Daily Health Policy Report

Wednesday, January 16, 2013

Last updated: Wed, Jan 16

KHN Original Reporting & Guest Opinion

Health Spending And Fiscal Battles

Health Reform

Public Health & Education

Medicare

Coverage & Access

Health Information Technology

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Slowly Dying Patients, An Audit And A Hospice's Undoing

Reporting for Kaiser Health News, Randy Dotinga writes: "Across the country, hospices with generous admissions policies may find themselves on life support too. Medicare, which heavily funds hospice programs, is cracking down on the industry's growing habit of embracing those whose deaths aren't imminent. It's not clear how many hospice programs are being investigated. But there's definitely an increased level of scrutiny, said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization" (Dotinga, 1/16). Read the story.

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Capsules: Study: Seniors Look For Star Ratings On Medicare Advantage Plans

Now on Kaiser Health News' blog, Ankita Rao reports: "America's seniors are benefiting from a star rating system that ranks the quality of Medicare Advantage plans, according to a study published in the Journal of the American Medical Association" (Rao, 1/16). Check out what else is on the blog.

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Twitter Topics: We're Talking #BodegaClinics

What are our social media talking about? Recently, Kaiser Health News' Tweet sparked conversation about so-called Bodega Clinicas, where patients pay cash for care, and how officials are torn about their quality and wide use.

Would you ever get care at such a clinic? Join the conversation on Twitter using the hashtag #BodegaClinics and follow @KHNews for the latest.

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Political Cartoon: 'Paved Paradise?'

Kaiser Health News provides a fresh take on health policy developments with "Paved Paradise?" by Chip Bok.

Meanwhile, here is today's health policy haiku:

Find The Best Advantage...

Stars rate Medicare?
 It seems to help some seniors
weigh Advantage plans.
-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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Health Spending And Fiscal Battles

Partisan Strife, Interest Group Concerns Emerge In Spending Debate

The New York Times explores how intra-GOP allegiances to the business community are changing. Meanwhile, AARP acknowleges that adjustments must be made, but argues against cutting back entitlements. Also in the news, the director of the National Institutes of Health expresses his wariness about the impact sequestration could have on biomedical research.

The New York Times: For 'Party Of Business,' Allegiances Are Shifting
Big business is so fearful of economic peril if Congress does not allow the government to keep borrowing — to pay creditors, contractors, program beneficiaries and many others — that it is nearly united in skepticism of, or outright opposition to, House Republicans' demand that Mr. Obama first agree to equal spending cuts in benefit programs like Medicare and Medicaid (Calmes, 1/15).

Roll Call: AARP Warns Against Cutting Entitlements To Solve Budget Crises
The influential seniors’ lobby AARP issued a warning Tuesday for members of Congress and Obama administration officials looking to narrow the deficit: Don’t do it with cuts to Social Security, Medicare and Medicaid. As lawmakers and the White House consider squeezing savings from those programs, AARP CEO Barry Rand, in a lengthy speech at the National Press Club, said his organization will work to put the emphasis on people, not balance sheets (Ackley, 1/15).

Politico: AARP's Barry Rand: Mend, Don't End Entitlements
“Yes, we do need to make adjustments to Medicare and Social Security and Medicaid — and AARP members realize that — but we need to do so without compromising the health and retirement security of the American people or undermining the values that we all cherish,” [Rand] said (Glueck, 1/15).

Politico: Biomedical Science At Stake With Sequestration
From his perch at the National Institutes of Health's sprawling campus in Bethesda, Md., Director Francis Collins is eyeing the impending sequestration cuts warily. If lawmakers don't find a way to blunt the across-the-board cuts, the government's premier medical research center will lose 6.4 percent of its budget — a cut Collins calls a "profound and devastating blow" for medical research at a time of unprecedented scientific discovery (Cunningham, 1/16).

Also, CNN provides details on who benefits from entitlement programs --

CNN Money: Entitlement America: Who Benefits?
Entitlements -- including Social Security, Medicare and safety net programs such as Medicaid and food stamps -- don't just benefit the poor and unemployed. More than 90% of the benefits go toward working families, the disabled and the elderly. And more than half of all entitlement spending helps middle class Americans. In 2010, those age 65 and older collected 53% of the dollars, while the non-elderly disabled received 20%, according to the Center on Budget and Policy Priorities, a left-leaning group (Luhby, 1/15).

