Daily Health Policy Report

Wednesday, January 2, 2013

Last updated: Wed, Jan 2

KHN Original Reporting & Guest Opinion

Fiscal Cliff

Capitol Hill Watch

Health Reform

Health Care Marketplace

Coverage & Access

Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Health Care Predictions For A New Year

Kaiser Health News reporters preview some of the big issues coming this year: The fight over controlling spending and what it means for Medicare; state decisions on health law implementation; and changing how hospitals and doctors are paid. Watch the reporters' videos.

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When Employers' Health Plans Disappear, Workers Often Have Few Options

In her latest Kaiser Health News consumer column, Michelle Andrews writes: "For some people, the promise of employer-provided health insurance is reason enough to take a job or stay put in one. But unexpected events -- a corporate bankruptcy or sale, for example -- can undermine the security of on-the-job coverage and leave both employees and retirees with few affordable options" (Andrews, 12/31). Read the column.

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Feds Approve Minn. Exchange, Insurers Scramble To Develop Health Plans

Minnesota Public Radio News' Elizabeth Stawicki, working in partnership with Kaiser Health News and NPR, reports: "The federal government's conditional approval (in December) for Minnesota to operate a health insurance exchange means the state has cleared a key hurdle to develop a system designed to reshape the insurance market under the health law. Without knowing what the new plans will be required to cover, insurers say they have to hustle to develop new health plans in a matter of months, when the process would normally take at least a year" (Stawicki, 12/21). Read the story.

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Capsules: 'Doc Fix' In 'Fiscal Cliff' Plan Cuts Medicare Hospital Payments; School Cafeterias Join Fight Against Childhood Obesity; HHS Stops Short Of Calling For Safety Regulation Of Digital Records

Now on Kaiser Health News' blog, Mary Agnes Carey reports on “doc fix” details: “The bill would require that, over the next decade, hospitals pick up nearly half of the approximately $30 billion cost of stopping a 26.5 percent payment cut for Medicare physicians, scheduled to begin today” (Carey, 1/1).

Also on Capsules, Colorado Public Radio's Eric Whitney, working in partnership with Kaiser Health News and NPR, reports on changes in how school cafeterias operate: "Increasingly, though, the movement to reduce childhood obesity by improving what kids eat in school has changed the game. It means schools are now required to serve more fresh fruits and vegetables. And there’s a movement within the movement that promotes the retro notion of cooking meals from scratch. And that takes a change in the hearts and minds of those behind the lunch line" (Whitney, 12/28).

Finally, Jay Hancock writes about the latest administration effort to make fixes to the nation's electronic health records: "The Obama administration ... urged cooperation between software companies and caregivers to prevent patient harm caused by faulty electronic records. But it stopped short of calling for regulation or a federal requirement to report computer mistakes that pose a risk to patients" (Hancock, 12/21). Check out what else is on the blog

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Political Cartoon: 'Going With The Flow?'

Kaiser Health News provides a fresh take on health policy developments with "Going With The Flow?" by Arend Van Dam.

Meanwhile, here is today's health policy haiku:

TWO MORE MONTHS TIL SEQUESTRATION

Ringing in the year
with compromise? Or, will it
be more contention?
-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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Fiscal Cliff

House Follows Senate And Passes Bill To Avert 'Fiscal Cliff'

The measure, which awaits the president's signature, puts off large cuts in federal spending and increases taxes. But it delays efforts to revamp entitlement programs.

The New York Times: Amid Pressure, House Passes Fiscal Deal
Ending a climactic fiscal showdown in the final hours of the 112th Congress, the House late Tuesday passed and sent to President Obama legislation to avert big income tax increases on most Americans and prevent large cuts in spending for the Pentagon and other government programs. ... In approving the measure after days of legislative intrigue, Congress concluded its final and most pitched fight over fiscal policy, the culmination of two years of battles over taxes, the federal debt, spending and what to do to slow the growth in popular social programs like Medicare (Steinhauer, 1/1).

