Daily Health Policy Report

Thursday, January 17, 2013

Last updated: Thu, Jan 17

KHN Original Reporting & Guest Opinion

Administration News

Health Reform

Medicare

Quality

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Q&A: Disclosing Mental Health Records To An Insurer (Video)

Kaiser Health News consumer columnist Michelle Andrews answers a reader question about minors' mental health records and whether they need to be disclosed to insurers paying for care (1/17). Watch the video.

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Children, Teens, Young Adults Focus Of Mental Health Provisions In Obama's Gun Plan

Kaiser Health News staff writer Sarah Varney, working in collaboration with NPR, reports: "If the National Rifle Association’s plan to curb violence was, in part, arming school employees with guns, President Barack Obama wants to arm them with something quite different: mental health training. The president's plan centered largely on training teachers and others who work with children, teens and young adults to recognize mental illness as it’s developing" (Varney, 1/17). Read the story

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Political Cartoon: 'Do-Se-Don'ts?'

Kaiser Health News provides a fresh take on health policy developments with "Do-Se-Don'ts?" by Joel Pett.

Meanwhile, here is today's health policy haiku:

PROCEED WITH CAUTION

Fiscal cliff gone, but …
Debt, C.R., Sequestration!
The "fun" keeps coming.
- Paul Hughes-Cromwick

If you have a health policy haiku to share, please send it to us at http://www.kaiserhealthnews.org/ContactUs.aspx and let us know if you want to include your name. Keep in mind that we give extra points if you link back to a KHN original story.

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Administration News

Mental Health Improvements Are A Key Part Of Obama's Plan To Reduce Gun Violence

In addition to calling for changes in how the country handles gun sales, the proposal would increase mental health services, finish rules on mental health parity and restore federal gun research.

Modern Healthcare: Mental Health Care Part Of Obama Plan To Fight Gun Violence
Surrounded by schoolchildren, President Barack Obama on Wednesday introduced his plan to reduce gun violence ... that includes increasing access to mental health services and conducting federal scientific research on gun-violence causes and prevention. The president's announcement comes one month after a lone gunman murdered 20 children and six school staffers in a shooting massacre at Sandy Hook Elementary School in Newtown, Conn. In addition to 23 executive actions, the plan includes recommendations that Congress act swiftly to pass legislation that would require a universal background check for all gun sales, restore a ban on military-style assault weapons and limit ammunition magazines to 10 rounds (Zigmond, 1/16).

USA Today: Obama Challenges Congress To Pass New Gun Regulations
At the heart of his agenda are calls to close background-check loopholes, make schools safer, increase access to mental health services and, most controversial, ban the sale of assault weapons and high-capacity ammunition magazines. All are measures that will require congressional action, and all face a level of opposition from some lawmakers — on both sides of the political aisle — and gun rights groups (Jackson and Madhani, 1/17).

The Wall Street Journal: Obama's Gun Curbs Face A Slog In Congress
Mr. Obama also on Wednesday set in motion 23 executive actions, most of them aimed at filling holes in law enforcement, mental health and school safety. They included efforts to push agencies to submit more mental-health records into the existing background-check system, to allow federal research into gun violence and provide funding for schools to hire law-enforcement officers (Meckler, Nicholas and Nelson, 1/16).

The Washington Post: A Challenge For Obama's Anti-Gun-Violence Reforms: Mental-Health Data Prove Elusive
President Obama, in trying to curb gun violence, is pushing for improved mental-health services, a revival of gun-related research and beefed-up reporting about potentially dangerous people who shouldn't own guns — efforts that are likely to rely heavily on the states and the public health sector. … A 2011 study by (Mayors Against Illegal Guns) found that while some states such as New York had submitted hundreds of thousands of records to the federal database, other states had lagged. Seventeen states had submitted fewer than 10 mental-health records, and four states had submitted none (Dennis and Sun, 1/16).

Bloomberg: Obama Pushes Mental Health Changes As Part Of Gun Package
President Barack Obama's proposals to increase access to mental health services and start a national dialogue as part of the effort against gun violence encouraged advocates who say the system fails many in need. Obama's measures include training teachers to recognize students who need help and refer them to mental-health services and finishing regulations that define what mental-health coverage must be included by insurance plans (Flinn, 1/17).