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Health Reform

Feds Launch 'Full Throttle' Effort To Expand Health Coverage

The Department of Health and Human Services redesigns its website as part of its campaign to raise awareness about the health law's requirement that most people carry insurance. Meanwhile, a U.S. appeals judge temporarily blocks the government from forcing a Christian publisher to comply with its mandate to cover all birth control options.

USA Today: New Website Part Of Push For Uninsured To Get Coverage
The federal government Wednesday kicks off an effort to raise awareness about the most controversial part of the health care law — the requirement that the uninsured buy health care insurance. Wednesday morning, the Department of Health and Human Services plans to relaunch its website to try to draw in the millions of uninsured people needed to make the health care law work when open enrollment in state and federal health care exchanges begins in October (Kennedy, 1/16).

The Associated Press/Washington Post: US Appeals Judge's Ruling Allowing Religious Publisher To Reject Contraceptive Coverage
The Obama administration is appealing a judge's order that is temporarily preventing the government from forcing a Christian publishing company to provide its employees with certain contraceptives under the new health care law (1/15).

Meanwhile, states continue to wrestle with decisions regarding health exchanges and the Medicaid expansioin--

Health Policy Solutions (a Colo. news service): Health Exchange Needs Army Of Navigators To Aid Customers
Colorado’s health insurance exchange has morphed from a Travelocity-style self-service website to an online interface with in-person navigators slated to help hundreds of thousands of customers choose from an array of complex health plans. The most vexing questions now are if there will be enough navigators and who will pay them to avoid conflicts of interest. New surveys of potential health exchange clients released Monday found customers want simple TurboTax-style guidance, help from people in their communities whom they trust and side-by-side comparisons of complex health plans. Doubts are surfacing, however, about how exchange managers will be able create this system by Oct. 1 and how they can avoid having navigators or health insurance brokers steer clients to plans that financially benefit the workers or health systems they represent (Kerwin McCrimmon, 1/15).

The Associated Press: AG Jim Hood Says Insurance Coommissioner Mike Chaney Can Set Up Health Exchange
Mississippi Insurance Commissioner Mike Chaney has the authority to establish and manage a health insurance exchange, according to a legal opinion released late Tuesday by the state attorney general's office. Exchanges are online marketplaces where people can shop for insurance. Under the federal health law that President Barack Obama signed in 2010, every state is required to set up an exchange. States that don't create their own will have one run by Washington (1/15).

The Seattle Times: McKenna Obamacare Gesture Draws Attention
Outgoing Attorney General Rob McKenna, who joined an unsuccessful lawsuit against President Obama’s health-care overhaul, appeared to show support for the law during Gov. Chris Gregoire’s farewell speech Tuesday. McKenna’s gesture was small — he stood along with a group of mostly Democrats to applaud a reference to the law, while most other Republicans stayed seated and silent (1/15).

The Associated Press: Study: Medicaid Expansion A Boon To Ohio At First
Ohio stands to make $1.4 billion over the next decade by expanding Medicaid under the Affordable Care Act, but the savings would eventually drop and just about break even as the state's costs increase, according to a study released Tuesday (Seewer, 1/5).

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Public Health & Education

Role Of Mental Health Professionals Becomes Flashpoint In Efforts To Curb Gun Violence

Just a day after New York passed a landmark gun control law which would require mental health workers to report to authorities patients deemed to be a danger to themselves or others, President Barack Obama is also expected to unveil his gun control agenda. The New York measure, however, is already drawing criticism from experts who worry that its reporting requirement could hinder treatment.

The Washington Post: Obama To Announce Most Expansive Gun-Control Agenda In Generations
In addition to background checks and restrictions on military-style guns and ammunition magazines, Obama is expected to propose mental health and school safety initiatives such as more federal funding for police officers in schools, according to lawmakers and interest group leaders whom White House officials briefed on the plans (Rucker, 1/15).