The Wall Street Journal: Congress Passes Cliff Deal
But the compromise bill, which blocked most impending tax increases and postponed spending cuts largely by raising taxes on upper-income Americans, left a host of issues unresolved and guaranteed continued budget clashes between the parties. ... At the same time, the bill defers some of America's toughest spending problems—in particular the ballooning cost of health care—and it doesn't come close to the kind of $4 trillion deficit-reduction deal the country's leaders had hoped to negotiate (Hook, Boles and Hughes, 1/2).

USA Today: Divided GOP House Approves Senate 'Fiscal Cliff' Plan
A divided Republican House passed the Senate's "fiscal cliff" agreement Tuesday night, following a tense day of GOP protests that the plan does not do enough to rein in federal spending. ... Spending cuts totaling $24 billion over two months aimed at the Pentagon and domestic programs would be deferred. That would allow the White House and lawmakers time to regroup before plunging very quickly into a new round of budget brinkmanship certain to revolve around Republican calls to rein in the cost of Medicare and other government benefit programs (Davis and Jackson, 1/2).

Los Angeles Times: 'Fiscal Cliff' Plan Clears House With GOP Divided
Speaking at the White House before leaving to rejoin his family on vacation in Hawaii, Obama called the compromise "just one step in the broader effort" to reduce the deficit, and specifically pointed to spending on Medicare for an aging population as the major force driving the red ink. "I am very open to compromise," he said. But, he added, "we can't simply cut our way to prosperity" (Mascaro and Hennessey, 1/1).

Politico: The Fiscal Cliff Deal That Almost Wasn't
But the failure to address several big issues sets up another fiscal showdown in late February, when the two-month delay in the sequester coincides with the deadline to raise the country's $16.4 trillion debt limit. The pact also does little to reduce trillion-dollar-plus deficits, shore up entitlement programs, overhaul the tax code or stimulate the U.S. economy — the casualty of a polarized political culture that scorns compromise (Bresnahan, Budoff Brown, Raju and Sherman, 1/2).

The Associated Press: Congress OKs Cliff Deal, Signaling Future Fights
"Now the focus turns to spending" and overhauling the tax code, [Speaker John] Boehner said in a written statement after the vote. He said the GOP will fight for "significant spending cuts and reforms to the entitlement programs that are driving our country deeper and deeper into debt," a reference to costly benefit programs like Medicare, Social Security and Medicaid (Fram 1/2).

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Congressional Accord Preserves Medicare Doctor Pay

The deal averts for one year a 26.5 percent cut in payments to doctors who treat Medicare patients. It also repeals the long-term care provision of the 2010 health overhaul.

The Wall Street Journal: Senate Cliff Bill Would Avert Cuts For Doctors
The Senate’s fiscal cliff package would avert a steep cut in payments to doctors and officially wipe out a contentious piece of the health overhaul law. The bill would delay for one year a cut in reimbursements to physicians who treat patients on Medicare, the federal insurance program for the elderly and disabled. The cost: $25.2 billion (Adamy, 1/1).

The New York Times: Insurance Program Is Cut To Help Reach An Accord
The bill, the American Taxpayer Relief Act, also freezes Medicare payments to doctors, which otherwise would have been cut by at least 26.5 percent in 2013. The Congressional Budget Office said the freeze would cost $25 billion over 10 years, with most of that coming in 2013-14. Congress offset the cost with changes in Medicare and other federal health programs. For example, it reduced Medicare payments to hospitals by $10.5 billion over 10 years after finding that many hospitals had increased their Medicare revenue by describing the severity of patients' illnesses in more detail (Pear, 1/1).

Kaiser Health News: 'Doc Fix' In 'Fiscal Cliff' Plan Cuts Medicare Hospital Payments
The bill would require that, over the next decade, hospitals pick up nearly half of the approximately $30 billion cost of stopping a 26.5 percent payment cut for Medicare physicians, scheduled to begin today (Carey, 1/1).

Roll Call: Cuts To Some Medicare Payments Provide Offsets For 'Doc Fix'
The Senate-passed fiscal cliff bill would block for one year a scheduled 27 percent cut in reimbursements for Medicare physicians, paid for by familiar cuts and adjustments to other provider payments. The bill (HR 8) would keep reimbursement rates steady through Dec. 31, 2013 — providing one more in a series of short-term patches for the Medicare physician payments (Ethridge, 1/1).

