Daily Health Policy Report

Friday, January 18, 2013

Last updated: Fri, Jan 18

KHN Original Reporting & Guest Opinion

Health Reform

Health Spending And Fiscal Battles

Administration News

Health Care Marketplace

Coverage & Access

State Watch

Health Policy Research

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Political Cartoon: 'Towing The Line?'

Kaiser Health News provides a fresh take on health policy developments with "Towing The Line?" by Gary Varvel.

Meanwhile, here is today's health policy haiku:

FUTURE TENSE?

First term agenda
dominated by health care.
And the next four years?
-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 Reform

Federal Gov't. Awards Health Exchange Grants To Some States

News outlets report on federal funds awarded to 11 states to develop these marketplaces.

The Hill: HHS Announces $1.5B For State Exchanges
The federal health department announced $1.5 billion in new grants Thursday for states to continue building their insurance exchanges under the Affordable Care Act. California, Delaware, Iowa, Kentucky, Massachusetts, Michigan, Minnesota, New York, North Carolina, Oregon and Vermont received funding — either one-or multi-year awards based on their progress in creating the marketplaces (Viebeck, 1/17).

Los Angeles Times: State's Health Exchange Gets $674-Million Federal Grant
Federal officials awarded California's new health insurance exchange a $674-million grant, providing money for a crucial marketing campaign aimed at millions of uninsured consumers (Terhune, 1/18).

The Associated Press: California Awarded $674M To Build Health Exchange
California has been awarded a $674 million federal grant to continue developing and building an online insurance marketplace under the federal health care reform law, state officials announced Thursday. The state is receiving substantial support from the U.S. Department of Health and Human Services as part of the effort to aid millions of uninsured Californians, said Peter Lee, executive director of Covered California, the state entity in charge of the exchange (1/17).

Sacramento Bee: Latest Grant Helps California Health Exchange Plan Move Forward
Bolstered by a federal grant of $674 million on Thursday, Covered California outlined an agenda to keep the state health exchange on pace for a full-scale launch on Jan. 1, 2014. California's nascent health-insurance shopping site faces a complex and expensive ramp-up process as it seeks to sign up customers from throughout the state's diverse communities. Officials Thursday laid out an action plan for outreach that includes signing up translators fluent in the 13 languages common in the Golden State. Because California's land mass is so huge, Covered California expects to develop seven geographical exchanges reflecting different markets in Sacramento, Northern California, the Greater Bay Area, the San Joaquin Valley, the Central Coast, Los Angeles and the rest of Southern California (Craft, 1/18).

California Healthline: Covered California Lands $674 Million Federal Grant
Yesterday federal officials awarded $674 million to the California exchange, a Level 2 establishment grant that funds the set-up of the exchange through the end of 2014. It was slightly short of the $706 million originally requested for the grant, but Lee was not about to quibble. "The feds reduced 2014 potential payment for outreach and enrollment by about $30 million," Lee said. "But we think we have enough resources on hand to do the biggest outreach that I've ever seen." State HHS Secretary Diana Dooley pointed out that the extensive planning for the exchange was accomplished in a relatively brief time frame, as the exchange board was only formed in April 2011 (Gorn, 1/18).

Pioneer Press: Minnesota Health Insurance Exchange Receives $39M
The federal government has awarded a $39 million grant to fund more work on Minnesota's health insurance exchange, according to a Thursday, Jan. 17, statement from state officials. The latest award means the federal government has granted the state $110 million to develop the exchange, which is intended to be an online marketplace for individuals and small employers to buy coverage starting later this year (Snowbeck, 1/17).

WBUR: Mass. Gets $81M Federal Grant To Develop Insurance Exchange
The federal government announced Thursday that Massachusetts is receiving an $81.2 million grant to help its Connector Authority comply by 2014 with the requirements of the Affordable Care Act and further develop its health insurance exchange. According to the federal Centers for Medicare & Medicaid Services, the grant will "support the development and operation of a Massachusetts-specific risk adjustment program that will ensure stability in the state's merged market and will provide funding to develop and execute a robust outreach and education campaign" to inform residents about benefits available through the ACA and the Connector (Norton, 1/17).