Kaiser Health News: Children, Teens, Young Adults Focus Of Mental Health Provisions In Obama's Gun Plan
If the National Rifle Association’s plan to curb violence was, in part, arming school employees with guns, President Barack Obama wants to arm them with something quite different: mental health training. The president’s plan centered largely on training teachers and others who work with children, teens and young adults to recognize mental illness as it’s developing (Varney, 1/17).

NPR: Mental Health Gun Laws Unlikely To Reduce Shootings
States aren't likely to prevent many shootings by requiring mental health professionals to report potentially violent patients, psychiatrists and psychologists say (Hamilton, 1/16).

USA Today: Obama Calls For Changes To Mental Health Care
Mental health advocates hailed President Obama's sweeping agenda to improve mental health care, part of his larger plan to reduce gun violence in the USA following the shooting last month in Newtown, Conn. After decades of disappointment, advocates for the mentally ill said they are cautiously optimistic that the nation may finally take meaningful action to repair a broken system (Szabo, 1/16).

Medpage Today: Mental Health Parity Coming, President Says
President Obama promised Wednesday that his administration would issue final rules implementing a 2008 law that requires insurers to cover mental health services on a par with physical care, but the President gave no time frame for doing so. The law -- the Mental Health Parity and Addiction Equity Act -- states that if a group health plan covers the treatment of mental illness or drug or alcohol abuse, it cannot charge higher copayments, deductibles, and out-of-pocket expenses for those services than for treatment of physical illnesses. Companies with fewer than 50 employees in their group insurance plans are excluded from the law (Pittman, 1/16).

Medpage Today: Mental Health Big Player In Obama's Gun Plan
Mental health issues were in the spotlight Wednesday in the executive orders President Obama signed and proposals he issued for Congress, all aimed at curbing violent gun deaths. The actions, announced in a news conference shortly before noon Wednesday, include several that focus on increasing research on gun violence while furthering access to mental healthcare, in part by widening screening and awareness and by putting mental health services on a par with physical health. The executive orders and proposals to Congress came after a series of White House meetings with more than 220 groups -- including public health organizations and medical societies -- following the massacre at Sandy Hook Elementary School that killed 26 people on Dec. 14 (Pittman, 1/16).

USA Today: Obama Demand Could End Research Blackout Into Gun Violence
President Obama's demand Wednesday for research into gun violence could usher in a flood of data on the nation's 32,000 annual gun deaths after decades of an information blackout. Scientists and policy makers say they have little scientific data about gun violence after Congress prohibited federal agencies, such as the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), from offering research grants to study anything that could be used to promote gun control (Leger, 1/17).

Politico: Obama: Doctors' Gun Talk Legal
Doctors may ask their patients about guns without fear that they are breaking the law, President Barack Obama declared Wednesday. Obama said he wants to clarify language in his 2010 health law that some health providers took to mean as a ban on such conversations (Cheney, 1/17).

Medscape: Obama Sides With Physicians In Fray Over Gun Questions
As part of his new initiative against gun violence, President Barack Obama today announced an executive action to protect the right of clinicians to talk to their patients about gun safety. In doing so, the president jumped squarely into a fray between organized medicine and the National Rifle Association (NRA).The executive action, one of 23 unveiled at a White House event, has a limited scope. It states that the administration will issue guidance clarifying that the Affordable Care Act (ACA), contrary to what some believe, does not prohibit or regulate communication about firearms between clinicians and patients (Lowes, 1/16).

Kaiser Health News also tracked news coverage yesterday of the announcement and details of President Barack Obama's gun control plan (1/16).

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Health Reform

New Rule Sets 2013 As The Time For Small Business To Count Staff Size For Health Law

Health law implementation headlines include reports about how new regulatory guidance might impact small businesses. Also, prominent physicians call for the government to release regulations for the part of the law forcing drug and medical device makers to disclose financial ties to doctors.