Modern Healthcare: House OKs Bill To Avert Fiscal Cliff, Doc Pay Cut
The House of Representatives late Tuesday approved the Senate's last-minute fiscal cliff package (PDF) that staves off a sharp Medicare physician pay cut by cutting billions from other Medicare providers, including hospitals, pharmacies and dialysis clinics (Zigmond, 1/1).

Politico Pro: Health Care Cuts Send Ripple Through The Industry
The potential fiscal cliff deal … squeezes health savings from a variety of places. But spreading the pain around didn’t prevent complaints from rippling through the industry and Congress. Hospitals are protesting the loudest, since about half of the agreement’s $30 billion in health care cuts would fall on their backs — and most of that $30 billion would go to preventing doctor Medicare pay cuts from kicking in under SGR this month. But insurers and pharmacies are irked as well, since some of the savings would come from trimming payments to Medicare Advantage plans and reimbursements for diabetes tests (Cunningham, 1/1).

Medpage Today: 'Fiscal Cliff' Bill Passes, Medicare Cuts Averted
The 26.5 percent cut in Medicare reimbursement mandated by the sustainable growth rate (SGR) formula was averted in a literal 11th hour vote Tuesday in the House of Representatives. The House vote to pass the "fiscal cliff" bill ok'd earlier by the Senate delays the SGR cuts for a year and pushes back another 2 percent cut for two months. The bill cleared the House by a vote of 257-167; senators had passed the same bill in an 89-8 vote just after 2:00 a.m. vote. Between the SGR and sequestor, doctors were facing a 28.5 percent in Medicare payments scheduled to take effect Tuesday (Pittman, 1/1).

Roll Call: Long-Term Care Provisions Would Be Repealed In Fiscal Cliff Bill
The bill to avert the fiscal cliff would repeal a suspended program in the 2010 health care law that has long been targeted by Republicans. ... Most Democrats resisted, saying the program needed to remain on the books so it could be improved and replaced. But the fiscal cliff bill (HR 8) would fully repeal the Community Living Assistance Services and Supports (CLASS) Act and put a commission on long-term care in its place. Including the provision is a victory for Republicans, who have been concerned that the administration could bring the program back in a form they would oppose (Ethridge, 1/1).

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Capitol Hill Watch

New Congress Means New Key Health Care Leaders, As One Steps Away

NPR: Pete Stark, Health Policy Warrior, Leaves A Long Legacy
The 113th Congress will be the first one in 40 years to convene without California Congressman Pete Stark as a member. Stark was defeated in November by a fellow Democrat under new California voting rules. Stark may not be a household name. But he leaves a long-lasting mark on the nation's health care system (Rovner, 1/2).

The Hill: Reps. Kingston, Aderholt To Lead Approps Subpanels On HHS, FDA
Reps. Jack Kingston (R-Ga.) and Robert Aderholt (R-Ala.) will lead two key Appropriations subpanels in the 113th Congress, House leaders announced Monday. House Appropriations Chairman Hal Rogers (R-Ky.) vowed that all new subcommittee chairmen would "shepherd tax dollars in a responsible, frugal and common-sense way" (Viebeck, 12/31).

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Health Reform

Businesses And Individuals Grapple With Decisions About Coverage, Penalties

News organizations preview what's to come in 2013 as provisions of the Affordable Care Act are put in place.

Kaiser Health News: Health Care Predictions For A New Year (Video)
KHN reporters preview some of the big issues coming this year: The fight over controlling spending and what it means for Medicare; state decisions on health law implementation; and changing how hospitals and doctors are paid (1/1).

Politico Pro: The Year Ahead In Health Care: What To Watch In 2013
This year, the Obama administration will have to guide the states through set-up of the exchanges — or, in many states, set them up entirely on its own. The law will have to withstand at least some level of rate shock as insurers adjust to new coverage requirements. And with deficit reduction sure to be a hot topic this year, the health law may have to withstand new attempts to dip into its funding (Haberkorn, 1/2).