Los Angeles Times: New York State Adopts Toughest Gun Laws In U.S.
The Secure Ammunition and Firearms Enforcement Act, or SAFE Act, gives New York the toughest gun laws in the nation and touches on the mental health issues that both pro-gun and anti-gun activists say should be part of any new legislation. Among its key provisions is one requiring the revocation or suspension of gun licenses held by people who are deemed a danger to society by mental health workers. The bill would require mental health workers to report such patients to authorities (Susman, 1/15).

The Associated Press/Washington Post: Experts Say Proposed NY Gun Law Could Hinder Mental Health Treatment Of Dangerous People
Mental health experts say a new tougher New York state gun control law might interfere with treatment of potentially dangerous people and even discourage them from seeking help (1/15).

The Wall Street Journal: Law's Mental-Health Provision Draws Ire
The measure requires physicians, psychologists, nurses or clinical social workers to alert local health officials if a patient "is likely to engage in conduct that would result in serious harm to self or others." After an evaluation, the health officials would pass on the person's information to law-enforcement agencies that would be authorized to seize any firearm owned by the patient. If a person is found not to own any firearms, the patient would be added to a statewide criminal background check database, marking a significant expansion of who would be made ineligible to legally buy a firearm (El-Ghobashy, 1/15).

The New York Times: Warning Signs Of Violent Acts Often Unclear
That hard fact drives the public longing for a mental health system that produces clear warning signals and can somehow stop the violence. And it is now fueling a surge in legislative activity, in Washington and New York. But these proposed changes and others like them may backfire and only reveal how broken the system is, experts said (Carey and Hartocollis, 1/15).

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Medicare

Study: Star Rating System Resonating With Seniors

A study published in the Journal of the American Medical Association finds that first-time enrollees in Medicare Advantage plans are relying on Medicare's star-rating system to make plan choices.

Medpage Today: Seniors Favor Higher-Rated Medicare Plans
First-time enrollees in Medicare Advantage plans and those switching plans were more likely to enroll in ones with a higher star rating, a study of nearly 1.3 million Medicare beneficiaries found. An increase of one star in the ratings made it 9.5 percent more likely a first-time Medicare Advantage enrollee would choose a given plan, the study published in Tuesday's Journal of the American Medical Association found. Similarly, for those switching plans, a higher star rating was associated with a 4.4 percent greater chance of enrollment. … But awareness and use of Medicare Advantage's star-rating system has been mixed, Jack Hoadley, PhD, of the Health Policy Institute at Georgetown University, in Washington, wrote in an accompanying editorial (Pittman, 1/15).

Kaiser Health News: Capsules: Study: Seniors Look For Star Ratings On Medicare Advantage Plans
America's seniors are benefiting from a star rating system that ranks the quality of Medicare Advantage plans, according to a study published in the Journal of the American Medical Association" (Rao, 1/16).

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Coverage & Access

Big Cities Face Funding Gaps For Pensions, Retiree Health Benefits

The Wall Street Journal: Pension Funding Gap Widens For Big Cities
Major U.S. cities emerged from the financial crisis with increasingly underfunded pension and retiree health-care plans, according to a study released Tuesday. Cities employing nearly half of U.S. municipal workers saw their pension and retiree health-care funding levels fall from 79% in fiscal year 2007 to 74% in fiscal year 2009, using the latest available data, according to the Pew Center on the States (Ackerman, 1/15).

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Health Information Technology

EHRs: Quality Care Versus Cost Savings, Next 'Meaningful Use' Rules

Some say adoption of electronic health records are not saving money like they'd hoped, but that it does improve care. In the meantime, doctor groups want a delay in the next round of "meaningful use" rules that give doctors financial incentives for utilizing such records.

HealthyCal: Electronic Health Records Improve Care, But Don’t Save Money
Thirty billion dollars was set aside to help Medicare and Medicaid providers move their operations into the high tech world of electronic health records as part of the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act. Four years later, providers say electronic health records aren't the time and money saver they hoped for -- but, they added, electronic records do improve the quality of care. Under the legislation, providers can apply for six years of funding to offset the costs of switching to this new way of operating. The earliest qualifiers received their initial grant of up to $63,750 for each provider to purchase certified software, a costly endeavor. The Department of Health and Human Services estimates that it will cost at least double that for a doctor to set up a new certified system, but often costs almost four times as much (Shanafelt, 1/16).