The Wall Street Journal: Insurance Rule Will Go By Size Of 2013 Staff
Start counting your staffers now. That is the upshot of regulatory guidance issued by the government on Dec. 28, when few small-business owners noticed in the midst of the holidays and the "fiscal cliff" debate (Maltby, 1/16).

The Wall Street Journal: A Health Scare For Small Businesses
During her two-plus years in business, Elizabeth Turley has steadily recruited new employees for her apparel company, Meesh & Mia Corp., to keep pace with its rapid growth. But this year could be different. Instead of increasing her staff, she plans to hire independent contractors for tasks that can be outsourced. … Her reason? Meesh & Mia is on the cusp of having 50 full-time employees. If the company hits that threshold, it will have to provide health coverage that meets government standards or potentially pay a penalty (Maltby, 1/16).

Fox News: Premiums Set To Rise This Year In Run-Up To ObamaCare Tax On Insurance Industry
While the most sweeping provisions of the health care overhaul have not yet gone into effect, plenty of Americans will still be paying higher insurance premiums this year -- as insurance companies try to preemptively cover the cost of a tax increase included in President Obama's Affordable Care Act. That tax doesn't take effect until next year, when other major provisions like the so-called "individual mandate" and insurance subsidies also kick in. But that hasn't stopped insurance companies from charging higher premiums this year to cover the hike, as well as the cost of ObamaCare benefits such as free birth control and preventive care. Premiums for individuals and small businesses are projected to increase due to the tax by roughly 2 percent this year and by as much as 3.7 percent in 2023, according to a widely cited analysis by the insurance industry (Weber, 1/16).

Politico: HHS Keeping Up With The Times Online
Health reform — you've got mail. The Obama administration is giving its health reform website a 21st-century revamp, inviting consumers to sign up for text alerts and email updates. That's a prelude to encouraging people to jump in when enrollment opens in the fall for the exchanges — henceforth to be known as "health insurance marketplaces" (Cheney, 1/17).

Medpage Today: Clamor For Sunshine Act Rules Continues
Demand is growing for the Obama administration to issue regulations implementing the Physician Payments Sunshine Act (PPSA), a provision of the Affordable Care Act that requires drug and device makers to publicly disclose their financial relationships with physicians, including how much money they are being paid. On Tuesday, a group of prominent physicians including former New England Journal of Medicine editors Marcia Angell, MD, and Jerome Kassirer, MD, wrote to outgoing White House Chief of Staff Jack Lew expressing their concerns about the lack of action (Frieden, 1/16).

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Penalties, Progress And Politics All Play Into State Health Law Decisions

States like California, Kansas and Virginia continue to contemplate specific aspects of the health law. Meanwhile, Florida will face health law penalties if it doesn't make changes to its insurance program for state workers. And, in Indiana, Democrats are pushing for more implementation, despite the opposition of Republicans -- who control the state legislature and governor's mansion.

The Associated Press: Fla. Must Offer Insurance Or Pay $300M Penalty
It turns out that the state of Florida has yet another major decision to make in the next few months when it comes to the federal health care overhaul. The state may be forced to make sweeping changes to its health insurance program for state workers if it wants to avoid paying substantial penalties required under the law pushed by President Barack Obama (Fineout, 1/16).

The Associated Press: Ind. Democrats Pushing For More Health Care Action
Democratic lawmakers pushed Wednesday for Indiana to take steps toward implementing the federal health care overhaul that Republicans who control state government have so far rejected. States have the option of setting up their own insurance exchanges to allow individuals and small businesses to compare and buy private insurance policies (1/16).

Kansas Health Institute: Legislators Request 'Lengthy Discussion' On HIE Developments
In the session's first meeting of the Senate's health committee, among the concerns raised by legislators was that they were "in the cold" regarding developments of the state's health information exchange. Sen. Jim Denning, an Overland Park Republican, asked Dr. Robert Moser, secretary of the Kansas Department of Health and Environment, to prepare an update on Kansas' health information exchange, which launched in July (Cauthon, 1/16).

