Daily Health Policy Report

Friday, January 10, 2014

Last updated: Fri, Jan 10

KHN Original Reporting & Guest Opinion

Health Reform

Capitol Hill Watch

Coverage & Access

Women's Health


State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Maryland's Bold Hospital Spending Plan Gets Federal Blessing

Kaiser Health News staff writer Jay Hancock reports: "Maryland officials have reached what analysts say is an unprecedented deal to limit medical spending and abandon decades of expensively paying hospitals for each extra procedure they perform. If the plan works, Maryland hospitals will be financially rewarded for keeping people out of the hospital —a once unimaginable arrangement" (Hancock, 1/10). Read the story

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Obamacare Giving Big Boost To Georgia's Health IT Industry

WABE's Jim Burress, working in partnership with Kaiser Health News and NPR, reports: "Politically, Georgia is fighting the health law at every turn. Gov. Nathan Deal, a Republican, has chosen not to expand Medicaid, and the state's insurance commissioner publically vowed to obstruct the Affordable Care Act. But that doesn’t mean Georgia isn’t seeing a financial benefit from the law" (Burress, 1/9). Read the story.

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Capsules: Some Breast Cancer Drugs To Be Free For High-Risk Women

Now on Kaiser Health News’ blog, Phil Galewitz reports: "Starting next September, women at increased risk for breast cancer will be able to get some drugs shown to help prevent the disease without a co-pay, the Obama administration said Thursday. The U.S. Preventive Services Task Force recommended last September that clinicians give medications such as tamoxifen or raloxifene to such women to reduce their risk of the disease. Under the Affordable Care Act, items or services rated A or B by the independent review board of physicians and academics must be covered by insurers without a co-pay or deductible. Insurers are given a year to make the change" (Galewitz, 1/9). Check out what else is on the blog.

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New Providers Face Obstacles in Texas Women's Health Program

The Texas Tribune's Becca Aaronson, working in partnership with Kaiser Health News, reports: "Since ousting Planned Parenthood clinics from the Women's Health Program, which provides cancer screening, well-woman exams and contraception for low-income women, Texas leaders have made a concerted effort to recruit physician groups to fill the void. They also widened the services covered, adding testing and some limited treatment for sexually transmitted diseases. But unlike specialty family planning clinics, physician groups generally don't receive additional government funding to help low-income women access services not expressly covered by the program -- and that has created obstacles for both providers and patients" (Aaronson, 1/9). Read the story.

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Political Cartoon: 'Boss's Orders?'

Kaiser Health News provides a fresh take on health policy developments with "Boss's Orders?" By Larry Lambert.

And here's today's health policy haiku:  


A bright spot each month
Jobs growth in health industry
Oh, but not this time.

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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Health Reform

Most Uninsured Unaware Of Tax Credits, Survey Finds

More than two-thirds of uninsured Americans don't know they might be eligible for financial assistance to buy health coverage and therefore haven't visited new online marketplaces, according to a survey of the uninsured released Thursday by Enroll America, a nonprofit with close ties to the Obama administration. Meanwhile, media outlets report on developments in Oregon, Connecticut, Massachusetts and Minnesota.

McClatchy: Most Uninsured Unaware Of Cost Breaks For Obamacare
Obamacare supporters say nonstop news coverage of HealthCare.gov’s early technical problems has hurt efforts to inform the uninsured about financial assistance that can help them purchase marketplace health coverage. With less than three months before the Affordable Care Act’s six-month open enrollment period ends on March 31, a whopping 69 percent of uninsured Americans don’t know about the tax credits and other assistance that will make coverage more affordable, according to a new survey of the uninsured released Thursday by Enroll America, a national coalition working on behalf of Obamacare. That helps explain why 68 percent of survey respondents haven’t visited their state marketplace or HealthCare.gov, the federal exchange portal that serves 36 states. They simply don’t believe they can afford coverage (Pugh, 1/9).

The Hill: Most Uninsured People Haven’t Visited O-Care Site, Survey Finds
A strong majority of uninsured adults lack basic knowledge about the Affordable Care Act and haven’t visited an Obamacare exchange yet, according to a poll released Thursday. The survey from Enroll America, a nonprofit with close ties to the Obama administration that is aiming to sign people up, found seven out of 10 uninsured people in the United States haven’t visited an ObamaCare online exchange yet (Easley, 1/9).

The Associated Press: Some Find Insurers Have No Record Of Them
Record-keeping snags could complicate the start of insurance coverage this month as millions of people begin using policies they purchased under President Barack Obama’s health care overhaul. Insurance companies are still trying to sort out cases of so-called health insurance orphans, customers for whom the government has a record that they enrolled, but the insurer does not (Murphy and Alonso-Zaldivar, 1/9). 

Reuters: Humana Says Mix Of Obamacare Enrollment Worse Than Expected
Health insurer Humana Inc. said on Thursday that it projected its enrollment mix in private plans through the exchanges created by President Barack Obama's healthcare law will be "more adverse than previously expected." Humana attributed the enrollment trend to regulatory changes allowing people to remain in previously existing plans not sold on the exchanges (1/9).