Medpage Today: Groups Want Delay In Meaningful Use Rules
Some leading medical groups have called on the Department of Health and Human Services (HHS) to delay implementation of Stage 3 of meaningful use of electronic health records (EHRs), saying providers are still trying to implement Stages 1 and 2. In its comments on proposed Stage 3 requirements issued by HHS, the American Academy of Family Physicians (AAFP) called for a delay in implementation until at least 2017, adding it also wants to delay or eliminate penalties for the third and final stage of the EHR incentive program. … The American Medical Association (AMA), which also called for a delay in implementation, said the meaningful use program has helped kick start EHR use but noted there are still technical, financial, regulatory, and operational challenges that must be dealt with first (Pittman, 1/15).

Also, a study looks at "e-visits" to the doctor's office --

Reuters: Are E-Visits As Good As Office Appointments
A new study suggests that "e-visits" for sinus infections and urinary tract infections (UTIs) may be cheaper than in-person office visits and similarly effective. For e-visits, patients fill out online forms about their symptoms and a doctor or nurse gets back to them within a few hours with treatment advice (Pittman, 1/15).

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State Watch

State Roundup: Maine Hospitals Fighting For Timely Medicaid Payments

News outlets report on a variety of health care issues in Colorado, Florida, Georgia, Kansas, Maine, Minnesota, New York and Oregon.

Los Angeles Times: NYPD To Try GPS In 'Bait Bottles' To Track Drug Thieves
New York police plan to distribute "bait bottles" of fake pain-killers equipped with invisible GPS devices in a drive to combat the scourge of pharmacy robberies by addicts and sellers looking for oxycodone tablets, which can fetch more than $80 per pill on the street. New York Police Commissioner Raymond Kelly announced the novel approach at the 2013 Clinton Health Matters Conference in La Quinta on Tuesday, saying his city's cases of oxycodone-related crime have included a retired police officer who resorted to robbing pharmacies to satisfy his craving for the highly addictive narcotic (Susman, 1/15).

The Wall Street Journal: Delays In Medicaid Pay Vex Hospitals
Hospitals in Maine, concerned that further deficit-reduction agreements in Washington could erode funding for Medicaid, are demanding hundreds of millions of dollars in back payments from the state for treatment of patients in the program. States across the nation have long been slow to reimburse hospitals for treating needy Americans in the Medicaid program, but hospitals usually haven't quibbled, knowing they would be paid eventually. But now, a coalition of 39 Maine hospitals is demanding $484 million in Medicaid payments owed for bills dating to 2009 (Levitz and Radnofsky, 1/15).

Georgia Health News: Bid To Avert Fee Battle Galvanizes Capitol
It was just the second day of the legislative session, but a state Capitol meeting room was packed with health care officials and lobbyists Tuesday. Besides those with seats, there were people standing against every available wall or massed at the door. Just as unusual as the early timing and the heavy attention was the venue of the meeting. The Senate Regulated Industries and Utilities Committee is not the typical panel to hear a major health care bill. In fact, health care veterans said they couldn't recall any such bill ever being considered by the committee before. Senators on the panel met Tuesday to weigh legislation that would shift authority to levy the state's Medicaid hospital provider fee from the Legislature to the Department of Community Health (Miller, 1/15).

Oregonian: Bill To Reduce Medical Tort Claims In Oregon Gets Bipartisan Support
Gov. John Kitzhaber said Tuesday that a bill is in the works that could reduce the number of medical malpractice lawsuits in Oregon and fulfill a promise he made to get his Medicaid reforms through the Legislature last year. Under his proposal, which he said has gotten the needed sign-off from trial lawyers and doctors, patients who think they were wronged by a doctor would get a chance at mediation -- and a settlement -- without going to court. The governor said similar laws have worked in other states. The program would be voluntary, and suing for damages would remain an option. But experiments elsewhere show it can save time and money, Kitzhaber said (Esteve, 1/15).

