Daily Health Policy Report

Tuesday, January 15, 2013

Last updated: Tue, Jan 15

KHN Original Reporting & Guest Opinion

Medicare

Health Reform

Health Care Marketplace

Public Health & Education

Administration News

Capitol Hill Watch

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Emergency Departments Are On The Frontline Of The Flu

Kaiser Health News staff writer Jenny Gold, working in collaboration with NPR, reports: "Though it is still too soon to say whether this is a historically bad flu season or just a bad flu season, one thing is clear: Emergency rooms around the country are filled with a feverish throng that is much larger than last year. Washington Hospital Center had just 20 patients test positive for flu all of last year's season. This year, as of last week, there were already 160 cases positive for flu" (Gold, 1/15). Read the story.

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Insuring Your Health: Health Law Offers Dental Coverage Guarantee For Some Children

In her Kaiser Health News consumer column, Michelle Andrews writes: "Starting in 2014, the Affordable Care Act requires that individual and small-group health plans sold both on the state-based health insurance exchanges and outside them on the private market cover pediatric dental services. However, plans that have grandfathered status under the law are not required to offer this coverage" (Andrews, 1/14). Read the column.

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Obama: 'Our Commitment To Medicare … Is Really Important' (Video)

Kaiser Health News offers video of today's White House news conference in which President Obama discussed how he sees Medicare, Medicaid and other health care spending factoring into the looming conflict over raising the federal debt ceiling (1/14). Watch the video or read the transcript.

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Capsules: Not Too Early To Plan For Health Taxes, H&R Block Says; Utah, HHS Quibble Over Best Way To Run State Insurance Market

Now on Kaiser Health News' blog, Jay Hancock writes about H&R Block's health law advice for consumers: "Even if you owe Affordable Care Act taxes, you probably won't have to start paying them until next year. But H&R Block wants you to come in and talk about them now" (Hancock, 1/14).

Also on Capsules, Phil Galewitz reports on the latest developments regarding Utah's health exchange: "The Obama administration says it is bending over backwards to help states carry out the federal health law. Utah'’s top health insurance exchange official says the federal government could do more" (Galewitz, 1/15). Check out what else is on the blog.

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Political Cartoon: 'Viral Spiral?'

Kaiser Health News provides a fresh take on health policy developments with "Viral Spiral?" by David Fitzsimmons.

Meanwhile, here is today's health policy haiku:

THE LONG-AWAITED DECISION... NOW WHAT?

Brewer says OK
to Medicaid expansion.
Will there be backlash...
-Anonymous

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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Medicare

As Debate Heats Up, How Does Medicare Fit Into Debt Limit Fight?

President Barack Obama signals an interest in "modest adjustments" to Medicare and other safety net programs -- but not in the context of debt limit discussions -- as Republicans demand spending cuts be part of a deal to raise the federal debt limit.

The Wall Street Journal: Obama Escalates Debt Fight
Mr. Obama said he was willing to work with the GOP on an agreement to cut spending—including "modest adjustments to programs like Medicare"—but not in the context of the debt ceiling. He said agreeing to link the two would be like a "negotiation with a gun at the head of the American people'' in which Republicans would threaten to cut safety-net programs under a threat "to wreck the entire economy.'' House Speaker John Boehner (R., Ohio) has acknowledged that delaying an increase in the debt limit could cause economic harm, but he said not reining in government spending also carried consequences (Lee and Hook, 1/14).

The Associated Press/Washington Post: Americans Like Spending Cuts In Theory, Not In Detail, Complicating Deficit Talks In Capital
Meanwhile, the clock is ticking toward the March 1 start of major, across-the-board spending cuts that both parties call unwise. These are the postponed cuts — or "sequester," in Congress-speak — lingering from the partial resolution of the "fiscal cliff" on Jan. 1. These cuts would hit military and domestic programs hard. But they would spare "entitlements," the popular but costly programs that include Medicare and Social Security. Leaders in both parties say lawmakers soon must confront entitlements if they are to stem the nation's long-term deficit-spending problem (1/15).

Kaiser Health News: Obama: 'Our Commitment To Medicare… Is Really Important' (Video)
Kaiser Health News offers a video and transcript of yesterday's White House news conference in which President Obama discussed how he sees Medicare, Medicaid and other health care spending factoring into the looming conflict over raising the federal debt ceiling (1/14).