The Boston Globe: Outside Review Ordered For State’s Failed Insurance Website
An independent technology firm will review the state’s failed health insurance website and make recommendations about how to move forward in rebuilding a system that allows people to easily shop for and buy coverage online. That’s how the state’s old virtual insurance marketplace, created under a 2006 state law and run by the Massachusetts Health Connector, used to work. But the system was overhauled in October to comply with the federal Affordable Care Act. Since then, technical problems have frustrated consumers and required the state to process applications offline in order to prevent tens of thousands of people from losing coverage (Conaboy, 1/10).

The Oregonian: Despite Exchange Problems, Kitzhaber Defends Oregon's Coverage Expansion
In an Oct. 1 speech in Monterey, Calif., Gov. John Kitzhaber told an audience of health care officials that Oregon's landmark health exchange website went live without issue. "I told them the website was rolled out without a glitch," a rueful Kitzhaber said Thursday. Actually, the exchange site was in shambles. After $90 million paid to the state's primary IT contractor, the website failed to launch and has since become a major technological and political fiasco (Budnick, 1/9).

The Lund Report: Health Share Of Oregon Boasts 25,000 New Enrollees
Oregon's largest coordinated care organization expected to get 20,000 to 23,000 new members in the first year after the state's Medicaid expansion kicked in. Just days into the new year, chief operating officer Susan Kirchoff announced that it had already exceeded that projection (McCurdy, 1/8).

The CT Mirror: Obamacare Coverage Problems? Here's What You Need To Know
Nine days after health plans sold as part of the federal health law were slated to take effect, some state residents are still struggling to get their coverage set up. Here’s what you need to know about the payment deadlines, what to do if you need an insurance ID card, who to call if you’re having problems, what you can do if you need a prescription filled before you get your insurance information, and the deadlines to know if you’re still shopping for coverage (Becker, 1/9).

MinnPost: MNsure’s Rocky Rollout: It’s Blame-Game Time
MNsure’s bumpy rollout has moved into full blame-game mode. The vendors are blaming the state. Gov. Mark Dayton and state officials are blaming the private companies who built the faulty technology, and MNsure leaders are quick to point out that they weren’t around when controversial decisions were made (Nord, 1/9).

Minnesota Public Radio: Lawmakers Putting MNsure On The Hot Seat
The interim CEO and board chair of MNsure, the state's new online health insurance marketplace, faces a grilling about its troubled website on Thursday from Minnesota lawmakers. Scott Leitz goes before a Legislative Oversight Committee whose members include Republicans strongly opposed to MNsure's creation. And the hearing takes place with the online health insurance marketplace under fire from angry, frustrated consumers, an unhappy governor, and an increasingly critical legislative auditor (Stawicki, 1/9).

Minnesota Public Radio: Legislative Auditor: MNsure Oversight, Accountability 'Top Priority'
Legislative Auditor Jim Nobles has laid out his plans for investigating the state's new online health insurance marketplace. In testimony to the MNsure Legislative Oversight Committee on Thursday, Nobles said he plans at least two investigations into MNsure, and a third if the Legislature will let him. "This year is going to be the year of ... oversight and accountability (for MNsure)," he said. "We'll be doing a lot of other things as well. But it is the top priority” (Richert, 1/9).

The Star Tribune: Minnesota Lawmakers Take Their Swipes At MNsure
Minnesota legislators blasted the troubled MNsure website Thursday and railed against a lack of accountability over its continued woes. In their first opportunity to question leaders of the insurance exchange since it opened for business, the 10 members of the bipartisan MNsure Legislative Oversight Committee grilled agency executives about decisions last year to downgrade the participation of the lead technology contractor, which came to light only in recent days. Maximus Inc., a Reston, Va., data services firm that specializes in government projects, was initially awarded the job as general contractor under a $41 million federal grant that later grew to nearly $46 million. But that contract was amended last February, and MNsure took over management and responsibility for building its website and technical infrastructure, according to a document that Maximus provided to the committee (Crosby, 1/10).

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Medicaid Expansion News: Wis. Gov. Wins Federal Nod For Controversial Plan

And other states are dealing with Medicaid expansion issues as well.

Modern Healthcare: Wisconsin's Controversial Medicaid Plan Gets Federal Nod
Wisconsin Gov. Scott Walker won federal approval Thursday to expand Medicaid coverage to as many as 83,000 low-income childless adults while ending coverage for about 77,000 childless adults who earn between 100% to 133% of the federal poverty level. Those taken off the state's Medicaid program, known as BadgerCare, will be directed to the new health insurance marketplace created by the Patient Protection and Affordable Care Act (Dickson, 1/10).

The Milwaukee Journal Sentinel: 83,000 Of State Poor To Get BadgerCare Coverage Under Federal Waiver
At the core of the governor's vision for the state's health care marketplace is the shift of some patients from BadgerCare coverage for the needy onto subsidized federal markets for private insurance called exchanges. ... Legislation approved by Walker and GOP lawmakers requires some 77,000 adults in BadgerCare with incomes above the poverty line — $23,550 for a family of four — to be dropped from that state Medicaid coverage (Stein, 1/9). 

Meanwhile, in Nevada --

The Associated Press:  Nevada Medicaid Enrollments Surge
Nevada's Medicaid enrollments swelled to more than double the number projected in the last quarter of 2013 as people who were eligible but never signed up before sought health insurance coverage mandated under the federal health care overhaul, officials said Thursday. From October through the end of December, the Medicaid caseload increased by 10,483 to 341,106, said Mike Willden, Health and Human Services director (Chereb, 1/9).