NPR: What The Health Law Will Bring In 2013 
Most of the really big changes made by the 2010 health law don't start for another year. ... But Jan. 1, 2013, will nevertheless mark some major changes. One of those changes that will affect everyone with private health insurance actually took effect last September. But most people won't see it until they renew or apply for new health insurance. It's called a summary of benefits and coverage. The idea is to help people actually understand what's in their insurance policies (Rovner, 1/1).

McClatchy: New Year Means Tax Increases To Pay For Health Care Law
Five new tax increases take effect on Jan. 1 to help pay for the nation’s health care overhaul. New provisions of the Affordable Care Act require affluent taxpayers to pay more for Medicare and, for the first time, have their investment income subject to Medicare taxes as well. Also, people who use flexible spending accounts for health care expenses will pay higher taxes. And taxpayers who spend a lot out of pocket on their health care will find it harder to deduct those expenses from their taxable income (Pugh, 12/31).

The Wall Street Journal: Companies Prepare For Health Law
One of the biggest decisions for many companies this year will be what to do about their health benefits. They have just 12 months before the major provisions of the federal overhaul law take effect on Jan. 1, 2014, reshaping health coverage in the U.S. Employers with at least 50 workers will owe penalties if they don't cover full-time employees. Most Americans will face a parallel "individual mandate" to obtain insurance. And new online marketplaces called exchanges will sell insurance plans in each state, paired with federal subsidies for lower-income people (Mathews, 1/1).

The Wall Street Journal: Under Health Law, Employers Must Insure Workers' Dependents
Large employers who are subject to the health overhaul law's requirement to provide insurance or pay a fee must also extend coverage to their workers' dependent children, according to federal regulations released Friday. The 144-page proposed regulation that the Obama administration unveiled late Friday offered new details for how employers will have to comply with the health overhaul law (Adamy, 12/28).

CBS (Video): Businesses Begin Bracing For The Affordable Care Act
The new legislation will require businesses with 50 or more workers to provide affordable health care for their employees starting in 2014 or pay a penalty of up to $2,000 per worker. Businesses with fewer than 50 employees -- that's 96 percent of all companies, will be exempt. They won't have to do anything. Dr. Ezekiel Emanuel, a health policy advisor to the White House who helped develop the new plan, said the cost to businesses is a "real concern" (Mason, 1/1).

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Contraception Coverage Mandate Could Drive Health Law Back To Supreme Court

A number of challenges to the birth control coverage requirement are making their way through the lower courts. Meanwhile, a U.S. district judge issued a ruling that the property mangement firm owned by the founder of Domino's Pizza will not have to immediately comply with this health law provision.

NewsHour: Health Reform May Be Headed Back To Supreme Court In 2013
The nation's highest court may have upheld a central pillar of the law last summer -- the so-called "individual mandate" that most Americans either purchase health insurance or pay a fine -- but that doesn't mean the rest of the ACA is free from debate. Questions are slowly percolating through the lower courts -- with some possibly headed toward the Supreme Court -- about contraception coverage, the Senate's ability to "originate" a tax and the legality of the online insurance marketplaces known as exchanges. For an overview of where all these new challenges stand, we turn once again to Marcia Coyle of the National Law Journal (Kane, 1/1).

The Associated Press: Judge Halts Contraceptive Mandate For Mich. Firm
A federal judge has ruled a property management company owned by the founder of Domino's Pizza doesn't have to immediately implement mandatory contraception coverage in the health care law. U.S. District Judge Lawrence Zatkoff ruled Sunday in favor of Tom Monaghan and his Domino's Farms Corp., near Ann Arbor. Monaghan, a devout Roman Catholic, says contraception isn't health care but a "gravely immoral" practice (12/31).

The Hill's Healthwatch: Federal Judge Halts Obama's Birth Control Policy For Domino's Pizza Founder
Federal District Court Judge Lawrence P. Zatkoff issued the decision Sunday, less than two days before the policy would have taken effect and exposed Monaghan to fines for non-compliance. "Plaintiff has shown that abiding by the mandate will substantially burden his exercise of religion," Zatkoff wrote (Viebeck, 12/31).

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Health Care Marketplace

Hospitals, Nursing Homes, Pharmacies Face Changing Marketplace

News outlets are covering various aspects of the health care industry.