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Health Reform

States To Get More Time To Set Up Exchanges, Flexibility In Medicaid Expansion

The Centers for Medicare & Medicaid Services published a rule Monday detailing how states should coordinate certain elements of health exchanges and Medicaid.

The New York Times: States Will Be Given Extra Time To Set Up Exchanges
Under the law, the secretary of health and human services was supposed to determine “on or before Jan. 1, 2013,” whether states were prepared to operate the online markets, known as insurance exchanges. But the secretary, Kathleen Sebelius, working with the White House, said she would waive or extend the deadline for any states that expressed interest in creating their own exchanges or regulating insurance sold through a federal exchange (Pear, 1/14).

Politico Pro: States See Flexibility In Proposed Medicaid Rule
The 474-page rule CMS published Monday lays out requirements to streamline the Affordable Care Act consumer experience by requiring a single, clear, "one-stop-shopping" response for people wanting to know whether they are eligible for Medicaid, premium subsides or nothing. But not right away. In a nod to the technological and data barriers to aligning the federal and state roles in making Medicaid and exchange subsidy decisions, that single response requirement won't take effect until the beginning of 2015 (Norman, 1/14).

CQ HealthBeat: Medicaid Officials Release Rule Affecting Cost-Sharing And Coordination With Exchanges
The proposed rule also affects a wide range of other Medicaid provisions, including appeals of eligibility determinations; coordination between Medicaid and the new health care law’s insurance exchanges; the role of counselors to assist people with their coverage applications; procedures to verify employer-sponsored coverage; and the use of updated Medicaid eligibility categories. Centers for Medicare and Medicaid Services Deputy Administrator Cindy Mann said on a call with reporters Monday that the new proposal would increase the amount that states could charge patients for non-preferred drugs, non-emergency care in emergency departments and some other services (Adams, 1/14).

Meanwhile, Florida lawmakers explore various issues related to the health law --

Miami Herald: Lawmakers Review Obamacare Impact On Medicaid, Small Business
As lawmakers decide how — or whether — to move forward with parts of the federal Affordable Care Act, House and Senate select committees plunged Monday into issues such as a potential expansion of the Medicaid program and the law's effects on Florida businesses. In back-to-back meetings, lawmakers heard testimony from people with far-different perspectives about the controversial health overhaul, which Florida Republican leaders resisted for more than two years (Saunders, 1/15).

Also in the news, H & R Block is telling consumers to start planning now for the law's future tax changes --

Kaiser Health News: Capsules: Not Too Early To Plan For Health Taxes, H & R Block Says
Even if you owe Affordable Care Act taxes, you probably won't have to start paying them until next year. But H&R Block wants you to come in and talk about them now (Hancock, 1/14).

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Ariz. Governor Backs Medicaid Expansion Under Health Law

Gov. Jan Brewer, a Republican critic of the law,  surprised many when she announced in her State of the State speech that she would support expansion of the federal-state program for low-income residents.

The Associated Press: Arizona Gov. Opts For Federal Medicaid Expansion
Arizona Gov. Jan Brewer said Monday she plans to push for an expansion of the state's Medicaid program under the federal health care law, a surprising decision that could have an impact on other Republican governors weighing a similar decision. Brewer has opposed the federal health care law known as the Affordable Care Act, citing worries over a potential overreliance on federal funding (Christie, 1/14).

Arizona Republic/USA Today: Ariz. Governor Opts To Expand Medicaid
The Republican governor's decision, long awaited by lawmakers and health-care professionals and opposed by many in the GOP, would bring the state an additional $7.9 billion in federal funds over four years to restore and expand the state's health-care insurance program to an estimated 300,000 low-income residents, according to the Arizona Hospital and Healthcare Association (Sanders and Sanchez, 1/14).

The Arizona Republic: Surprise Medicaid Plan Draws Tepid GOP Reaction
Gov. Jan Brewer waded into choppy political waters Monday with her decision to push for Medicaid expansion, but she offered a financial strategy that could improve the odds that reluctant Republican lawmakers will go along. Brewer, bucking GOP legislative leadership in a reversal of her long-held opposition to federal health-care reform, said in her annual State of the State speech that Arizona can no longer afford not to extend health-care coverage to tens of thousands of uninsured (Reinhart, 1/14).