Las Vegas Review Journal: Nevada Medicaid Caseload Jumps; Obamacare Cited
The division historically has processed about 12,000 applications each month for Medicaid and the state’s children’s health insurance, Nevada Check Up. That number hit 38,000 in December, however. The federal Patient Protection and Affordable Care Act mandate that people have health insurance has spurred low-income Nevadans, who may have always qualified but never applied for Medicaid, to seek coverage, Willden (Whaley, 1/9). 

And several other states consider plans for expansion.

The Associated Press: Pennsylvania Health-Care Plan Draws Fire At Last Hearing
The Corbett administration's plan to expand subsidized health care coverage for low-income people includes premiums and job-search requirements that would serve as potential barriers to enrollment, the Pennsylvania chapter of the AARP said Thursday. The testimony from AARP Pennsylvania came during the seventh and final hearing on the proposal to overhaul the state Medicaid program and use federal Medicaid expansion dollars to buy private coverage for an estimated 500,000 newly eligible people under the federal Affordable Care Act (Jackson, 1/9).

The Associated Press: Wyoming Committee Postpones Medicaid Expansion Vote
A Wyoming legislative committee heard impassioned testimony Thursday from citizens urging the state to accept federal money to expand the Medicaid program to cover thousands more low-income adults. The committee plans to take up the issue again Friday. Several witnesses addressing the Joint Labor, Health and Social Services Interim Committee in Cheyenne said they can't afford health insurance on the open market (Neary, 1/9).

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Capitol Hill Watch

House To Vote Today On GOP's Healthcare.gov Security Bill

The measure, which would "require the Obama administration to notify Americans within 48 hours if their identity is compromised" via the Obamacare website, is part of the GOP strategy.

The Washington Post: House Set To Vote On Healthcare.gov Security Bill
House lawmakers are set to vote Friday on a proposal designed to address potential security breaches on the HealthCare.gov Web site as Republicans seek to keep political attention focused on concerns with the ongoing rollout of the new federal health-care law (O’Keefe and Eilperin, 1/10).

Fox News: Cantor: House Bill On ObamaCare Identity Theft Notification Is A 'No-Brainer'
[House Majority Leader Rep. Eric Cantor] said on The Kelly File that many Americans are “legitimately” concerned with information and identity theft when sharing personal information online. “If there is any chance that one’s information and identity can be stolen or abused on the healthcare.gov website or in any way shape or form connected with the ObamaCare exchange then we should take the precautionary measures necessary,” Cantor said (1/9).

The Associated Press: GOP-Led House Again Targets Obama Health Care Law
The bill, sponsored by Rep. Joe Pitts, R-Pa., would require the secretary of health and human services to notify an individual within two business days of any security breach involving personal data provided to the government during health care enrollment. The administration, in objecting to the measure, said it already has implemented safeguards to secure personal information and notify consumers if a breach occurs (Cassata, 1/10).

The Hill: White House Stops Short Of Veto Threats On House Healthcare Bills
The Obama administration stopped short Thursday of threatening to veto House bills to require officials to tell people if their personal data has been compromised through ObamaCare, and to require weekly reports on the health law's implementation. ... The White House added that more staff would likely be needed to comply, which would add "millions of dollars in costs to the States and the Federal Government, without additional funding from the Congress" (Kasperowicz, 1/9).

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Sen. Reid's Plan To Cut Payments To Medicare Providers Sets Up Showdown On Jobless Aid

Senate Majority Leader Harry Reid's proposal to pay for reinstating jobless benefits by extending $17 billion in so-called sequestration cuts has set up a fight with Republicans. The Reid plan would cut Medicare provider pay -- but not until 2024.

The Washington Post: Showdown Vote Ahead On Senate Democrats' Bill To Extend Jobless Benefits
Regardless of the outcome Monday, House Republicans signaled skepticism because most of the budget savings come from what they consider a gimmick. Reid’s plan would draw $17 billion in savings by extending for one additional year portions of the mandatory spending cuts, known as sequestration. That would represent a cut to funds for Medicare providers, but it would not be implemented until 2024 -- a frequent complaint from House conservatives, who dislike it when spending in the near term is offset by cuts that will happen years from now (Kane, 1/9).

The New York Times: Reid's Uncompromising Power Play In Senate Rankles Republicans
Senate legislation has increasingly turned into a battle over amendments and [Majority Leader Harry] Reid's uncompromising control over the process. The six Republicans who voted to take up the unemployment bill on Tuesday expected at least to be allowed votes on their amendments to shape the legislation. Instead, Mr. Reid dismissed all Republican proposals as unacceptable and then proposed his own new unemployment deal. Under it, benefits would be extended until mid-November of this year, and paid for largely by extending a 2 percent cut to Medicare health providers in 2024. Republicans were outraged, and an obscure procedural fight is likely to leave up to three million out-of-work Americans without benefits (Weisman, 1/9).