Richmond Times-Dispatch: Panel Backs Giving SCC Authority To Manage Exchange Insurance Plans
A Senate subcommittee today endorsed a proposal to give the State Corporation Commission the authority to manage insurance plans that would be offered through a federal health benefits exchange under the Affordable Care Act. By unanimous vote, the subcommittee recommended to the Senate Commerce and Labor Committee that the SCC Bureau of Insurance be allowed to review and approve rates for individual and small group plans offered on the exchange, and to certify health insurance plans that are qualified to participate. The legislation, proposed by Sen. John Watkins, R-Powhatan, who chairs the Commerce and Labor Committee, would not commit Virginia to a so-called partnership or hybrid exchange with the U.S. Department of Health and Human Services (Martz, 1/16).

California Healthline: How Will Covered California Service Centers Work?
Service centers -- the places where California consumers will be directed through an 800 phone number and a web portal to get answers to their exchange and eligibility questions -- are on the agenda at today's meeting of the Health Benefit Exchange board. Betsy Imholz, director of the West Coast office of Consumers Union, hopes her questions about service centers will be answered at today's meeting. Consumers Union is one of 13 advocacy groups that signed onto a recent letter to the exchange board, asking for assurance that the board hasn't yet adopted a particular type of protocol model for the service centers, a protocol that Imholz said could discourage people from participating in the exchange (Gorn, 1/17).

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At Least 22 Governors -- Including 4 Republicans -- Hope To Expand Medicaid

In Arizona and Missouri, lawmakers and advocates are pushing for the expansion of Medicaid coverage as called for in the Affordable Care Act. 

Reuters: Governors In 22 States Back Expanded Medicaid Plan
At least 22 governors, including four Republicans, support an expansion of Medicaid under President Barack Obama's healthcare reform law, while others are expected to decide in the coming weeks, experts said on Wednesday. An analysis published by the New England Journal of Medicine said the headcount, which includes 13 Republican governors who staunchly oppose Medicaid expansion, portends an uneven start for "Obamacare" when its most sweeping reform provisions begin on January 1, 2014 (Morgan, 1/16).

The Associated Press: Brewer Wastes No Time Pushing Medicaid Expansion
Gov. Jan Brewer is wasting no time rallying support for her effort to expand Arizona's Medicaid plan, using a news conference at Maricopa Medical Center Wednesday to show she has backing from hospitals and the business community. Hospitals are being asked to agree to a new bed tax to help pay the state's cost of adding about 300,000 low-income people to the plan, which Brewer said would bring billions of dollars in spending to the state health care industry (Christie, 1/16).

St. Louis Beacon: Backers Of Medicaid Expansion Gear Up To Show Legislative Critics That 'We Mean Business'
As nurse practitioner Judith Gallagher related story after story of families or individuals who had no health insurance or had lost it – and couldn't qualify for Medicaid in Missouri – she emphasized one common fact about each case. Gallagher was among a parade of speakers Wednesday addressing more than 100 people at the Kirkwood Baptist Church as part of a statewide kickoff of a campaign to persuade the Republican-dominated General Assembly to support the expansion of Medicaid in Missouri (Mannies, 1/16).

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Medicare

Business Roundtable Offers Medicare Plan To Increase Eligibility Age To 70

The Associated Press reports that, under this plan, "people 55 and older would be protected from cuts but younger workers would face significant changes." Meanwhile, CNN Money takes a look at the cost of such a move.

The Associated Press: Business Group Of CEOs Calls For Raising Retirement Age
An influential group of business CEOs is pushing a plan to gradually increase the full retirement age to 70 for both Social Security and Medicare and to partially privatize the health insurance program for older Americans. ... Medicare recipients would be able to enroll in the traditional program or in private plans that could adjust premiums based on age and health status. ... [Gary] Loveman, who chairs the Business Roundtable's health and retirement committee, said the business leaders will be meeting with members of Congress and the administration to press them to enact their plan (Ohlemacher, 1/16).

CNN Money: The High Cost Of Raising The Medicare Age
If seniors were not allowed to enroll in Medicare until 67 starting next year, federal spending would drop by $5.7 billion in 2014, according to the Kaiser Family Foundation. But Americans enrolled both in private health insurance plans and Medicare, as well as employers and states, would see expenses jump by $11.4 billion. "Raising the age doesn't address the larger concern of reducing health care spending overall," said Juliette Cubanski, associate director of Kaiser's Program on Medicare Policy. "It just shifts costs from the federal government to other payers in the system." Medicare reform is back in the spotlight as the White House and Congress gear up for another deficit reduction battle in coming weeks (Luhby, 1/17).