The Hill: Jan Brewer Backs Obama Health Law's Medicaid Expansion
Arizona Gov. Jan Brewer (R) proposed expanding Medicaid under President Obama's signature healthcare law, a surprising move from a vocal critic of the White House. Brewer backed the policy in her fifth State of the State speech Monday, vowing to create "circuit breakers" to protect Arizona's budget from onerous Medicaid bills in the future. "I won’t allow 'ObamaCare' to become a bait and switch," she said to applause from Republicans (Viebeck, 1/14).

Politico Pro: Brewer Says Arizona Will Expand MedicaidArizona
Gov. Jan Brewer on Monday announced she'll propose a plan to expand Medicaid under the Affordable Care Act — but also issued a stern warning to the feds not to shut off funding to the program. "Taking advantage of this federal assistance is a strategic way to reduce pressure on the state budget," Brewer said in her State of the State address. Brewer's support makes her the third Republican governor of a Western state to embrace the ACA's Medicaid expansion. Brian Sandoval in Nevada and Susana Martinez in New Mexico both support the expansion and state-based health insurance exchanges, though Brewer turned down a state-run exchange late last year (Millman, 1/14).

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Advocates Place Focus On Need For 'Seamless Transitions' Between Medicare, Medicaid And Private Insurance

A Medicare Rights Center report cautioned that seniors will face coverage gaps unless officials streamline enrollment for Medicare, Medicaid and private insurance under the health law's state exchanges.

The Hill: Patient Group Wants Seamless Transitions Into Medicare
An activist group representing Medicare patients urged state and federal officials to overhaul their Medicare enrollment systems as they implement the Affordable Care Act. In a report Monday, the Medicare Rights Center warned that seniors will face harmful gaps in coverage unless officials streamline enrollment for Medicare, Medicaid and private insurance under the health law's state exchanges. "The complexity of eligibility determination and enrollment processes for Medicare, Medicaid and related subsidy programs, both now and after implementation of the [Affordable Care Act], is daunting," the group wrote (Viebeck, 1/14).

CQ HealthBeat: Advocates Want Seamless Medicaid To Medicare Transition
Individuals that get health insurance because of the overhaul law could see coverage gaps and unnecessary costs as they transition to Medicare if state and federal officials don't make proper preparations, according to a report released Monday by the Medicare Rights Center. The report emphasizes the importance of developing "a thoughtful and comprehensive plan" that provides consumers with seamless coverage as the transition occurs, and it lays out recommendations to accomplish that goal. The health care law creates brand-new transitions to Medicare, beginning in 2014, as individuals who obtain coverage because of the overhaul become eligible for the program, the authors note (Attias, 1/14).

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Health Care Marketplace

UnitedHealth, Mayo Partnering To Merge Insurance, Care Data

UnitedHealth announced it will partner with the Mayo Clinic to merge insurance and medical data to try to improve and standardize care in order to lower costs.

The Wall Street Journal: Researchers Mine Data From Clinic, Big Insurer
The new effort, dubbed Optum Labs, will be part of UnitedHealth's Optum health-services arm. UnitedHealth Group Chief Executive Stephen J. Hemsley said the company viewed it as a "dedicated research unit ... not a profit-driven undertaking," and the goal was to create "a neutral place to conduct research" with partners from around the health industry, with the findings to be made public. He compared it to the historic Bell Labs, where a number of important technology discoveries were made over decades (Mathews, 1/15).

Bloomberg: UnitedHealth Joins Mayo Clinic In Pact To Improve Care
UnitedHealth Group Inc. (UNH), the largest U.S. provider of medical coverage, will join the Mayo Clinic in a research alliance designed to merge insurance records and medical data to find more efficient ways to deliver care. The venture will focus on fundamental issues that may help standardize care in a way that will lower costs, said Veronique Roger, head of the clinic’s Center for the Science of Health Delivery. This could include things such as analyzing the steps needed for successful hip replacement surgery or ways to get patients to consistently take their medicines, she said. "Every doctor, every nurse, every academic medical center wants only to do the right thing for their patients," said John Noseworthy, the clinic’s chief executive officer (Cortez, 1/15).

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Public Health & Education

Flu: ERs Seeing More Patients, N.Y. Declares State Of Emergency

Emergency rooms around America are dealing with an influx of those with the flu while the virus forces New York officials to declare a state of emergency.

Kaiser Health News: Emergency Departments Are On The Frontline Of The Flu
Though it is still too soon to say whether this is a historically bad flu season or just a bad flu season, one thing is clear: Emergency rooms around the country are filled with a feverish throng that is much larger than last year. Washington Hospital Center had just 20 patients test positive for flu all of last year's season. This season, as of Monday, there were already 179 cases positive for flu (Gold, 1/15).