Bloomberg: For-Profit Nursing Homes Lead In Overcharging While Care Suffer
A report by federal health care inspectors in November said the U.S. nursing home industry overbills Medicare $1.5 billion a year for treatments patients don’t need or never receive. Not disclosed was how much worse it is when providers have a profit motive. Thirty per cent of claims sampled from for- profit homes were deemed improper, compared to just 12 percent from non-profits, according to data Bloomberg News obtained from the inspector general’s office of the U.S. Department of Health and Human Services via a Freedom of Information Act request (Waldman, 12/31).

The New York Times: Doctors Warned On 'Divided Loyalty'
With hospitals buying up medical practices around the country and seeking to make the most of their investment, the American Medical Association reached out to doctors this week to remind them that patient welfare must always come first and not be overridden by the economic interests of hospitals that now employ doctors in ever-growing numbers (Pear, 12/26).

McClatchy/Milwaukee Journal Sentinel: Aging Boomers Seen As More Of A Market Than Burden
[T]he health care industry is the most obvious benefactor of a longer-living active community. Demand for home health aides is expected to grow 70% in the next decade, according to the Department of Labor. … Concern about a drain on entitlements from retiring baby boomers has increased with worries over the fiscal cliff. … Those projections fail to take into account that boomers are expected to work longer and they've never followed in the footsteps of previous generations, said Matt Thornhill, an author of "Boomer Consumer" (Ordonez and Conley, 1/1).

Kansas Health Institute: Independent Pharmacies Pinched By Preferred Provider Networks
Preferred provider networks can help seniors save money on their prescription drugs. If a senior’s Medicare Part D plan includes a network of preferred providers and if they have their prescriptions filled at one of the participating pharmacies, they get a discount. That’s how the networks work. But most of the participating pharmacies are large, corporate owned stores in towns large enough to have a Walmart, and owners of smaller, independent pharmacies say the chains' Medicare arrangements are hurting their businesses (Ranney, 12/31)

Los Angeles Times: Medical Field Works To Reduce Number Of Surgical Mistakes
Surgical errors have attracted widespread attention over the past several years, leading to new laws and policies. In 2007, California started requiring hospitals to report certain errors and fining them if the mistakes killed or seriously injured patients. The next year, Medicare stopped paying hospitals for the costs associated with certain errors. In 2011, Medicaid announced that it also would stop paying to fix certain preventable mistakes. Nevertheless, about 2,000 patients nationwide have surgical material inadvertently left behind each year during operations. The errors have occurred during all types of procedures (Gorman, 12/23).

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Coverage & Access

Cost/Quality Relationship In Health Care Still Poorly Understood: Study

A new study examines -- and finds little clear -- on the relationship between health care quality and cost.

Medscape: Link Between Cost And Quality Of Health Care Remains Unclear
When it comes to improving health care in the United States, most discussions revolve around the twin pillars of quality and cost: Will higher expenditures result in better care, or will better clinical outcomes help to contain costs? In a review of the evidence currently available, there was no clear relationship between the two, leading the authors of an article published in the January 2013 issue of the Annals of Internal Medicine to conclude that the association between health care cost and quality is still poorly understood (MacReady, 12/31).

Meanwhile, another article looks at what happens to coverage when an employer goes out of business or drops health care.

Kaiser Health News: When Employers' Health Plans Disappear, Workers Often Have Few Options
For some people, the promise of employer-provided health insurance is reason enough to take a job or stay put in one. But unexpected events -- a corporate bankruptcy or sale, for example -- can undermine the security of on-the-job coverage and leave both employees and retirees with few affordable options (Andrews 12/31).

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Public Health & Education

A Little Extra Fat Could Be Protective

A review of almost 100 studies found that people who were overweight or slightly obese had a lower risk of dying compared to those considered "normal" weight.

The New York Times: Study Suggests Lower Mortality Risk For People Deemed To Be Overweight
The report on nearly three million people found that those whose B.M.I. ranked them as overweight had less risk of dying than people of normal weight. And while obese people had a greater mortality risk over all, those at the lowest obesity level (B.M.I. of 30 to 34.9) were not more likely to die than normal-weight people (Belluck, 1/1).