MPR News: Two Minn. Health Giants Announce Collaboration
A new collaborative research initiative between two Minnesota health giants will work to improve patient care and lower costs. Announced Tuesday morning, the partnership between Mayo Clinic and UnitedHealth Group's Optum division is the largest health data-sharing effort of its kind in the country. The new alliance is called Optum Labs. Think of it as a massive database that combines Optum's claim records from more than 100 million patients over the last 20 years, with five-million of Mayo's clinical records from the last 15 years. Together, these records will help health care providers better understand health care delivery to create more efficient approaches to care, said Mayo Clinic CEO Dr. John Noseworthy. He said this is particularly important for illnesses that require long-term care, like heart disease (Baier, 1/15).

MPR News: Gov's Office Wants MinnesotaCare Paid For With Federal Funding
The Dayton administration wants to use funds available under the federal health care law to help pay for MinnesotaCare. MinnesotaCare is a state-subsidized health plan that insures about 130,000 people under age 65. The program serves people who earn too much to qualify for Medicaid but still have difficulty affording commercial insurance. The federal health care law gives states the option of enacting a similar program known as a Basic Health Plan, with the help of federal funding. Last week, Minnesota Human Services Commissioner Lucinda Jesson met with Cindy Mann, deputy director for the Centers for Medicare and Medicaid, to ask if the state could use federal Basic Health Plan dollars to fund MinnesotaCare (Stawicki, 1/15).

MinnPost: Uncertain Fate Awaits Minnesota's Health Plan For Working Poor
The fate of a key state program that provides health coverage to low-income Minnesotans appears uncertain as the state begins serious efforts to implement the federal health care reform law. The program, called MinnesotaCare, provides subsidized insurance to about 130,000 of the state's working poor. Aspects of the current program make it incompatible with higher standards included in federal health care reform, which many states will race to enact before the 2014 deadline (Nord, 1/15).

Stateline: Colorado Preps For Recreational Marijuana
Driving east on Interstate 70 through Denver's warehouse district, the smell of the marijuana plants growing inside unmarked industrial buildings blasts through car air vents and overwhelms drivers who roll down their windows. The smell is a pungent reminder that the state of Colorado is now home to some of the world's laxest marijuana regulations. The state legalized medicinal marijuana use in 2000, but in November voters in Colorado went even further by approving a constitutional amendment that legalizes recreational marijuana for all users over 21 and aims to "regulate marijuana like alcohol" (Clark, 1/16).

Kansas Health Institute: Bill Filed To Legalize Medical Marijuana In Kansas
A bill to legalize medical marijuana in the state was introduced in the Kansas Senate and referred today to the Public Health and Welfare Committee. The "Cannabis Compassion and Care Act" would permit the use of marijuana to treat pain and nausea associated with a number of conditions including cancer, glaucoma, Alzheimer's disease, or multiple sclerosis (1/15).

Health News Florida: 3 Companies Win Big In FL Medicaid
Three companies stand out as major winners in Florida's competition for contracts in the Statewide Medicaid Managed Care Program for Long-Term Care, a market worth an estimated $3 billion. They are American Eldercare, Sunshine State Health Plan and UnitedHealthcare of Florida (Gentry, 1/15).

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Editorials and Opinions

Viewpoints: N.Y. Gun Law Could Pose Problems For Health Professionals; 'Jarring Discrepancy' Between Medical Costs And Premium Increases; State Officials Wage Battle Against Health Law

The New York Times: New York Leads On Gun Control
The broad gun control bill approved Tuesday by the New York Legislature substantially strengthens the state’s gun control laws. ... Some sections of the law, however, were not fully vetted in the rush. One provision asks health care professionals — physicians, psychologists, registered nurses or licensed clinical social workers — to report to local health care officials when they have reason to believe that patients could harm themselves or others. ... The provision would seem to raise significant legal questions (1/15).

The Wall Street Journal: Hickenlooper's Gun Control
Gun control has been the exclusive political fixation of President Obama's Washington after Newtown, so perhaps readers will be surprised to learn that some states are being more constructive. One of them is Colorado, where Governor John Hickenlooper is promoting an innovative overhaul of his state's mental health-care system (1/15).

The New York Times: Behind Double-Digit Premium Increases
National health care spending has been rising at an unusually low rate for three consecutive years. Yet health insurance companies in some states with lax regulations are requesting and winning double-digit premium increases for some customers. That jarring discrepancy suggests that both the federal government and the states need more power to reject premium increases that can't be justified (1/15).