Medpage Today: Flu Puts N.Y. In State Of Emergency
New York governor Andrew Cuomo (D) declared a statewide public health emergency on Saturday in response to this season's ongoing influenza epidemic. The executive order declaring the emergency provided temporary authorization for pharmacists to administer flu vaccine to children as young as 6 months to allow for as many people to be immunized as possible. The order temporarily modifies -- for 30 days -- the relevant state laws that restrict pharmacist-administered vaccination to individuals 18 and older. There have been reports of vaccine shortages in the face of increased demand as influenza activity picks up (Neale, 1/14).

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Administration News

Mental Health Advocates Await Final Rule

Politico: Focus On Obamacare Delays Mental Health Law
Mental health advocates say a landmark 2008 law meant to expand access to millions of Americans has gotten back-burner treatment by the Obama administration because of its relentless focus on the Affordable Care Act. As a result, key details are missing from the Mental Health Parity and Addiction Equity Act, awaiting a final rule from the administration that supporters say is "imminent" (Cheney, 1/15).

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Capitol Hill Watch

NARAL Names Ilyse Hogue To Be New President

This former staffer for Media Matters for America and MoveOn.org most recently co-founded Friends of Democracy, a super PAC that raised more than $2.4 million last cycle to support candidates who back campaign finance reform.

Politico: Ilyse Hogue Announced As New NARAL President
NARAL Pro-Choice America announced Monday that its new president will be Ilyse Hogue, a longtime advocate for liberal causes who the organization hopes will help pass the torch to a younger generation of abortion-rights leaders (Smith, 1/14).

Roll Call: K Street Files: Media Matters, MoveOn Adviser Takes Reins At NARAL 
NARAL’s PAC spent more than $1.5 million in support of candidates who back abortion rights in 2012. ... She replaces Nancy Keenan, who announced last spring that she would retire after eight years with the organization (Lorber, 1/14).

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State Watch

State Roundup: Texas, Ga. Companies Forming ACOs

A selection of health policy news from New York, Texas, California and Georgia.

CBS (Video): Thousands Search For Doctors After Texas Planned Parenthood Ban Upheld
College student Emily Howell depended on her local Planned Parenthood clinic. Now, she and nearly 50,000 other Texas women will have to find a new place to get free breast cancer screenings, pap smears and birth control. ... Texas' revamped program began this January, with a website designed to help women choose from participating doctors or clinics. When CBS News randomly selected 25 in the Austin area and called, they found just four were participating in the program. Fifteen didn't offer women's health services at all (Werner, 1/14).

Modern Healthcare: NYC System Unveils P4P Plan; Doc Union Wary
Just months after the CMS launched its value-based purchasing program, the nation's largest public hospital system has announced its own pay-for-performance project, which will tie physician bonus payments to patient-satisfaction scores, readmission rates and other metrics.  Fourteen-hospital New York City Health and Hospitals Corp. said the program will award up to a total of $59 million in incentives over three years to its 3,500 affiliated physicians (McKinney, 1/14).

Georgia Health News: Emory, Blue Cross Exploring Possible Alliance
Emory Healthcare has entered talks with Blue Cross and Blue Shield of Georgia on creating an initiative aimed at improving quality of care and reducing health costs. Few details were given in a press release Monday announcing the talks, but there was immediate speculation that the two organizations will form an "accountable care organization." ACOs are medical networks that seek to improve patient care and contain costs (Miller, 1/14).

Modern Healthcare: Texas Health Resources, Blues Announce ACO Talks
Texas Health Resources, Arlington, Texas, and insurer Blue Cross and Blue Shield of Texas announced talks to form an accountable care organization.  Ronald Long, chief financial officer and executive vice president of resource development and deployment for the 13-hospital system, said a final agreement is expected in July and the newly formed ACO would launch Jan. 1, 2014.  Long said details such as cost-saving targets have yet to be finalized, but the agreement will tie performance payments to quality and cost controls (Evans, 1/14).

The Associated Press: SF Pizza Chain Settles Health Care Complaint
A San Francisco restaurant chain has agreed to spend $320,000 to settle a complaint alleging it collected a surcharge from customers for the city's health care law but did not use most of the money for its intended purpose, officials said. Patxi's Chicago Pizza agreed to the settlement after an investigation by the San Francisco city attorney's office and the Office of Labor Standards Enforcement, City Attorney Dennis Herrera said (1/15).