In the meantime, doctors worry over food stamp cuts and some Democrats seek to extend the health law's higher pay for Medicare and Medicaid doctors --

The Associated Press: Doctors Say Cutting Food Stamps Would Increase Health Care Costs
Doctors are warning that if Congress cuts food stamps, the federal government could be socked with bigger health bills. Maybe not immediately, they say, but over time if the poor wind up in doctors' offices or hospitals as a result. Among the health risks of hunger are spiked rates of diabetes and developmental problems for young children down the road (Neergaard and Jalonick, 1/10).

MedPage Today: Congress Grapples With Primary Care Pay
Some Democratic lawmakers have expressed interest in extending the pay increases for primary care physicians in Medicare and Medicaid that are temporarily in effect under the Affordable Care Act (ACA). The measure to continue the pay increases -- which could come in legislation that repeals Medicare's sustainable growth rate (SGR) payment formula -- faces a tough battle as a budget-conscious Congress works to keep an SGR repeal price tag low (Pittman, 1/9).

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Fact-Checking Rand Paul's Claims; GOP Attacks Sen. Udall's Insurance Cancellation Numbers

Politicians' assertions about the health law come under scrutiny.

The Washington Post’s The Fact Checker: How Did Rand Paul’s Son End Up On Medicaid?
This is an odd story—the saga of how Rand Paul’s oldest son tried to get health insurance via the Kentucky version of Obamacare, and ended up on Medicaid, the federal-state health-care program for the poor. ... Our colleagues at PolitiFact beat us to the punch with a comprehensive look at what Paul says happened—and ultimately concluded it was a “he-said-she-said” situation ... Obviously, there could be a software glitch–but at the same time Paul’s son supposedly did not take the key steps needed to enroll, so it’s unclear how the glitch could happen in the first place. ... Verdict Pending (Kessler, 1/10).

The Associated Press: GOP Says Sen. Udall Pressured Colorado State Health Officials On Insurance Cancellation Numbers
Republicans are accusing Democratic U.S. Sen. Mark Udall of Colorado of trying to pressure state health officials to change the number of people who had their health insurance policies cancelled as debate escalated over the national health care overhaul (Paulson, 1/9).

The New York Times: Gillespie, Former Republican Chairman, Readies To Run For Senate In Virginia
He begins the race as a pronounced underdog. [Democratic Sen. Mark] Warner, a former governor now in his first Senate term, is the most popular politician in Virginia, and has $7.1 million in his campaign account and access to millions from his personal fortune. But Republicans in the state believe that, because of resistance to the new health law and President Obama’s declining popularity, they have an opportunity to at least make the race competitive (Martin, 1/9).

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Coverage & Access

Medicines To Prevent Breast Cancer To Be Free For Some Women

HHS' decision means that drugs like Tamoxifen will be part of the health law's preventive services rule.

CQ HealthBeat: Insurers Will Need To Provide Free Anti-Breast-Cancer Pills To Some Women
As of September 2014, health insurance companies will need to fully cover the cost of certain anti-breast-cancer drugs for women considered to be at risk for the disease, the Centers for Medicare and Medicaid Services said. The CMS announcement was expected after the U.S. Preventive Task Force announced on Sept. 24, 2013, its final decision regarding certain strategies for preventing breast cancer (Young, 1/9).

Kaiser Health News: Some Breast Cancer Drugs To Be Free For High-Risk Women
The U.S. Preventive Services Task Force recommended last September that clinicians give medications such as tamoxifen or raloxifene to such women to reduce their risk of the disease. Under the Affordable Care Act, items or services rated A or B by the independent review board of physicians and academics must be covered by insurers without a co-pay or deductible. Insurers are given a year to make the change (Galewitz, 1/9).

The Hill: ObamaCare Expands To Cover Preventive Breast Cancer Drugs
"We are making significant advancements in combating this disease -- and for women who are shown to be at a higher relative risk for breast cancer, today, access to early treatments can improve their health," HHS Secretary Kathleen Sebelius wrote in a blog post. The directive expands Obamacare's preventive services mandate, which outlines medical care insurance plans must provide to patients without co-pays (Vieback, 1/9).

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Women's Health

Could The High Court Be Divided Over Contraception Case?

Los Angeles Times: Silence Suggests Supreme Court Divided Over Contraception Case
The surprising silence coming from the Supreme Court over the last week on a challenge to Obamacare by a group of Colorado nuns suggests justices are divided over what to with the complicated dispute. On New Year's Eve, Justice Sonia Sotomayor granted a temporary stay to the Little Sisters of the Poor, a Roman Catholic nonprofit charity that was seeking relief from an Affordable Care Act requirement that it formally request an exemption from offering contraceptives to its employees as part of its health plan (Savage, 1/9).

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Observation Care Status: The High Costs Of This Fine Print

NBC News: The Two Words That Cost Medicare Patients Thousands (VIDEO)
When it comes to Medicare claims, it’s all about the fine print on your hospital chart. Find out how being “under observation” can cost you (Kates, 1/9).

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State Watch

Maryland Moves Forward With Bold Hospital Spending Plan

Some say the deal will eventually change the way hospitals in all the states are paid for delivering health care and could become a national model for controlling health care costs.

Kaiser Health News: Maryland's Bold Hospital Spending Plan Gets Federal Blessing
Maryland officials have reached what analysts say is an unprecedented deal to limit medical spending and abandon decades of expensively paying hospitals for each extra procedure they perform. If the plan works, Maryland hospitals will be financially rewarded for keeping people out of the hospital -- a once unimaginable arrangement (Hancock, 1/10).