Oregonian: Oregon Receives $226 Million Federal Grant To Set Up Health Insurance Exchange Program
Oregon received a $226 million federal grant Thursday to set up the state's health insurance exchange program over the next two years. The money from the U.S. Department of Health and Human Services will go toward building the online marketplace for health coverage. By 2014, individuals and small businesses will be able to use it to shop for coverage and tap federal tax credits and other assistance if they're eligible. Officials plan to use the money to build a customer service center and to develop, test and train people to use the web-based program, among other uses, said Lisa Morawski, spokeswoman for Cover Oregon. Cover Oregon is the public corporation set up in 2011 to operate the exchange (Zheng, 1/17).

In other exchange news -

MPR News: Health Exchange Bill Passes First Senate Committee
A bill to create a key part of the federal health care law in Minnesota sailed through its first committee Wednesday on a party line vote. The state Senate Local Government committee passed a bill to create an insurance exchange. It's expected that one in five Minnesotans will use the online gateway to comparison shop for health care policies and enroll in Medicaid beginning in October. Two similar exchange bills failed to pass in previous sessions when Republicans were in control. Burnsville Republican, state Sen. Dan Hall called for delay. "It takes some time to digest it. I think it takes time to look at it," Hall said. "I see the stakeholders that are really in conflict with it. And I wonder if we just need to just wait on this thing, table it" (Stawicki, 1/17).

MinnPost: Minnesota Health-Exchange Bill Clears First Of Many Committtee Stops
The Minnesota health insurance exchange's sprint through the Legislature got off to a good start Wednesday, clearing its first Senate committee. The exchange legislation, with a late-March deadline, likely faces a dozen similar legislative hearings and hours of floor debate (Nord, 1/17).

Also regarding the health law's implementation --

The Washington Post: New Regulations Shed Light On Looming Health-Care Reform Costs For Businesses
The ramifications of health care reform for business owners are coming into focus as regulators float new rules to govern employer-sponsored coverage. Lost in the political fervor over the fiscal cliff, the Internal Revenue Service recently proposed new regulations to govern what has been dubbed the "employer mandate" section of the Affordable Care Act. The provision, which takes effect next year, requires companies with 50 or more employees to either provide adequate and affordable coverage to their workers or pay tax penalties (Harrison, 1/17).

The Hill: Hospitals Push White House To Back Change In Health Care Law
A coalition of 21 hospital associations is asking the White House to help fight a provision of President Obama's healthcare law that they say will cost them billions of dollars. Hospital associations from 20 states sent a letter to Obama this week arguing that a change to his healthcare law ought to be included in the next White House budget proposal (Baker, 1/17).

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UnitedHealth Indicates Limited Participation In State-Based Exchanges

CEO Stephen Hemsley said Thursday that the insurer expects to participate in 10 to 25 of these marketplaces and noted that there should be no assumptions that the company will participate widely. His announcement comes along with news that the company's 4th quarter profits were down slightly, which was mainly attributed to rising medical costs.

The Wall Street Journal: UnitedHealth Weighs In On New Exchange Option
UnitedHealth said it expected to participate in 10 to 25 or more of the marketplaces, out of what the insurer said could be as many as 100, with each state hosting exchanges for individual plans and for small businesses. However, the insurer also said it had "absolutely no firm commitment to that range," and its total will change based on the situation in each state (Mathews and Kamp, 1/17).

The Associated Press/Washington Post: UnitedHealth Says Participation In Overhaul Coverage Expansion Depends On Fairness, Viability
UnitedHealth CEO Stephen Hemsley said Thursday analysts shouldn't assume that the nation’s largest health insurer will participate widely in the health care overhaul's online insurance exchanges (1/17).

Reuters/The New York Times: Income At UnitedHealth Drops A Bit As Medical Costs Rise
The UnitedHealth Group, the nation's largest health insurer, reported a slight drop in its fourth-quarter net income on Thursday as medical costs rose, but its revenue increased more than 11 percent, helped by growth in its Medicare, care management, technology and international businesses (1/17).

The Associated Press/Washington Post: UnitedHealth 4th-Quarter Profit Down 1 Pct. As Costs Rise; Insurer Maintains 2013 Forecast
UnitedHealth Group Inc.'s fourth-quarter net income slipped 1 percent, as a rise in costs from medical claims and other expenses countered revenue gains for the nation's largest health insurer. The Minnetonka, Minn., company also said Thursday it was reaffirming a forecast for 2013 earnings it made in November (1/17).