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Quality

Researchers: Operating Room Checklists, Good Work Environments For Nurses Help Reduce Errors, Readmissions

A pair of studies examines how hospitals can manage O.R. emergencies and nurse patient loads.

Reuters: Checklists May Help Avoid Surgery Oversights: Study
Having step-by-step checklists on hand may help doctors and nurses manage emergencies in the operating room, a new study suggests. In situations when a person's heart stops beating on the operating table or a patient begins bleeding uncontrollably, those lists can save time and brainpower, researchers said. "The standard practice across the country has just been, you work from memory and reason your way through a crisis," said Dr. Atul Gawande, from Brigham and Women's Hospital in Boston, who worked on the study (Pittman, 1/16).

Medscape: Nurses' Work Environment May Influence Readmission Risk
Better hospital work environments and staffing levels for nurses may lower the risk for Medicare readmissions, according to the results of a new survey. For patients with 3 common conditions, 30-day readmission rates were significantly lower in hospitals with a good work environment compared with those with poor work environments, Matthew D. McHugh, PhD, JD, MPH, RN, and Chenjuan Ma, PhD, RN, from the Center for Health Outcomes and Policy Research, University of Pennsylvania, Philadelphia, report in an article published in the January issue of Medical Care. Readmission risk went up with each additional patient per nurse in the average nurse's workload (MacReady, 1/16).

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State Watch

Roundup: Officials Look To Resolve KanCare Concerns

A selection of health policy stories from Kansas, Idaho and California.

Kansas Health Institute: Ombudsman Says Most KanCare Concerns Are Being Resolved
Kancare Ombudsman James Bart today assured members of the Senate Public Health and Welfare Committee that he’s been able to resolve most of the 74 complaints that have reached his office since it opened on Jan. 2. Almost 95 percent of the concerns raised by providers and 89 percent of those raised by consumers were resolved within a few hours or days. The remaining issues, he said, were in the process of being addressed (Ranney, 1/16).

The Associated Press: Mental Health Hospitalizations Rising In Idaho
Officials with the Idaho Department of Health and Welfare say more Idaho residents are being committed to the state's psychiatric hospitals, but the length of time they spend in the hospitals is dropping. Ross Edmunds with the department's Division of Mental Health told members of the Legislature's budget-setting committee on Wednesday that there were 473 commitments to State Hospital South in Pocatello and State Hospital North in Orofino in fiscal year 2008, compared to a projected 818 commitments for fiscal year 2013 (Boone, 1/16).

California Healthline: Inside Three ACOs: Why California Providers Are Opting For The Model
While we're close enough to see their outline, some ACOs are still just teasing their promise. Many organizations have yet to launch a Web presence (or in San Diego Independent ACO's case, are waiting to get CMS approval). And more health care providers are rushing to build the ACO structure in hopes of winning federal contracts -- and filling out the details later. … Based on ACO participation, California continues to help set the pace for reform (Diamond, 1/16).

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Weekend Reading

Longer Looks: 'Bad Suga' Damages A Neighborhood

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

Health Affairs: To Fight Bad Suga’, Or Diabetes, My Neighborhood Needs More Health Educators
Bad suga' is devastating my neighborhood of North Lawndale, one of Chicago's poorest communities. Diabetes is commonly called "bad suga'" in many African American communities like the one where I grew up and live today. "Bad suga'": because when your blood sugar levels are out of control, it makes you feel bad, and over time, bad things start happening to your body. No matter what you call it, the disease is pervasive and destructive, and many people in my community are in its grip. At the same time, some in the community are working to ease the burden that bad suga' has heaped on an already suffering population (Joseph F. West, January 2013).