The Washington Post: Maryland's Plan To Upend Health Care Spending
The Obama administration is set to announce Friday an ambitious health-care experiment that will make Maryland a test case for whether aggressive government regulation of medical prices can dramatically cut health spending. Under the experiment, Maryland will cap hospital spending and set prices -- and, if all goes as planned, cut $330 million in federal spending. The new plan, which has been under negotiation for more than a year, could leave Maryland looking more like Germany and Switzerland, which aggressively regulate prices, than its neighboring states. And it could serve as a model -- or cautionary tale -- for other states looking to follow in its footsteps (Kliff, 1/10).

The Associated Press: Maryland Changes Unique Hospital Rate System
The state of Maryland is announcing a new initiative with the federal government to modernize the state's unique rate-setting system for hospital services. The agreement, which will be officially announced Friday by state and federal officials, is designed to move Maryland away from reimbursing hospitals on a fee-for-service basis to an emphasis on prevention and quality of care. Under the new plan, hospitals will do better financially as they provide high-quality care and help keep communities healthier, rather than being rewarded solely on the number of patients they treat, Dr. Joshua Sharfstein, Maryland's health secretary, said (Witte, 1/10).

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State Highlights: Md. Expected To Give Retroactive Health Coverage After Exchange Problems

A selection of health policy stories from Maryland, California, Texas, Vermont, Michigan, Florida, Wisconsin and Georgia.

The Washington Post: Md. Expected To Approve Retroactive Health Insurance For Some
Maryland lawmakers are expected to quickly approve emergency legislation sponsored by the administration of Gov. Martin O’Malley that would provide retroactive health insurance to residents who tried to sign up for coverage through the state's new exchange, encountered problems and were left uninsured (Johnson and Wagner, 1/9).

Los Angeles Times: GOP Candidate Tim Donnelly Slams Gov. Jerry Brown's Budget Plan
Brown on Thursday morning unveiled a $155-billion budget proposal that would increase general fund spending by more than 8 percent, to $106.8 billion. With his administration projecting a $4.2-billion surplus at the end of June, Brown called for setting up a $1.6-billion rainy-day reserve fund, and for paying down $11 billion of the state's debt. The proposal calls for a $10-billion infusion into schools and community colleges to make up for years of cutbacks, $1 billion in new money for higher education to ward off new tuition increases, and $670 million more for the state's public health care system to deal with new enrollees because of the federal healthcare overhaul (Mehta, 1/9).

Los Angeles Times: Gov. Brown's Overcrowding Plan Alters Parole For Elderly, Sick Felons
Gov. Jerry Brown's plan to at least partly comply with a federal court order to reduce prison overcrowding could make several thousand felons eligible for release, and free hundreds of them in the first six months. The governor's budget proposal, released Thursday, announces plans to immediately expand parole eligibility for inmates who are sick or mentally impaired, and creates a new parole program for the elderly. The governor also is, on his own, increasing the time some repeat offenders can reduce their sentences with good behavior (St. John, 1/9). 

California Healthline: Advocates Want Infant Program In Budget
In anticipation of Gov. Jerry Brown's budget proposal scheduled to be released tomorrow, children's advocacy groups have a long list of cutbacks and program eliminations they want re-funded. But they're starting small: They seek full funding for an infant health program cut back in 2009. Children's groups would like to see the Black Infant Health Program restored to its original scope and funding. The state still is running a version of the program, but in a limited number of areas and in a limited way, according to Rae Jones, executive director of Great Beginnings for Black Babies headquartered in Inglewood (Gorn, 1/9).

Kaiser Health News: New Providers Face Obstacles in Texas Women's Health Program
Since ousting Planned Parenthood clinics from the Women's Health Program, which provides cancer screening, well-woman exams and contraception for low-income women, Texas leaders have made a concerted effort to recruit physician groups to fill the void. They also widened the services covered, adding testing and some limited treatment for sexually transmitted diseases. But unlike specialty family planning clinics, physician groups generally don't receive additional government funding to help low-income women access services not expressly covered by the program -- and that has created obstacles for both providers and patients (Aaronson, 1/9).

NewsHour: Vermont Gov. Confronts Deadly Heroin Crisis As Public Health Problem
Gov. Peter Shumlin devoted his entire State of the State address to a "full-blown heroin crisis" ravaging Vermont. Shumlin joins Judy Woodruff to discuss his shift in focus on the issue of opiate addiction and Ryan Grim of the Huffington Post offers context on why heroin has made a major comeback in the United States (Woodruff, 1/9).

ABC News: Scourge of Heroin Abuse In Vermont Mirrors National Epidemic
The governor of Vermont devoted his entire State of the State speech on Wednesday to address the scourge of heroin abuse, a problem he described as a "full blown … crisis" in his state, but which is also spreading across the country. Gov. Peter Shumlin, a Democrat, described an epidemic that "may be invisible to many," but which has increased in his state by 770 percent since 2000 (Goldman, 1/9).

NBC News: Vermont Gov. Focuses On Heroin Crisis (VIDEO)
Vermont's governor focused the entire state of the state address discussing the region’s problem with heroin (Williams, 1/9).