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Health Spending And Fiscal Battles

Debt Ceiling, March Spending Cuts Present Policy And Political Choices

As the White House and congressional Republicans wrestle with strategies to deal with these upcoming budget issues, Medicare and Medicaid will be important factors.

The New York Times: Difficult Choices On Debt If The U.S. Hits The Ceiling
The Treasury Department is undertaking "extraordinary measures," … to leave it with more cash on hand. But such measures buy the country only so much time. … That day might be Feb. 15, for instance. According to a Bipartisan Policy Center analysis, the government expects about $9 billion in revenue to arrive in its coffers that day. But it has $52 billion in committed spending on that day: $30 billion in interest payments, $6.8 billion in tax refunds, $3.5 billion in federal salaries, $2.7 billion in military pay, $2.3 billion in Medicaid and Medicare payments … and a smattering of other commitments. The Treasury would be confronted with paying doctors but not soldiers (Lowrey, 1/17).

Los Angeles Times: House GOP Weighs Backing Off Default Threat
The threat of the coming March cuts – which both parties have said they hope to avoid – provide an opportunity for the GOP to try to force Obama and Senate Democrats to consider alternative reductions elsewhere. Republicans have long sought to spare the Pentagon from cuts and shift the burden to other domestic programs, including Medicare and safety net programs. But to get to that debate, Republicans must first dispatch with the need to raise the nation's debt limit, which could come as soon as mid-February (Mascaro, 1/17).

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Administration News

Mental Health Issues Take Pole Position In Gun Violence Debate

Agreement appears to exist that mental health is central to this debate, with the Obama administration eyeing the related provisions of the health law as one of the answers.

Politico: Mental Health Push Meets Politics
Here's one thing President Barack Obama and Republicans actually agree on: Mental health has to be a big part of the gun violence debate in Obama's second term — because people with serious mental illness shouldn't have guns. Obama thinks he has the perfect solution: the mental health provisions in Obamacare (Nather, 1/17).

Stateline: Easiest Path to Mental Health Funding May Be Medicaid Expansion
The recent mass killings in Tucson, Aurora and Newtown have sparked public conversations about the deficiencies in state-run mental health systems across the United States. But few states are poised to spend their own money to reverse as much as a decade of budget cutbacks in those areas. Instead, many of them are counting on an infusion of federal mental-health dollars. Because Medicaid includes mental-health benefits, those states that opt into the Medicaid expansion included in President Obama's Affordable Care Act will be able to make mental health coverage available to thousands of their citizens who do not now have it (Ollove, 1/18).

Fox News: Does White House Plan Enlist Doctors In Gun Control Fight?
A few lines in President Obama's sprawling gun control plan are stirring accusations from conservatives that the administration is trying to enlist doctors in a national campaign against owning firearms.  The easy-to-miss language was part of Obama's package of executive actions and legislative proposals that includes a new assault-weapons ban and universal background checks. The provision on doctors, though, has begun to generate just as much controversy.  "The idea that your doctor would ask you if you have firearms in your house as part of an examination of your health is repugnant," National Rifle Association President David Keene told Fox News on Thursday, accusing the administration of trying to "demonize firearms" by implying that owning them is a "health problem." One of the 23 executive actions Obama approved Wednesday was to "clarify" that the federal health care overhaul "does not prohibit doctors asking their patients about gun in their homes" (1/17). 

Related KHN coverage: The Gun Lobby’s Favorite Part Of The Health Law (Hancock, 12/20) and Medical Questions About Gun Ownership Come Under Scrutiny (Andrews, 11/26). 

PBS Newshour: In Preventing Violence, 'Very Hard To Identify' Individuals Who Need Help Most (Video)
Ray Suarez looks at responses by lawmakers and the NRA to President Obama's gun violence proposals. Jeffrey Brown hones in on the topic of mental health with Barry Rosenfeld, a clinical forensic psychologist at Fordham University, and Dr. Paramjit Joshi of the Children's National Medical Center in Washington, D.C. (1/17).

In related news --

California Healthline: Should Calif. Be Model For National Mental Health System?
In the California Legislature, Sen. Ted Gaines (R-Roseville) and Assembly member Nancy Skinner (D-Berkeley) have said they plan to introduce legislation dealing with mental health and firearms. We asked experts and lawmakers how policymakers in Sacramento and Washington, D.C., should respond to the public debate triggered by the killing of 26 people at an elementary school (1/17).