California Healthline: Online Game Asks Players To Design Hospital Of The Future
When officials at the Institute for the Future in Palo Alto laid the groundwork for their first health care crowdsourcing game for the general public, they expected to get 200 or 300 players. More than twice that many logged in to play Future of the Hospital last week. … The hospital game is one of several "collaborative forecasting" games designed for the Institute for the Future's online Foresight Engine. The goal is to tap into collective multidisciplinary expertise to encourage and steer change (Lauer, 1/14).

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Hospital Fees, Provider Cuts To Steady Medicaid Programs In Ga., Calif. Linger

New hospital fees and provider cuts in Georgia and California aim to make their Medicaid programs more solvent, but fights over details are keeping the plans shelved for now.

The Associated Press: Gov. Deal Pitches Medicaid Money Fix
Gov. Nathan Deal has settled on a proposal that could allow lawmakers to avoid voting directly to extend a high-profile hospital tax that helps provide a significant part of state health care spending. Republican leaders lauded the idea Monday, the opening day of the General Assembly's annual session. But at least one Democratic leader said questions might be raised about the constitutionality of such a move. At issue is the so-called "bed tax," which is an assessment on Georgia hospitals' net patient revenue. The yield — more than $230 million this year — is used as state matching money to secure another $400 million-plus of federal support for the Medicaid insurance program for low-income Georgians (Barrow, 1/14).

Georgia Health News: Bills Aim To Avoid Fight Over Hospital Fee
Legislation that aims to prevent a highly charged debate over the state's hospital provider fee has been officially proposed in the Georgia General Assembly. Identical bills were introduced in the House and Senate. The exact text was not available electronically as of early Monday evening. But a draft of the legislation shows that if approved, the bills would transfer the authority to levy the Medicaid hospital assessment from the Legislature to the state Department of Community Health (Miller, 1/14).

California Healthline: Provider Rate Cut Case May Linger
The state budget proposed by Gov. Brown counts on $488.4 million in savings from rate reductions to Medi-Cal providers in keeping with a law passed in 2011 that hasn't yet been implemented because it's been held up in court. Last month, a three-judge panel in federal Circuit Court overruled previous injunctions issued by federal appellate judges. However, the injunctions will remain in place and provider reimbursements won't be cut at least until the end of this month. Litigants in each of the four lawsuits have until Jan. 28 to file a re-hearing request (Gorn, 1/15).

In Florida, a plan for senior enrollment into Medicaid managed plans starts to take shape --

Health News Florida: Rollout Posted For Frail Elderly To Enter HMOs
The region that includes Orlando and Melbourne will be the first in the state to enroll its frail elderly patients who are on Medicaid into managed-care plans, the Agency for Health Care Administration announced Monday. A map on AHCA's website offers a guide as to which counties are included in the rollout, which hinges on approval by the U.S. Department of Health and Human Services for Florida's requests for a waiver of federal law for its Statewide Medicaid Managed Care program (Gentry, 1/14).

And Kansas hospitals worry about losing charity care money from Medicaid --

Kansas Health Institute: Kansas Hospital Worried About Loss Of Dollars For Charity Care
Many Kansas hospital officials say they are worried that if state policymakers choose not to expand eligibility for the state's Medicaid program, the hospitals will see a significant drop in the money they receive to help care for patients who can't or won't pay their medical bills. Currently, 64 of the state's 127 hospitals divide about $51.3 million a year in what are called Medicaid disproportionate share payments. They use the money, a mix of federal and state dollars, to offset some of the costs of caring for the uninsured. ... Under the Affordable Care Act, also known as Obamacare, those payments are to be significantly reduced, starting in October (Ranney, 1/14).

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Editorials and Opinions

Viewpoints: $4,000 A Night For A 'Cozy' Hospital Room; Texas Effort To Provide Women's Health Care Falls Short

Los Angeles Times: First The Cat, Now The Health System Puts The Bit On Me
Call it the $55,000 cat bite. That's the rough total in medical costs (so far) for a cat bite on my hand that turned into an infection that turned into surgery that turned into a week in the hospital. ... But the bill has finally arrived, and I'm a good deal less impressed with the money side of our medical system. Put simply, it's nuts. Case in point: My cozy hospital room at UCLA Medical Center in Santa Monica was priced at $4,000 a night. Four thousand. You can book a 1,400-square-foot Premier Suite at the Beverly Hills Hotel for less than that. Another case in point: Sixteen bucks for a Tylenol. Actually, not even a proper Tylenol. That's for the generic equivalent. "It's totally crazy," admitted Dr. David Feinberg, who isn't just some innocent bystander when it comes to UCLA's medical pricing. He's the president of UCLA Health System. He runs the place (David Lazarus, 1/15).