Bloomberg: Detroit's Retired City Workers Sue Over Health Benefits
Detroit, struggling to provide its 700,000 residents with basic services, was sued by retired workers including police and firefighters who are seeking to block the bankrupt city from unilaterally cutting their health care benefits. The retirees said the city's decision to reduce funding of vested health-care benefits by 83 percent, starting in March, will force retirees to spend money out of pocket to replace the coverage, according to a filing today by representatives of the workers in federal bankruptcy court in Detroit (Rosenblatt, 1/9).

Health News Florida: 133,000 Waiting For Medicaid
The number of low-income Floridians waiting in computer limbo for their Medicaid card is far more than previously thought, according to the Department of Children and Families. Ninety thousand Florida Medicaid accounts that cover 133,000 people have been stuck in the federal Healthcare.gov data system for weeks pending transfer to the state, said Jennifer Lange, project director for the Medicaid Eligibility System Project at DCF (Gentry, 1/10).

The Milwaukee Journal Sentinel: Bill To Detain Dangerously Mentally Ill Advances
A bill to allow a limited number of Milwaukee County mental health care workers to temporarily detain people considered dangerously ill won unanimous approval Thursday from the state Assembly's Health Committee. The bill only slightly expands the ability to hospitalize psychiatric patients who are considered in danger of harm but is a symbolic victory for those trying to increase the options to get dangerously ill patients in to care. State Rep. Erik Severson (R-Star Prairie) said he believed the bill might turn out to be the most important legislation coming out of an Assembly task force on mental health he led along with state Rep. Sandy Pasch (D-Shorewood) (Kissinger and Stein, 1/9).

Georgia Health News: Critics Of New Health Plan Send Message To State
Jan. 1 rang in a major change for more than 650,000 members of the state employees' health plan. And on Jan. 2, the wife of a Cherokee County teacher started a Facebook page to voice complaints about the 2014 changes to the State Health Benefit Plan. In just days, the Facebook page has exploded, with thousands joining the group.  The governor's office has been deluged with phone calls. Preparations are under way for a rally against the new plan. State employees' leading complaint is the lack of choice of health plan providers, said Ashley Cline (Miller, 1/9). 

California Healthline: Will Mexico's Soda Tax Spur California
With a massive experiment underway next door and more research supporting the premise at home, California policymakers may try again to tax sugar-sweetened beverages in the effort to discourage sugar consumption, reduce obesity and raise money. A new tax on soda and other high-calorie foods went into effect on New Years Day in Mexico, the newly crowned fattest country in the world. Beverage and food manufacturers, led by U.S. soft drink companies, fought the proposal but health advocates, worried by the increase in obesity and diabetes -- now the country's leading cause of death -- pushed hard for the new tax (Lauer, 1/9).

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Health Policy Research

Research Roundup: Impact Of Early Medicaid Expansion

Each week, KHN compiles a selection of recently released health policy studies and briefs.

Health Affairs: New Evidence On The Affordable Care Act: Coverage Impacts Of Early Medicaid Expansions 
Since 2010, California, Connecticut, Minnesota, and Washington, D.C., have taken advantage of the [health] law's option to expand coverage earlier to a portion of low-income childless adults. ... Using administrative records, we documented that the ramp-up of enrollment was gradual and linear over time in California, Connecticut, and D.C. Enrollment continued to increase steadily for nearly three years in the two states with the earliest expansions. ... Medicaid enrollment rates were highest among people with health-related limitations. We found evidence of some crowd-out of private coverage in Connecticut (30–40 percent of the increase in Medicaid coverage), particularly for healthier and younger adults (Sommers, Kenney and Epstein, 1/6).

Kaiser Family Foundation: State Profiles: How Will The Uninsured Fare Under The Affordable Care Act?
The state-level reports serve as a guide to the potential impact of the ACA in each state and the District of Columbia as legislatures begin to convene and governors prepare their budget proposals and state-of-the-state addresses. Based on analysis by Kaiser researchers, each state report provides a breakdown of how many uninsured people are eligible for Medicaid or for financial assistance to help them buy private insurance in the new Marketplace, and how many may gain new coverage but will not receive any financial assistance. Each report also details the income levels at which people in each state are eligible for Medicaid or financial assistance in the Marketplace. For states not expanding Medicaid, each report quantifies how many uninsured people with incomes below the poverty level fall into the "coverage gap" and will be ineligible for financial assistance in the Marketplace or for Medicaid in their state (1/6).

Health Affairs: Analysis Of Early Accountable Care Organizations Defines Patient, Structural, Cost, And Quality-Of-Care Characteristics
Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. ... We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics (Epstein et al., 1/6).

JAMA Pediatrics: A Statewide Medicaid Enhanced Prenatal Care Program 
Data, including birth records, Medicaid claims, and monthly program participation, were extracted from the Michigan Department of Community Health warehouse. Participants included all 60 653 pregnant women who had a Medicaid-insured singleton birth between January 1 and December 31, 2010, in Michigan. The [Maternal Infant Health Program] MIHP participants were propensity score-matched with nonparticipants ...  Participation in MIHP reduced the risk for adverse birth outcomes in a diverse, disadvantaged population. The study adds to the evidence base for enhanced prenatal care home visiting programs and informs state and federal investments (Roman et al., 1/6).