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Health Care Marketplace

Paying Medical Expenses, Raising Hopes, Triggering Fears ...

USA Today and Marketplace report on ways in which the cost of health care, especially regarding a serious illness, causes patient anxieties, challenges for the health system and new approaches within the marketplace.

USA Today: 'Crowdfunding' Sites Pay Medical Bills, Raise Medical Hopes
Nothing, that is, except try fundraising. More and more people are turning to crowdfunding sites such as the Human Tribe Project (humantribeproject.com), FundRazr (fundrazr.com), GoFundMe (gofundme.com), GiveForward (giveforward.com) and others to ask friends, and friends of friends, to consider making a donation, or, in the case of Human Tribe Project, purchasing a necklace or key chain, where the item's cost includes a donation. These can include situations such as fundraising for a loved one's cancer diagnosis, aftercare following an accident, fertility treatments or even replacing a pair of eyeglasses held together with duct tape (Alkon, 1/17).

Marketplace: Born On Inauguration Day: Health Care Hits Home
As a chaplain at Lurie Children's Hospital in downtown Chicago, Ashley-Anne Masters sees tangible evidence of one of the nation's most critical challenges every day at work. Masters says patient anxieties over access to health care transcend socioeconomic divides inside stark waiting rooms. "Every day I would see families who were terrified about how they could pay for their child's chemo," she says on a day off from the hospital, seated inside a coffee shop."At the end of the day, it doesn't matter what your job is or who the president is -- nobody can afford to have cancer." In 2010, the year President Barack Obama signed the Affordable Care Act, the country's health expenditures topped $2.6 trillion. According to the Centers for Medicare and Medicaid Services, that’s more than 10 times the $256 million spent in 1980, when Masters' mother was preparing for the arrival of her first and only child. The country spent roughly $1,110 per capita in 1980, a figure that skyrocketed to $8,402 in 2010 (Green, 1/17).

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FDA To Step Up Evaluation Of Metal Hip Implants, Other Devices

The Wall Street Journal: Metal Hip Implants Face Tighter Controls
The Food and Drug Administration is studying whether several medical devices already on the market, such as electroconvulsive therapy devices for depression and emergency defibrillators, require additional evidence to prove they're safe. As part of that re-evaluation, the federal agency on Thursday proposed that companies making so-called metal-on-metal artificial hip joints produce medical evidence demonstrating their safety in order to stay on the market (Burton, 1/17).

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Coverage & Access

Law Banning Genetic Discrimination Doesn't Apply To Some Insurers

NPR examines a key loophole in the law designed to keep health insurers from raising rates or denying coverage because of genetic issues. The law doesn't apply to life, disability or long-term-care insurance.

NPR: It's Legal For Some Insurers To Discriminate Based On Genes
There's a federal law that's supposed to protect people from having their own genes used against them, the Genetic Information Nondiscrimination Act, or GINA. Under GINA, it's illegal for an employer to fire someone based on his genes, and it's illegal for health insurers to raise rates or to deny coverage because of someone's genetic code. But the law has a loophole: It only applies to health insurance. It doesn't say anything about companies that sell life insurance, disability insurance or long-term-care insurance (Schultz, 1/17).

Meanwhile, a new study shows that people who offer their DNA for medical research may not be able to remain anonymous.

NPR: Anonymity In Genetic Research Can Be Fleeting
People who volunteer for medical research usually expect to remain anonymous. That includes people who donate their DNA for use in genetic studies. But now researchers have shown that in some cases, they can trace research subjects' DNA back to them with ease. And they say the risk of being identified from genetic information will only increase (LaCapra, 1/17).

Medpage Today: No Privacy Guarantee For Genomic Data
Supposedly anonymous individuals who have contributed their genomic information for research can sometimes be identified through free, publicly available Internet tools, researchers found. An effort to find the full names of 10 participants in a Utah-based genomic research project was successful for five of them, reported Yaniv Erlich, of the Whitehead Institute for Biomedical Research in Cambridge, Mass., and colleagues. In fact, the researchers said in a report in the Jan. 18 issue of Science, they were able to identify not only the participants but their entire families, a total of nearly 50 people -- relying entirely "on free, publicly available resources," they wrote (Gever, 1/17).

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State Watch

Calif. Officials Push Campaigns Informing Public Of Health Law's New Provisions

Officials in California seek to inform the public of what the health care law does for insurance coverage and health care with a series of public campaigns.