Los Angeles Times: For Democrats, Unity And Its Pitfalls
Medicare already accounts for about 15% of federal spending (not counting interest), and the Congressional Budget Office projects that the cost will nearly double in 10 years if no changes are made. Bringing federal spending under control without touching Medicare simply isn't practical. But it's a prospect that chills many Democrats because defending Medicare and Social Security benefits is the clearest unifying doctrine their party has, just as resisting tax increases is for Republicans. So though Obama may agree in theory about the need for cuts, deciding what to cut is certain to be divisive (Doyle McManus, 1/16).

The Wall Street Journal: How To Save The Federal Safety Nets
The fiscal cliff has been averted, preventing immediate economic calamity. But for long-term economic growth, we must get serious about entitlement reform and government spending. … The math on debt is clear: Medicare, Medicaid and Social Security consume 42% of the federal budget and are projected to account for half of the budget by 2020. Addressing debt and deficits means tackling the projected spending growth without undermining the retirement security that Americans rely on (Gary W. Loveman, 1/15). 

The New Republic: In Georgia, A Blueprint For Battling Obamacare
Sharon Cooper is not a national political figure. She is a state legislator in Georgia, one I happened to encounter at a recent event in Atlanta. But Cooper is also an archetype of Obamacare's newest adversary: the state official fighting health care reform on the ground. These officials can't stop the new law from taking effect. The Supreme Court and the presidential election settled that. But they can interfere with its implementation, potentially denying insurance to millions of poor people across the South and the interior West. To accomplish that, they're wielding some specious arguments (Jonathan Cohn, 1/14).

The Washington Post: The Troubling State Of America's Health
America is dangerous to your health. A recent international commission reported that U.S. men rank last in life expectancy for the 17 industrial nations in the study; U.S. women rank next to last. When it comes to health, the United States is exceptional — exceptionally bad (Katrina vanden Heuvel, 1/15).

The Washington Post: The United States Needs To See The Doctor
Part of the answer is Darwinian: Those Americans who have been less able to access reliable medical care, maintain good diets and live in neighborhoods that are not prey to gun violence have disproportionately died off before age 80. That isn't natural selection but social selection — the survival of the economically fittest in a nation that rations longevity by wealth (Harold Meyerson, 1/15).

Health Policy Solutions (a Colo. news service): Covering All Colorado Kids Is Within Reach
In December the U.S. Department of Health and Human Services once again recognized Colorado as a national leader in providing health coverage for kids. For the third year in a row, Colorado was awarded a bonus payment for efforts to make public coverage programs—Medicaid and CHP+—work better for Colorado kids and families. The national recognition is nice—and the accompanying $43 million payment to the state certainly doesn't hurt—but it isn't a reason to rest on our laurels and call the job done. We still have about 120,000 uninsured kids in our state. But the momentum is in our favor. Covering all Colorado kids is within reach, if we're willing to invest the resources—time, money and political capital—to do it (Cody Belzley, 1/15).

Kansas City Star: Great News On KC Police Pensions, Health Insurance Plan
Some very positive developments for Kansas City taxpayers could occur Wednesday at City Hall. First, city officials at a private meeting hope to broker peace with the Fraternal Order of Police over health care coverage. The FOP filed a lawsuit last year after the police board agreed with City Manager Troy Schulte, that the police should be part of the city's health care plan to save money for taxpayers. The FOP didn't want to change from the current police-directed plan. But on Wednesday, the FOP could agree to drop that lawsuit in exchange, partly, for getting some past raises they have long wanted. In the long run, this should save money for the public, with a larger and healthier group having access to city health insurance plans (Yael Abouhalkah, 1/15).

Boston Globe: State Retiree Health System Needs Major Reforms
One of the biggest fiscal challenges for cities and towns is the cost of health care benefits for retirees. The reform package proposed by Governor Patrick last week would curb some of the most egregious giveaways in the current system, which is out of whack with benefits for most private-sector retirees. It's a significant step forward, but it also includes some concessions to state unions that would tie the hands of municipal governments. The Legislature should embrace the governor's plan, and then improve it (1/16).

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EDITOR:
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.