatory reforms that should appeal to Republicans. ... So what is it? It's defragmenting health care. To explain: the fragmented nature of the U.S. healthcare system is remarkable. Even physicians who practice within the same hospital are typically independent from each other and from the hospital and its nurses. At some hospitals, case managers gamely try to coordinate the physicians working on a given case but have no direct control and little leverage, because the physicians bill separately. Outside of hospitals, the situation is even worse (Einer Elhauge, 1/6).

Forbes: Inside The Pricing Of A $300,000-A-Year Drug
NPS Pharmaceuticals announced that it was pricing Gattex, its drug for short bowel syndrome, at $295,000 per patient per year, about triple what analysts on Wall Street expected. It is the fourth drug approved in 2012 to be priced at more than $200,000 per patient per year. ... How, though, does anyone pay for such a medicine? The answer is that pricing of these rare disease drugs, known as ultra-orphan drugs in the biotech industry, are not paid for the way that most medicines are. Nobody buys them out of pocket, and the manufacturer refuses to grant discounts to insurers or to Medicare. Commercial insurers will usually not pay the whole cost of the drug, asking patients to cover a co-pay that could be 30% of the drug's price. Through what is known as a co-pay assistance program, NPS will cover patients' out-of-pocket costs (Matthew Herper, 1/3).

Fortune: Lloyd Dean: The Medicine Man Of Dignity Health
As CEO of San Francisco-based Dignity Health -- as of early 2012, the new brand name for Catholic Healthcare West -- the 62-year-old (Lloyd) Dean has been working rooms at corporate and civic levels for more than a decade. In his manner and method, Dean has come to stand out as an unconventional leader in a staid, grave industry. Before a dinner crowd he can kid about his "brother-to-brother" relationship with Barack Obama over the past four years. ... To check up on "customer service" at his hospitals, he's been known to put on a sweats-and-sunglasses disguise in the lobby -- the better to hear what they're complaining about. (The No. 1 beef: parking!) When Dean has heard enough, he'll send around JUST THINKING memos to staff, which pretty much amount to JUST FIX it directives. ... Now Dean has entered the national stage (David A. Kaplan, 1/9).

Houston Chronicle: Native Americans Say Health Care Promises Here Not Fulfilled
When her husband was laid off in 2010 from his engineering job and the couple lost his insurance, Anna Edwards said her monthly prescription bill quadrupled to almost $1,200 and she was forced to abandon some medications. "It's like having to play Russian roulette every day and gamble on it and pray," she said. ... But the U.S. government made treaty commitments to provide Edwards, a San Juan Pueblo, and other Native Americans from federally recognized tribes with health care regardless of financial situation. In Houston, it's an unfulfilled promise. Of the 10 U.S. cities with the largest American Indian populations, Houston is the only one without an Indian Health Service facility (Jayme Fraser, 1/6).

Mother Jones: America's Real Criminal Element: Lead
Experts often suggest that crime resembles an epidemic. But what kind? if it's everywhere, all at once—as both the rise of crime in the '60s and '70s and the fall of crime in the '90s seemed to be—the cause is a molecule. ... What molecule could be responsible for a steep and sudden decline in violent crime? Well, here's one possibility: Pb(CH2CH3)4 (tetraethyl lead, which was a gasoline additive). ... The biggest source of lead in the postwar era, it turns out, wasn't paint. It was leaded gasoline. And if you chart the rise and fall of atmospheric lead caused by the rise and fall of leaded gasoline consumption, you get a pretty simple upside-down U: Lead emissions from tailpipes rose steadily from the early '40s through the early '70s, nearly quadrupling over that period. Then, as unleaded gasoline began to replace leaded gasoline, emissions plummeted. Intriguingly, violent crime rates [later] followed the same upside-down U pattern (Kevin Drum, January 2013).

The New York Times: Plan To End Methadone Use At Albuquerque Jail Prompts Alarm
For the last six years, the Metropolitan Detention Center, New Mexico's largest jail, has been administering methadone to inmates with drug addictions, one of a small number of jails and prisons around the country that do so. ... In November, however, the jail's warden, Ramon Rustin, said he wanted to stop treating inmates with methadone. Mr. Rustin said the program, which had been costing Bernalillo County about $10,000 a month, was too expensive. ... The New Mexico office of the Drug Policy Alliance, which promotes an overhaul to drug policy, has implored Mr. Rustin to reconsider his stance, saying in a letter that he did not have the medical expertise to make such a decision (Dan Frosch, 1/6).