Los Angeles Times: Alameda County Launches Nearly Nude Campaign For Health Care
To help implement President Obama's health care overhaul in California, officials around the state are rushing to raise awareness and enroll hundreds of thousands of Californians in Medi-Cal, the state's public insurance program. For its part, Alameda County has settled on a decidedly stripped-down message, launching an ad campaign this week that features scantily clad families holding strategically placed signs that read: "Cover Your Family" (Mishak, 1/17).

HealthyCal: Using The Affordable Care Act To Close The Health Gap
Young people may be less likely to suffer from severe health problems, but Tamika Butler wants them -- and the lawmakers who draft policies affecting them -- to remember they are not immune to illness and disease. Butler is just one of many advocates worried about how youth of all incomes levels and ethnicities are going to fare once the Affordable Care Act is implemented. She directs the California branch of the Young Invincibles, an organization dedicated to informing and advancing health care options for young adults aged 18 to 34. In California, 3.1 million people in that age group do not have insurance -- a pool that accounts for 42 percent of the entire uninsured population in the state (Bartos, 1/18).

In the meantime, Kansas business leaders talked to lawmakers about what negative consequences the law could have for them --

Kansas Health Institute: Business Groups Testify On Consequences Of Obamacare
Spokesmen for three business groups testified today before the Senate Public Health and Welfare Committee about what state legislators might do -- as one put it -- to "mitigate the negative impact" of the federal health reform law on the Kansas economy. The short answer: Not much (Cauthon, 1/17).

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Va. Lawmakers Block Abortion Ultrasound Repeal; Other State Abortion News

Lawmakers in Virginia blocked a repeal of a state law that requires women to have an ultrasound before an abortion as well as a law that requires stricter regulation of abortion clinics. In the meantime, however, a state Senate committee there killed a proposal that would have forbidden public money from being used for abortions where the fetus is likely to be deformed and unlikely to survive.

The Washington Post: Va. Republicans Block Ultrasound Repeal
Senate Republicans on Thursday thwarted an effort by Democrats to repeal a law to require women to undergo an ultrasound before getting an abortion. Republicans also rejected legislation that would have rolled back new regulations requiring abortion clinics to meet hospital-style building standards (Vozzella, 1/17).

The Associated Press/Washington Post: Panel Thwarts Bid To Prevent State-Funded Abortions Of Doomed Fetuses, Keeps Ultrasound Law
A Virginia Senate Committee killed a bid to prevent Medicaid patients from having abortions when doctors determine the fetus has profound deformities that make survival unlikely. The Republican-run Education and Health Committee voted 8-7 against banning state-funded abortions for women with fatally flawed fetuses. Virginia Beach Republican Sen. Harry Blevins joined the panel's seven Democrats (1/17).

In Nebraska, a bill would require abortion clinics post ultrasound images --

The Associated Press: Abortion Bill Would Require Link To Ultrasounds
Abortion clinics would be required to post ultrasound images of fetuses to a state website under a bill that a Nebraska senator introduced Thursday. Sen. Bob Krist of Omaha said he introduced the measure because he wants women to have access to non-judgmental, scientific information when deciding whether to have an abortion (Skelton, 1/17).

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State Highlights: Trying To Save Care For Poor With Medicaid Budget Deals

A selection of health policy stories from South Carolina, Georgia, Minnesota, New York, California, Texas and Massachusetts.

The Associated Press: Education, Health Care Among Haley's Topics
South Carolina Gov. Nikki Haley asked legislators in her third State of the State address Wednesday to overhaul how public schools are funded, improve crumbling roads, and make prisons a safer place for those who guard the most violent offenders. She pledged to work to improve residents' health, especially in rural areas, without expanding Medicaid. For example, she said, next year the state's Medicaid agency will begin fully reimbursing rural hospitals for uncompensated care (Adcox, 1/17).

The Associated Press: SC Medicaid Director Touts Agency Savings
South Carolina's Medicaid director said Thursday his agency's savings initiatives are allowing tens of millions of dollars to be spent on the state's many other needs. Under the Department of Health and Human Services' preliminary budget request last fall, the escalating cost of Medicaid would have eaten up every dollar of additional revenue currently projected to come into state coffers next fiscal year. But Gov. Nikki Haley's executive budget proposal recommends spending an additional $156 million. That's about $40 million less on the government health care program for the poor and disabled than that initial request (Adcox, 1/17).