The Wall Street Journal: A Few Extra Pounds Won't Kill You—Really
But people with a BMI of 25 to 30—who are considered overweight and make up more than 30% of the U.S. population—have a 6% lower risk of death than people whose BMI is in the normal range of 18.5 to 25, according to the study, being published Wednesday in the Journal of the American Medical Association (Beck, 1/1).

NPR: Research: A Little Extra Fat May Help You Live Longer
One of the experts who takes issue with Flegal's conclusions is epidemiologist Walter Willett of the Harvard School of Public Health. ... Willett says it's not helpful to look simply at how peoples body mass indexes, or BMIs, influence their risk of death — as this paper did without knowing something about people's health or fitness. Some people are thin because they're ill, so of course they're at higher risk of dying. The study doesn't tease this apart (Aubrey, 1/2).

Reuters: More Evidence For "Obesity Paradox"
Being severely obese, however, was still tied to an almost 30 percent higher risk of death. The idea that being somewhat overweight could be linked to better health has been dubbed the obesity paradox, even though actual obesity is generally not associated with the apparent "benefit." ... The study results certainly do not give people permission to pack on extra pounds, according to Dr. Steven Heymsfield, the executive director of the Pennington Biomedical Research Center in Baton Rouge, Louisiana (Seaman, 1/1).

Meanwhile, efforts to fight fat are spurring big changes in school cafeterias -

Kaiser Health News: School Cafeterias Join Fight Against Childhood Obesity
Increasingly, though, the movement to reduce childhood obesity by improving what kids eat in school has changed the game. It means schools are now required to serve more fresh fruits and vegetables. And there’s a movement within the movement that promotes the retro notion of cooking meals from scratch. And that takes a change in the hearts and minds of those behind the lunch line (Whitney, 12/28).

And the federal government is examining energy drinks -

The New York Times: Energy Drinks Promise Edge, But Experts Say Proof Is Scant
Energy drinks are the fastest-growing part of the beverage industry ... The drinks are now under scrutiny by the Food and Drug Administration after reports of deaths and serious injuries that may be linked to their high caffeine levels. But however that review ends, one thing is clear, interviews with researchers and a review of scientific studies show: the energy drink industry is based on a brew of ingredients that, apart from caffeine, have little, if any benefit for consumers (Meier, 1/1).

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State Watch

Roundup: Medicaid Waiver Challenges In Texas; Detailing Sandy's Impact On NYC's Mental Care

The Texas Tribune: Medicaid Waiver Presents Structural Challenges
By [2012's] end, health care providers across Texas will have submitted proposals to state leaders to transform the way they care for the poor and uninsured. They have been spurred by a Medicaid waiver Texas officials sought and received in 2011 from the federal government, one that ties financing to cooperation, cost efficiency and better patient outcomes (Aaronson, 12/30).

The New York Times: Storm Weakened A Fragile System For Mental Care
Psychiatric hospital admission is always a judgment call. But in [New York City], according to hospital records and interviews with psychiatrists and veteran advocates of community care, the odds of securing mental health treatment in a crisis have worsened significantly since [Hurricane Sandy]. The storm's surge knocked out several of the city's largest psychiatric hospitals, disrupted outpatient services and flooded scores of coastal nursing homes and "adult homes" where many mentally ill people had found housing of last resort (Bernstein, 12/26).

Los Angeles Times: Reckless Doctors Go Unchecked
Kamala Harris has a powerful tool for identifying reckless doctors, but she doesn't use it. As California's attorney general, Harris controls a database that tracks prescriptions for painkillers and other commonly abused drugs from doctors' offices to pharmacy counters and into patients' hands. The system, known as CURES, was created so physicians and pharmacists could check to see whether patients were obtaining drugs from multiple providers. Law enforcement officials and medical regulators could mine the data for a different purpose: To draw a bead on rogue doctors. But they don't (Girion and Glover, 12/30).

Los Angeles Times: Medical Board Appeals To Public To Combat Prescription Overdoses
In an appeal for the public's help in stemming the epidemic of prescription drug deaths, the Medical Board of California is asking people whose relatives died of overdoses to contact the board if they believe excessive prescribing or other physician misconduct contributed to the deaths. Linda K. Whitney, the board's executive director, urged those with information about improper treatment to contact the board without delay. By law, the agency has seven years from the time of the alleged misconduct to take disciplinary action against a physician (Glover and Girion, 12/29).