PBS NewsHour: How A Boy Became The First To Beat Back Diabetes
On Jan. 11, 1922, a 14-year-old boy hovered between life and death. His name was Leonard Thompson and he was suffering the end stages of diabetes mellitus. Because the only treatment available was a starvation diet, the boy weighed a mere 65 pounds when he was admitted to the Toronto General Hospital. Worse, Leonard was drifting in and out of a diabetic coma. His father was so desperate to save the boy that he agreed to let the doctors inject Leonard with a newly discovered wonder drug that had never been tried on another human being. The doctors called it insulin (Dr. Howard Markel, 1/11).

The New York Times: As Nurse Lay Dying, Offering Herself As Instruction In Caring
It was early November when Martha Keochareon called the nursing school at Holyoke Community College, her alma mater. She had a proposal, which she laid out in a voice mail message. "I have cancer," she said after introducing herself, "and I'm wondering if you’ll need somebody to do a case study on, a hospice patient." ... Kelly Keane, a counselor at the college who received the message, was instantly intrigued. Holyoke's nursing students, like most, learn about cancer from textbooks. ... Ms. Keochareon, 59, a 1993 graduate of Holyoke’s nursing program, was offering students something rare: an opportunity not only to examine her, but also to ask anything they wanted about her experience with cancer and dying (Abby Goodnough, 1/10).

The Atlantic: 40 Years After Tuskegee: Reuniting Medical Research And Practice
It is estimated that we lack sufficient scientific evidence about the effectiveness of over 50 percent of commonly used medical treatments, and that 100,000 patients die annually from healthcare acquired infections. The pressing need for better evidence on how to deliver medical care effectively, safely, and efficiently, however, is butting up against another moral imperative -- protecting patients from unethical research. ... The need to build a firewall between research and practice emerged during a period of intense societal focus on egregious violations of human rights that occurred in research, including most notably the Tuskegee Syphilis Study. The dominant concern then was to protect patients and other subjects from risky and exploitative research. Today, however, the segregation model we put in place to protect patients is actually harming them (Ruth Faden, 1/16).

American Medical News: Using Mindfulness To Soothe Physician Stress
At a Rush University Medical Center continuing education course in Chicago last fall, a room of more than 80 physicians and other health professionals did something they rarely do during days packed with rushed patient encounters and consultations with colleagues — they sat together in silence for a solid 35 minutes. ... "The effort in this practice is remembering to come back — back to your posture, back to your breathing, over and over again," said Mitchell M. Levy, MD. He led the exercise, known as mindfulness meditation, with a quiet yet commanding tone of voice. ... the well-attended course is just one sign of the rising interest among physicians, medical schools and hospitals in using mindfulness practices to help alleviate doctors' stress and reconnect them with their patients and their calling in medicine. Nearly half of doctors report experiencing at least one symptom of burnout, according to a nationwide survey (Kevin B. O’Reilly, 1/7).

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Editorials and Opinions

Viewpoints: Obama 'Wise' To Add Mental Health Focus To Gun Initiative; Calif. Considers Giving Localities Responsibility For Expanded Medicaid

The Washington Post: A Big Agenda On Gun Violence
President Obama's sweeping proposals to combat gun violence represent a sound response to the mass shootings that have horrified the country. In his legislative proposals and executive actions announced Wednesday, the president and Vice President Biden showed a willingness to confront a difficult problem head-on -- a problem that is not only about laws but also about culture and mental-health care (1/16).

The Wall Street Journal: Obama At The Gun Rack
After Newtown, the most important policy goal ought to be keeping firearms away from the mentally unstable and other people who pose a danger to society. There Mr. Obama moved the needle by appealing for better mental health care, even if it seemed like something of an afterthought. The gun-control lobby believes mass shootings and the broader matter of U.S. gun violence (which are not the same problem) can be solved by regulating firearms alone. Mr. Obama's raft of suggestions was wise to focus on mentally troubled young people (1/16).

Los Angeles Times: A Crucial Time For Medi-Cal
Gov. Jerry Brown has thrown his support behind expanding Medi-Cal, the health insurance program for impoverished Californians, to the full extent authorized by the 2010 federal health care reform law. It was the right choice, and Brown deserves credit for recognizing that the benefits to public health and the economy outweigh the potential costs. But his budget proposal left state lawmakers to decide whether to keep responsibility for the expanded program in Sacramento or hand it off to the counties. And while it's worth reevaluating how to pay for the medically indigent, it would be a disaster to transfer so much of Medi-Cal's duties to ill-prepared local authorities (1/17).