The Associated Press: Deal Cautious With Third-Year Plans
Gov. Nathan Deal presented Georgia lawmakers with a wide-ranging but cautious agenda Thursday, asking the new General Assembly not to divert from the path set during the Republican governor's first two years in office. The governor urged lawmakers to ratify his plan for an appointed state health policy board to assess fees on Georgia hospitals as a way to avert steep cuts to the Medicaid health insurance program for low-income residents, most of them children or disabled adults. That plan would replace a direct tax that expires at the end of the current fiscal year (Barrow, 1/17).

Georgia Health News: Provider Fee Bill Sails Through Senate
The state Senate passed legislation Thursday that would facilitate the renewal of the hospital provider fee, after soundly rejecting a bid to tie the bill's approval to Georgia expanding its Medicaid program. As envisioned by the 2010 federal health reform law, Medicaid expansion would add more than 600,000 lower-income Georgians to the program. Senate Democrats offered the amendment to allow the provider fee to fund expansion of the Medicaid program. The amendment failed on a party-line vote, 36-18 (Miller, 1/17).

Pioneer Press: MinnesotaCare: Legislators Ask Feds To Preserve Health Insurance Program
A bipartisan group of legislators is asking the federal government to help Minnesota tap funds that could preserve and improve the MinnesotaCare health insurance program. MinnesotaCare was created by the Legislature in 1992 as a way to provide coverage to lower-income people who don't get health insurance through their jobs (Snowbeck, 1/17).

The New York Times: Audit, Citing Mismanagement Finds SUNY Downstate In Dire Fiscal Straits
As SUNY Downstate Medical Center bled money over the past few years, 15 of the hospital's top administrators were paid taxpayer-financed salaries over $200,000, while nearly 500 lower-paid employees were sent layoff notices, according to a state comptroller's audit released on Thursday (Hartocollis, 1/17).

Los Angeles Times: California Ranks Low In Providing Special-Needs Care To Children
California children with special healthcare needs receive worse care than those in most other states, according to an analysis by the Lucile Packard Foundation for Children's Health. The foundation ranked California 46th in effective coordination of medical care and 50th for referrals to specialty care (Gorman, 1/17).

The Texas Tribune: Lawmakers Look To Medical Parole To Cut Prison Costs
As lawmakers deal with rising costs to provide health care for prison inmates around the state, some are looking to cut costs by re-examining a program that releases inmates who are deemed the oldest, sickest and most expensive. State Rep. Senfronia Thompson, D-Houston, filed HB 512 this week, a bill that would change state laws governing which prison inmates are reviewed by the Board of Pardons and Paroles for release under a program called Medically Recommended Intensive Supervision (Chammah, 1/18).

Boston Globe: Longtime Advocate To Lead Mass. AARP
A former state representative and secretary of the Executive Office of Elder Affairs has been tapped to lead the Massachusetts office of AARP, the state's largest advocacy organization for older people. AARP announced Thursday that Michael E. Festa, 58, a longtime Melrose lawyer and resident, will take over as director on Tuesday. Festa said in a phone interview that one of his top priorities will be to make sure the voices of 800,000 Massachusetts members are heard in Washington, particularly on the issue of protecting the future of Social Security. AARP figures show that Social Security accounts for 56 percent of the typical older Massachusetts resident’s income (Lazar, 1/17).

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Health Policy Research

Research Roundup: Ameliorating Physician Shortages; Patients' Perceptions Of Bias

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

Health Affairs: Primary Care Physician Shortages Could Be Eliminated Through Use Of Teams, Nonphysicians, And Electronic Communication -- The authors note that there is a consensus "that the current shortage of primary care physicians will worsen over the next ten years as the nation’s population grows and ages and as insurance coverage expands as a result of the Affordable Care Act." They examine whether workplace changes will impact that assessment.  "We show that the implementation of some increasingly popular operational changes in the ways clinicians deliver care—including the use of teams or 'pods,' better information technology and sharing of data, and the use of nonphysicians—have the potential to offset completely the increase in demand for physician services while improving access to care, thereby averting a primary care physician shortage," they write (Green, Savin and Yu, January 2013).