This Story: Print | Link to | Top

Editorials and Opinions

Viewpoints: Rove Says GOP Unlikely To Make Much 'Structural Change' To Entitlements; Roe Anniversary And Fading Public Understanding; Fast Food Workers' Health Insurance

The Washington Post: An Opening Bid On Taxes That Is Good Politics But Bad Policy
[As] a matter of policy, rather than politics, it is no more sensible to draw the line at $620 billion in additional revenue over the next decade than to insist, as have some Democrats, that Medicare and Social Security remain untouched. The country's structural deficit poses too large a threat to future prosperity, and there is no politically or fiscally realistic scenario under which entitlement cuts alone can solve the problem (1/9).

The Wall Street Journal: A GOP Strategy For The Debt-Ceiling Fight
With control of just one chamber, Republicans won't be able to advance much-needed structural changes in entitlements. That's the cost of losing the 2012 election. A Republican wish list will have to await a GOP president and Congress. For now, Republicans must make Mr. Obama take ownership of his deficits ... It's impossible to negotiate with an ideologue, but Republicans can systematically unmask him and constrain him as much as their limited power allows, if they are united and acting in concert (Karl Rove, 1/9).

The New York Times: The Woes Of Roe
Forty years ago this month, the Supreme Court handed down the great abortion rights decision Roe v. Wade. To be honest, you’re not going to be seeing a whole lot of cake and Champagne. Time magazine recognized the occasion with a downbeat cover story. ("They've Been Losing Ever Since.") Gallup polls suggest support for abortion rights is fading, particularly among young Americans, and that more people now regard themselves as "pro-life" than "pro-choice." On the other hand — I know you had faith that eventually we’d get to the other hand — the polls depend on the question. According to the Quinnipiac poll, if you ask Americans whether they agree with the Roe decision, nearly two-thirds say yes (Gail Collins, 1/9). 

Los Angeles Times: Side Of Fast-Food Fries, Hold The Healthcare 
In anticipation of the healthcare overhaul that takes full effect next year, a couple of Taco Bell and Wendy’s franchises in Oklahoma and Nebraska are evidently cutting back the hours of employees to dodge requirements of the healthcare reform law. ... And to you patrons of these fast food places in these no-to-health-insurance places, don’t be surprised to see some group mounting a campaign asking, “Do you really want to eat at a restaurant whose idea of health care for the employees who fix your food is no more than a sign in the bathroom telling them to wash their hands?” (Patt Morrison, 1/9).

San Jose Mercury News: Medical Board Allows Over-Drugging Of Elderly Patients
Elders with dementia are often drugged indiscriminately with antipsychotic drugs in hospitals and long-term care settings. Despite sometimes-fatal side effects and a lack of efficacy, the drugs remain the treatment of choice for patients who present behavioral challenges resulting from their inability to communicate their needs. The drugs are frequently used as chemical restraints, designed to subdue patients for staff convenience, despite proven non-drug options. ... California's Medical Board, the agency charged with protecting the public from poor physician care and practices, has been conspicuously absent in robust efforts to end the overdrugging of California's elder and dependent adults (Anthony Chicotel, 1/8).

WBUR: Cognoscenti: A Common Sense Problem Approach To A Deadline
Fixing the twin public health "epidemics" in this country — abuse of opioid painkillers by addicts and under-treatment of legitimate pain patients who often need those same drugs — will take time, a lot of creative thinking and a willingness to change dysfunctional government policies. But there is one astonishingly simple step — a no-brainer, actually — that is immediately available and has been shown to reduce deaths from opioid overdoses. ... The idea is what doctors call "harm reduction," which means not necessarily trying to solve the root problem but to do things that make the problem less likely to be fatal (Judy Foreman, 1/9).

This Story: Print | Link to | Top

Stephanie Stapleton

Andrew Villegas

Lisa Gillespie
Shefali Luthra

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2014 Kaiser Health News. All rights reserved.