JAMA Internal Medicine: Rapid Increase In Breast Magnetic Resonance Imaging Use Trends From 2000 To 2011 
Breast magnetic resonance imaging (MRI) is highly sensitive for detecting breast cancer. Low specificity, cost, and little evidence regarding mortality benefits, however, limit recommendations for its use to high-risk women. ... Breast MRI use increased more than 20-fold from 6.5 per 10,000 women in 2000 to 130.7 per 10 000 in 2009. Use then declined and stabilized to 104.8 per 10,000 by 2011.  ... most women receiving screening and surveillance breast MRIs lacked documented evidence of meeting [American Cancer Society] criteria, and many women with mutations were not screened. Efforts are needed to ensure that breast MRI use and documentation are focused on those women who will benefit most (Stout et al., 1/6).

JAMA Surgery: Explaining Racial Disparities In Outcomes After Cardiac Surgery: The Role Of Hospital Quality
Racial disparities in mortality rates after coronary artery bypass graft (CABG) surgery are well established. We have yet to fully understand how care at high-mortality, low-quality hospitals contributes to racial disparities in surgical outcomes. ... Nonwhite patients had 33% higher risk-adjusted mortality rates after CABG surgery than white patients. In hospitals treating the highest proportion of nonwhite patients, the mortality was 4.8% in nonwhite and 3.8% in white patients. When assessed independently, differences in hospital quality explained 35% of the observed disparity in mortality rates. We were able to explain 53% of the observed disparity after adjusting for differences in socioeconomic status and hospital quality. However, even after these factors were taken into account, nonwhite patients had a 16% higher mortality (Rangrass, Ghaferi and Dimick, 1/8).

JAMA Neurology: Disparities In Access To Deep Brain Stimulation Surgery For Parkinson Disease  
Despite the fact that African American patients are more often discharged from hospitals with characteristics predicting [deep brain stimulation (DBS) use to treat Parkinson disease], these patients received disproportionately fewer DBS procedures compared with their non–African American counterparts. Increased reliance on Medicaid in the African American population may predispose to the DBS use disparity. Various other factors may be responsible, including disparities in access to care, cultural biases or beliefs, and/or socioeconomic status (Chan et al., 1/6). 

JAMA Psychiatry: Accuracy Of Reports Of Lifetime Mental And Physical Disorders
Our understanding of how mental and physical disorders are associated and contribute to health outcomes in populations depends on accurate ascertainment of the history of these disorders. Recent studies have identified substantial discrepancies in the prevalence of mental disorders among adolescents and young adults depending on whether the estimates are based on retrospective reports or multiple assessments over time. ... [Researchers analyzed] Prospective population-based survey (Baltimore Epidemiologic Catchment Area Survey) with 4 waves of interviews of 1071 community residents in Baltimore, Maryland, between 1981 and 2005. ... One-time, cross-sectional population surveys may consistently underestimate the lifetime prevalence of mental disorders. The population burden of mental disorders may therefore be substantially higher than previously appreciated (Takayanagi, 1/8).

JAMA Internal Medicine: Obesity And Late-Age Survival Without Major Disease Or Disability In Older Women 
The effect of obesity on late-age survival in women without disease or disability is unknown. ... Examination of 36,611 women from the Women’s Health Initiative observational study and clinical trial programs. ... Compared with healthy-weight women, underweight and obese women were more likely to die before 85 years of age. Overweight and obese women had higher risks of incident disease and mobility disability. Disability risks were striking. ... Waist circumference greater than 88 cm was also associated with higher risk of earlier death, incident disease, and mobility disability (Rillamas-Sun et al., 1/6).

Georgetown University Health Policy Institute/Kaiser Family Foundation: Medical Debt Among People With Health Insurance
An estimated 1 in 3 Americans report having difficulty paying their medical bills .... While the chances of falling into medical debt are greater for people who are uninsured, most people who experience difficulty paying medical bills have health insurance. ... People with unaffordable medical bills report higher rates of other problems – including difficulty affording housing and other basic necessities, credit card debt, bankruptcy, and barriers accessing health care. This report examines medical debt through case studies of nearly two dozen people who recently experienced such problems, and reviews their experiences in light of other studies and surveys about medical debt (Pollitz, Cox, Lucia and Keith, 1/7).

Kaiser Family Foundation: Health And Access To Care And Coverage For Lesbian, Gay, Bisexual, And Transgender Individuals In The U.S. 
The ACA expands access to health insurance coverage for millions, including [lesbian, gay, bisexual, and transgender] individuals, and includes specific protections related to sexual orientation and gender identity. The Supreme Court ruling on [Defense of Marriage Act] resulted in federal recognition of same-sex marriages for the first time, which also serves to provide new health insurance coverage options. In addition, President Obama's administration has undertaken a variety of other initiatives to improve the health and well-being of LGBT individuals, families, and communities (Ranji, Beamesderfer, Kates and Salganicoff, 1/8).

Journal of Interpersonal Violence: Prevalence Of Substance Use And Intimate Partner Violence In A Sample Of A/PI MSM
This study evaluates the prevalence of three forms of intimate partner violence (IPV) (i.e., experience of physical, psychological/symbolic, and sexual battering) among a national sample of Asian/Pacific Islander (A/PI) men who have sex with men (MSM) in the United States. ... The present findings suggest that individuals with a history of IPV in the past 5 years were more likely to report substance use (33.6%) compared to those without a history of IPV experience (16.1%). (Tran et al., 1/3).