The Washington Post: Shining A Light On Medicare Payments
Now costing more than $500 billion per year, Medicare is central to the United States' fiscal predicament. For this complicated problem, there are many complicated proposed solutions. But what if we try something simple, like journalism? ... the press and the public cannot examine the treatments individual physicians billed to Medicare or — most important — how much Medicare paid for them. Yet this is a matter of obvious public concern, given that Medicare made $28.8 billion in improper payments in 2011, according to a Government Accountability Office report last February. Media coverage could be a powerful weapon against waste, fraud and abuse, Dow Jones argues — plausibly, given the Journal's recent work (Charles Lane, 1/14).

The Washington Post: The Rush To Digitize Patient Records Has Not Cut Costs
There is good news on the health-care spending front. According to the federal Centers for Medicare and Medicaid Services, the nation's health-care bill grew only 3.9 percent in 2011, the third straight year at that pace — which is about half the average annual rate between 2003 and 2007. Consequently, health care is no longer consuming a rising share of the overall economy; it's held steady at 17.9 percent of gross domestic product since 2009. ... It’s easier to identify factors that did not contribute to the downward bending of the cost curve. Health information technology is a case in point (1/14).

The Dallas Morning News: Texas' Problem With Women's Health Care
Texas lawmakers determined in 2011 that taxpayers should not fund anything even tangentially related to abortion services, so they passed legislation designed to deny funds to the national reproductive health-services provider Planned Parenthood. As a result, the state said goodbye to federal funding that paid tens of millions of dollars for low-income women's reproductive health services — none of which were abortion-related to begin with. ... the result has been a waste of public money, enormous cuts in health care funding and creation of an informational black hole for low-income women seeking health services (1/14).

Kansas City Star: Brownback's Shell Game On Mental Health Funds
For Gov. Sam Brownback of Kansas, the mass shooting at Sandy Hook Elementary School was a wakeup call. He has announced a renewed focus on serving people who are mentally ill and resistant to treatment. It's a good idea, and one that families of mentally ill Kansans have been requesting for years. Both Kansas and Missouri desperately need crisis stabilization clinics — a middle ground between outpatient treatment and hospitalization. But the governor's plan is deficient in two respects (1/14).

The New York Times: Getting Through The Flu Season
The vaccines available for the strains of flu this year are deemed moderately effective; they can prevent flu cases severe enough to require a doctor’s visit about 62 percent of the time, roughly the same as in previous years. The vaccines provide no protection against other viruses that are circulating simultaneously, such as a new form of norovirus and a severe outbreak of whooping cough. Some shortages of vaccine have been reported around the country, but diligent searchers may be able to find some because the number of people seeking vaccines may be smaller than the remaining supplies. The lesson for future years is to get your shot early (1/14).

The New York Times: Colorado's Marijuana Muddle
Colorado is going to pot. It’s just having a tough time figuring out how. Although an Election Day referendum legalized marijuana for recreational use, it left questions unanswered. Like: how high can you be behind the wheel of a car? Lawmakers are debating a specific blood level, as with alcohol, above which a motorist is deemed an uneasy rider. In a restaurant or private club, might the dessert choices someday include an upscale riff on the pot brownie and a double entendre of a pot de crème? (Frank Bruni, 1/14).

Medpage Today: Is Freedom Of Choice Incompatible With Good Health?
What are the three greatest threats to the health of the American public over which individuals would appear to have control? We can't include those giant health threats like nuclear war and global warming over which only governments and corporations have control. In my view, the three greatest are tobacco smoking, obesity, and diabetes. So, I looked at the data on all 50 states regarding tobacco smoking, obesity, and diabetes rates. I then categorized the states by red or blue by the 2012 presidential election. Of course there are many blue votes in red states and many red votes in blue states. I tallied the highest and lowest 11 or 12 states by tobacco smoking, obesity, and diabetes rates: 24 states were red; 26 were blue (Dr. George Lundberg, 1/14).

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Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Ankita Rao
Marissa Evans

The Kaiser Daily Health Policy Report is published by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. (c) 2012 Kaiser Health News. All rights reserved.