Los Angeles Times: State Sued Over Medi-Cal Patients' Switch To Managed Care
Legal aid organizations filed a lawsuit Friday against the California Department of Health Care Services, alleging that the state violated patients' rights by forcing them into managed care. The suit is on behalf of five Medi-Cal recipients, all of whom have complex medical problems. Lawyers said the patients lost access to their doctors when they were automatically defaulted into managed care (Gorman, 12/23).

The Wall Street Journal: Florida 'Pill Mill' Crackdown Sets Off A Rush Into Georgia
Previously, Florida to the south was home to much of the "pill mill" trade, attracting drug dealers and addicts from thousands of miles away to stock up on prescriptions of oxycodone or hydrocodone they could either sell or use to get high themselves. But a Florida crackdown is sending the business sprinting across the border to Georgia. The rapid cross-border shift reflects how quickly operators can migrate when the business environment sours -- and why it is difficult to fight the prescription-drug epidemic on a national scale. Today Georgia is home to more than 125 clinics, up from fewer than 10 in 2010, according to Rick Allen, director of the state's Drugs and Narcotics Agency. Per capita prescription sales of oxycodone tripled between 2000 and 2010 (Martin, 12/25).

The Associated Press: Autism Bill, Other Measures Set To Take Effect In Alaska
One of the new laws set to take effect in Alaska will require health insurance policies to cover treatment of autism spectrum disorders. All or portions of a number of bills became law, effective Tuesday, with the start of 2013. … A part of the autism bill took effect earlier, establishing a task force to study issues such as the state providing insurance coverage for the disorder. The debate over autism coverage was one of the most emotional during the last regular session of the Legislature, as families and advocates descended on the Capitol to tell their stories and lobby for change (Bohrer, 12/31).

Las Vegas Review Journal: 24-Hour Mental Health Facility Sought For Las Vegas
Nevada health officials want to open a 24-hour urgent care center in Las Vegas for the mentally ill as part of a $7.5 million plan to relieve emergency rooms and provide troubled people better access to psychiatric services. The state budget proposal also includes a program to divert those with mental health problems from prisons and jails where they often don't get adequate care and are likely to return, crossing the law again if not treated (Myers, 12/31).

Boston Globe: Mass. To End Placing Of Homeless In Motels
The state government plans to eliminate a controversial emergency shelter program that places about 1,700 homeless families in motels and hotels paid by taxpayers, but housing advocates are worried officials will not be able to come up with better alternatives. Aaron Gornstein, undersecretary of the state Department of Housing and Community Development, said the state aims to phase out the program — now near peak levels — by June 30, 2014. Homeless families are placed in motels when the 2,000 rooms in the state’s family emergency shelter system reach capacity (McKim, 1/2).

Boston Globe: Network Health To Offer Insurance Through State Program
Medford-based Network Health, which provides health insurance for nearly 215,000 low- and moderate-income residents in Massachusetts, will be entering the commercial health insurance market by offering a half dozen plans through the Massachusetts Health Connector, the state’s online insurance marketplace, and through Network Health’s own website. Sixteen-year-old Network Health was acquired in 2011 by Tufts Health Plan, a large nonprofit seller of commercial health insurance in Massachusetts (Weisman, 1/2).

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Texas Judge Refuses To Stop Defunding Of Planned Parenthood Ahead Of Trial

A state district court ruled Monday that Texas' Women's Health Program can go forward without Planned Parenthood until a Jan. 11 trial is held in which the organization is challenging the state's rule excluding it from the new health care program for women.

The Texas Tribune: Judge: Texas WHP Can Proceed Without Planned Parenthood
A state district judge on Monday refused to grant a temporary restraining order allowing Planned Parenthood clinics to participate in the Texas Women's Health Program. The Jan. 1 launch of the program can proceed as planned, the judge ruled, until a trial challenging the state's rule excluding Planned Parenthood is held on Jan. 11 (Aaronson, 12/31).