The New England Journal of Medicine: U.S. Governors And The Medicaid Expansion -- No Quick Resolution In Sight 
[S]ince the Supreme Court ruling on the ACA, states have been grappling with the option the Court presented -- whether to participate in the expansion of Medicaid eligibility to all adults with family incomes at or below 138 percent of the federal poverty level. ... Though Medicaid was initially enacted in 1965, nine states did not participate until 1970 or later, and it took nearly 20 years before the last holdout joined. One can only speculate about whether that history is about to be repeated, with insurance coverage for millions and the fate of the ACA hanging in the balance (Drs. Benjamin D. Sommers and Arnold M. Epstein, 1/16).

Los Angeles Times: $1,079.28 Worth Of Reasons To Celebrate Obamacare
In December, I found myself suddenly doubled over with abdominal pain. My physician couldn’t see me right away, and since I’d never experienced anything so drastic and debilitating, I went to the emergency room -- one that was in-network. Now that I've gotten my bill, I really wish I hadn't. ... The hospital billed the insurance company $8,086.72, although my actual pre-inflation charges were $3,396.47. BCBS agreed to cover $2,317.19. So I owe the hospital $1,079.28. Gee, thanks. What's the point in paying so much for health insurance if I’m going to get stuck with a bill like that? (Alexandra Le Tellier, 1/16).

Health Policy Solutions (a Colo. news service): Rural Colorado To Benefit From Health Care Policy Changes
Coloradans living in rural communities face greater challenges in accessing health care compared to their urban counterparts. We at the Colorado Coalition for the Medically Underserved consider good access to health care to include: having health insurance coverage, having a place to go to receive health care and having a primary health care provider (Joe Sammen, 1/16).

The Washington Post: In Health, We're Not No. 1
It turns out that being American is bad for your health, relatively speaking. Anyone interested in health care ought to digest the findings of a massive new report from the National Research Council and the Institute of Medicine, which compared Americans' health with that of people in other advanced countries. After spending 18 months examining statistics and studies, the panel reached a damning conclusion: The United States ranks below most advanced countries (Robert J. Samuelson, 1/16).

The New York Times: A Hospital Network With A Vision
As the United States struggles to find new business models for health care, some innovators are looking to other industries, ones that provide high-quality services for low prices. In a recent article in The New Yorker, for example, Atul Gawande suggests that the Cheesecake Factory restaurant chain -- with its size, central control and accountability for the customer experience -- could be a model of sorts for health care. That's not as outlandish as it seems. The world's largest provider of eye care has found success by directly adapting the management practices of another big-box food brand, one that is not often associated with good health: McDonald's (Tina Rosenberg, 1/16). 

Baltimore Sun: The Sniffing And Coughing Season
Flu season is upon us again, but authorities say it won't exhibit as mild a form this year as in seasons past. On Friday, the federal Centers for Disease Control and Prevention officially declared flu an epidemic in Maryland and 46 other states, meaning the number of new cases significantly exceeds what would be expected during a normal year. Health officials are stockpiling vaccine and making it available at hospitals, clinics, pharmacies and doctors' offices, but members of the public have to do their part as well by doing everything possible to get vaccinated before they get sick (1/16).

Oregonian: Oregon May Need Mandatory Flu Shots For Health Care Workers
OHSU, stand back. The lower-profile Samaritan Albany General Hospital beat the mighty Oregon Health & Science University in Portland on an indicator of patient quality: flu shots for health care workers. Nearly 90 percent of the 1,000-plus Samaritan staff got flu shots last winter to protect elderly and medically fragile patients from the life-threatening influenza virus, according to state data. At OHSU, the reported rate was only 45 percent, with the immunization status of a high number of the institution's 14,000 employees classified as "unknown." Rates for other Oregon hospitals ranged from the low 50s to the low 90s, for reasons that can't be explained by size, geography or specialty (1/16). 

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
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.