Annals Of Family Medicine: Clinicians' Implicit Ethnic/Racial Bias And Perceptions Of Care Among Black And Latino Patients – The researchers in this study had earlier conducted a study that found nearly two-thirds of primary care doctors showed some type of implicit bias that favored whites, "even as they rejected explicit expressions of bias." In the new study, they wanted to determine if the clinicians' explicit and implicit ethnic/racial bias is linked to minority patients’ perceptions of the care they received. After surveying nearly 3,000 patients, they concluded that "clinicians’ implicit bias may jeopardize their clinical relationships with black patients, which could have negative effects on other care processes. As such, this finding supports the Institute of Medicine’s suggestion that clinician bias may contribute to health disparities. Latinos’ overall greater concerns about their clinicians appear to be based on aspects of care other than clinician bias" (Blair et al., Jan-Feb/2013).

The Pew Center On The States: Falling Short: Most States Lag On Dental Sealants – "Dental disease also has serious consequences for state budgets. Between 2010 and 2020, annual Medicaid spending for dental services in the United States is expected to increase 170 percent, from $8 billion to more than $21 billion," the authors write. Children account for about 60 percent of Medicaid’s total spending on dental services. But while a number of states are making progress, Pew’s analysis suggests that most states are underusing the cost-effective tool of dental sealants – plastic coatings on the chewing surfaces of molars – proven to prevent tooth decay: "State policy makers also need to remove regulations that create unnecessary and costly barriers for dental hygienists, the primary practitioners who apply sealants in school-based programs" (1/8).  

The Kaiser Family Foundation: Medicaid’s Role In Meeting The Long-Term Care Needs Of America's Seniors – The authors write: "This brief examines Medicaid's key role in meeting the long-term care needs of seniors in the United States, particularly those with limited incomes. Medicaid is the nation's primary payer of long-term services and supports, and state Medicaid programs provide a range of long-term care services. The brief includes state-by-state data on Medicaid enrollment and expenditures for elderly beneficiaries" (Reaves and Young, 1/15).

The Kaiser Family Foundation: Medicaid Provider Taxes And Federal Deficit Reduction Efforts – Implementation of the automatic spending cuts in January 2013 (the sequester) that was part of the "Fiscal Cliff" was delayed two months. Medicaid is exempt from the sequester; however, Medicaid cuts could be part of an alternate deficit reduction package. One option that has been mentioned in the debate concerns revenues that states receive from taxes on medical care providers and use for their share of Medicaid spending. This "quick take" highlights the role of provider taxes in states and the possible impact of proposals to limit the use of these taxes (1/10). 

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

Reuters: Patients Rarely Told About Medication Errors: Study
In what is likely to come as little surprise, a U.S. study has found that patients and their families are rarely told when hospitals make mistakes with their medicines. Most medication mistakes did not harm patients, the researchers said in a report published in Critical Care Medicine, but those that did were more likely to happen in intensive care units (ICUs) - with ICU patients and their families less likely to be told about errors (Seaman, 1/14).

Reuters: Some Docs Screen For Prostate Cancer Without Asking
One in four family doctors doesn't ask male patients before screening them for prostate cancer, according to a new survey. So-called prostate specific antigen (PSA) testing has been controversial in recent years because of uncertainty about whether it actually saves lives and concern about side effects from potentially unnecessary and invasive follow-up tests and treatments (Pittman, 1/14).

Medscape: Surgeons, Intensivists Often Disagree on Postoperative Goals
Surgeons and other intensivists are often at odds regarding postoperative goals of care, according to findings of a cross-sectional study published in the January issue of JAMA Surgery (formerly Archives of Surgery). Among 912 surgeons surveyed, 43% reported conflict with other intensive care unit (ICU) clinicians regarding postoperative goals of care, and 43% reported similar conflict with ICU nurses (Barclay, 1/16).

Medscape: Social Media Use by Physicians Can Spur Medical Board Action
A new study has identified several online activities by physicians that are likely to result in investigation by state medical boards. S. Ryan Greysen, MD, from the University of California, San Francisco, and colleagues published their findings in the January 15 issue of the Annals of Internal Medicine. The authors mention that this study was prompted by the lack of data on what activities were likely to result in investigation. "Previous research by our group has shown that 60% of U.S. medical school deans had concerns about students posting unprofessional content [such as depicted intoxication and sexually explicit material] and that 71% of U.S. state medical boards have investigated physicians for violations of professionalism online in 1 or more of these categories," the authors write (Barber, 1/15).