Here is a selection of news coverage of other recent research:

Reuters: PepsiCo's Workplace Wellness Program Fails The Bottom Line
Released on Monday in the journal Health Affairs and based on data for thousands of PepsiCo employees over seven years, the findings "cast doubt on the widely held belief" that workplace wellness programs save employers significantly more than they cost. ... PepsiCo's "Healthy Living" program ... has two components. One, called disease management, helps people with any of 10 chronic illnesses, among them asthma, diabetes and hypertension. They receive regular phone conversations with a nurse about managing the condition. Disease management produced healthcare savings of $136 per member per month, largely because of a 29 percent reduction in hospital admissions (Begley, 1/6).

NPR: Drinking Too Much? Don't Count On Your Doctor To Ask
Most of the people who have problems with drinking aren't alcoholics, and having a brief chat with a doctor is often all it takes to prompt excessive drinkers to cut back. But, it turns out, doctors aren't bringing the topic up. More than 80 percent of adults say they've never discussed alcohol use with a health professional, a survey finds. Young people and binge drinkers were most likely to be asked about alcohol use, according to a survey by the Centers for Disease Control and Prevention (Shute, 1/6).

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Editorials and Opinions

Viewpoints: The Legacy Of The Surgeon General's Smoking Report; One Solution For Hospitals That Dump Patients

The New York Times: Fitful Progress In The Antismoking Wars
Fifty years ago this Saturday, on Jan. 11, 1964, a myth-shattering surgeon general’s report on smoking and health brushed aside years of obfuscation by tobacco companies and asserted, based on 7,000 scientific articles, that smoking caused lung cancer and was linked to other serious diseases. Those findings expanded as more data was gathered (1/9).

The Wall Street Journal: The Disability Double Standard
In the 23 years since the passage of the Americans with Disabilities Act, I have watched its most celebrated ideals crumble under a double standard. Apparently, when it comes to people with disabilities having a right to live the fullest life possible, some disabilities are more deserving than others. ... When such fear is allowed to influence legislation to allow people with disabilities to kill themselves, the notions of personal autonomy, freedom and dignity that the ADA championed take on a grim irony (Joni Eareckson Tada, 1/9). 

Los Angeles Times: Want To Stop Hospitals From Dumping Poor Patients On Skid Row? Try This.
"In 2005 and 2006, patient dumping on L.A.'s skid row grabbed national headlines with images of mentally ill patients in hospital gowns, one holding a colostomy bag, being dropped off in ambulances, taxis and vans," The Times' Richard Winton writes. ... Most people thought the problem had abated since hospitals got slapped with major fines. Alas, we were wrong. "In a settlement announced Friday, the 224-bed Beverly Hospital in Montebello agreed to pay $250,000 in civil penalties and legal fees after it was accused of taking a patient by taxi to skid row and leaving her there without making any arrangements with a shelter," Winton reports. ... From now on, therefore, I humbly suggest that when cops and homeless shelters come across a case of patient dumping, they take the person to the hospital's CEO (Ted Rall, 1/9).

The New York Times: Rubio Demands States' Right To Ignore The Poor
For a senator who likes to hold himself out as the future of the Republican brand, Marco Rubio has come up with a remarkably retrograde contribution to the party's chorus of phony empathy for the poor: Let the states do it. ... One of the great achievements of the War on Poverty programs was to extend the safety net to the South, where white legislators saw little reason to spend taxpayer dollars on the basic needs of poor citizens, most of whom were black. ... If you think those days of recalcitrance are over, take a look at the map of the states that have refused to expand Medicaid under the Affordable Care Act (David Firestone, 1/9).

Health Policy Solutions (a Colo. news service): The Only Way Out
The Affordable Care Act, while providing some short-term benefits, is, on the whole, unworkable. Quite apart from website failures, its approach to healthcare is fundamentally flawed. It is exceedingly complex. It perpetuates and entrenches the inefficient insurance model of payment for healthcare. It does nothing to address the rapacious pricing of pharmaceuticals. It ignores hospitals' "medical arms race"  (Dr. Louis Balizet, 1/9).

Health Policy Solutions (a Colo. news service): Costs Go Up. Costs Go Down. What Does It All Mean?
Being a glass-half-full person, though, I believe that even when we see the rate of increase in health spending tick back over the 4 percent mark, we can keep it from growing as fast as it has in many previous years. BUT – only if we maintain momentum on reforming health care payment and delivery (Edie Sonn, 1/9).

JAMA: ICU Bed Supply, Utilization, And Health Care Spending
Intensive care is a substantial financial burden on the US health care system, with spending ... nearly 1% of the gross domestic product. In contrast, the United Kingdom spends only 0.1% of its gross domestic product on critical care services, with no evidence of worse patient outcomes and similar life expectancies as in the United States. Although there are many differences between these 2 countries, one significant difference is intensive care unit (ICU) bed supply. ... In the United Kingdom, the majority of ICU patients are at high risk for death, whereas in the United States, many patients are admitted to the ICU for observation (Dr. Rebecca A. Gooch and Dr. Jeremy M. Kahn, 1/9).

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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.