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Editorials and Opinions

Viewpoints: Krugman Cautions Against Locking In Benefit Cuts That May Not Be Necessary; Lift The Freeze On CDC's Gun Research

The New York Times: The Dwindling Deficit
Well, its probable (although not certain) that, within two or three decades, the Social Security trust fund will be exhausted, leaving the system unable to pay the full benefits specified by current law. So the plan is to avoid cuts in future benefits by committing right now to ... cuts in future benefits. Huh? O.K., you can argue that the adjustment to an aging population would be smoother if we commit to a glide path of benefit cuts now. On the other hand, by moving too soon we might lock in benefit cuts that turn out not to have been necessary. And much the same logic applies to Medicare. So there’s a reasonable argument for leaving the question of how to deal with future problems up to future politicians (Paul Krugman, 1/17). 

The New York Times: The Next Four Years
Polarization is too deep. Special interests are too strong. The negotiators are too rusty. Republicans are not going to give up their vision of a low-tax America. Democrats are not willing to change the current entitlement programs. So as the president enters his second term, there has to be a new controlling narrative, a new strategy for how to spend the next four years (David Brooks, 1/17).

The New York Times: Room For Debate: Guns, Safety And Mental Health
In the days after 20 children and four adults were shot dead in a Connecticut school, calls by gun control opponents for a focus on mental health care were seen as a diversionary tactic to avoid legislation limiting America’s arsenal. But elements of both President's Obama's proposals to address gun violence and new laws on the issue in New York deal with mental health care. Some are widely welcomed, some are more contentious. But can changes in the American mental health system reduce gun violence without creating more problems? (1/18).

Health Policy Solutions (a Colo. news service): Politics Stalls Research On Gun Violence Prevention
President Obama's package of initiatives and proposals includes a memorandum to lift the freeze on the CDC's gun violence research. The president asked Congress to appropriate $10 million to pay for it. But whether it's at the CDC or another organization, whether it's $1 million or $10 million, let's agree that we should gather information to be able to elevate our dialogue to a more productive level. In the name of all victims of shootings, that dialogue should include evidenced-based discourse on weapons availability, accessibility of mental health services, the influence of the entertainment industry and other topics deemed relevant by researchers (Amy Downs, 1/17).

Kansas City Star: To Improve Mental Health, We Must First Understand It
Here’s a better idea for "arming" the nation’s teachers. Let's do it with knowledge, support and resources about the mental health of children. The suggestion comes in the wake of the Sandy Hook Elementary School shooting, from people who understand the importance of early detection and intervention. "Teachers must be taught how to identify troubled children early and to guide them into effective supports before these children get into difficulties," wrote Ron Manderscheid, executive director of the National Association of County Behavioral Health and Developmental Disability Directors. Manderscheid's note is making the rounds among mental health professionals. Many are crafting similar messages to members of Congress (Mary Sanchez, 1/18).

North Carolina Health News: Early Intervention In Youth Mental Health
Much too frequently in America, we bear witness to horrific shootings. We try to make sense of these events and ask ourselves why they happened and how to prevent future tragedies. We call for gun control – anything – to stop the insanity. No doubt, stricter gun laws are needed in this country. But we also need a humane and effective mental health system that gives priority to young persons with emerging severe mental illness (Barbara B. Smith, 1/17).

The Washington Post: Five Myths About This Year’s Flu
The rapid onset of the flu season this year has led to illness, absenteeism, hospitalizations and, tragically, death. It has also led to speculation, misinformation and just plain falsehoods about the illness and the government’s pandemic policies. Here's a primer on what’s definitely not true about the flu (Tevi Troy, 1/17).

Health Policy Solutions (a Colo. news service): New Strategy To Tackle Growing Obesity Problem
As Coloradans launch their New Year's diets, with a good percentage of them destined to fail, it's worth noting that the federal Affordable Care Act requires — for the first time — that insurance companies cover obesity screening and management without cost-sharing. Of the roughly 610,000 obese Coloradans with health insurance, many may now be eligible to sign up for treatment programs without co-pays. The health reform law requires that Medicare as well as most private insurance companies, including employer self-insured plans, cover the cost of these services for in-network providers. …  It's a good bet that many eligible Coloradans are unaware of the change (Sara Schmitt, 1/17).

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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.