The Hill's Healthwatch: Judge: Texas Can Defund Planned Parenthood
A district judge ruled Monday that Texas can exclude Planned Parenthood from its new health care program for poor women (Viebeck, 12/31).

The Associated Press: Texas Judge OKs Ban On Planned Parenthood Funding
Texas can cut off funding to Planned Parenthood's family planning programs for poor women, a state judge ruled Monday, requiring thousands to find new state-approved doctors for their annual exams, cancer screenings and birth control. Judge Gary Harger said that Texas may exclude otherwise qualified doctors and clinics from receiving state funding if they advocate for abortion rights (Tomlinson, 12/31).

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2013 Brings Health Law Deadlines, Challenges To States

News coverage of how states are planning for the health law include details of state health insurance exchanges.

Marketplace: Awaiting Approval For State Health Insurance Exchanges
Today is the day the Secretary of Health and Human Services tells states whether their plans for health insurance exchanges pass muster. These are the new insurance marketplaces provided for under Obamacare. 24 states and the District of Columbia have applied to set up exchanges. Consumers in the rest of the states can use a single, federally-maintained exchange to help find coverage when the insurance mandate goes into effect a year from today (Horwich, 1/1).

Kaiser Health News: Feds Approve Minn. Exchange, Insurers Scramble To Develop Health Plans
The federal government's conditional approval Thursday [Dec. 20] for Minnesota to operate a health insurance exchange means the state has cleared a key hurdle to develop a system designed to reshape the insurance market under the health law (Stawicki, 12/21).

Los Angeles Times: Affordable Care Act Presents Many Unknowns For California Officials
As California positions itself at the vanguard of the national healthcare overhaul, state officials are unable to say for sure how much their implementation of the federal Affordable Care Act will cost taxpayers. The program, intended to insure millions of Americans who are now without health coverage, takes states into uncharted territory. ... The [Gov. Jerry] Brown administration will try to estimate the cost of vastly more health coverage in the budget plan it unveils next month, but experts warn that its numbers could be way off (York, 12/25).

San Francisco Chronicle: Primary Care Doctors Growing Scarce
Roughly 4 million additional Californians are expected to obtain health insurance by 2014 through the federal health law, an expansion that will likely exacerbate the state's doctor shortage and could even squeeze primary care access in the Bay Area, experts say. ... The need for more primary care doctors is addressed in the federal health law through various financial incentives, and California's medical schools and hospitals are putting a greater emphasis on primary care training and expanding residency programs. But the effects of such efforts may not be felt for years (Joseph, 1/1).

St. Louis Beacon: General Assembly Returns With New Leadership And Full Agenda
When the Missouri General Assembly kicks off Jan. 9, much will be the same. Republicans will once again be the arbiters on what passes and what fails in both chambers. And Gov. Jay Nixon, a Democrat, will still serve as a check of sorts against elements of the GOP agenda he finds objectionable. But there are also significant differences that may have a big impact on the session. ... One issue on which Senate Democrats could make a mark is the effort to expand Medicaid up to 138 percent of the federal poverty level. The expansion is a key aspect of the Affordable Care Act, also known as "Obamacare" (Rosenbaum, 1/2).

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Minn. Health System Merger Complete, Largest In Twin Cities In Decade

A merger of two health systems in Minnesota completed Tuesday creates a health care organization in the Twin Cities with 20,000 employees and 1,500 doctors.

(St. Paul) Pioneer Press: HealthPartners, Park Nicolette Complete Merger
HealthPartners and Park Nicollet Health Services completed their agreement to merge organizations Tuesday, Jan. 1, formally creating an organization of 20,000 employees and 1,500 physicians. The combination, which was announced in August, is the largest seen in the Twin Cities health care market in at least a decade (Ashenmacher, 1/1).

Modern Healthcare: HealthPartners, Park Nicollet Complete Merger
HealthPartners, Bloomington, Minn., has completed its merger with Park Nicollet Health Services, St. Louis Park, Minn., in a deal that will unite the systems under the HealthPartners name and a single board of directors. No money changed hands in the transaction, the systems said after the deal was announced in August. A news release described the new organization as an "integrated healthcare and financing organization" that will allow the two systems to collaborate on areas ranging from patient care to capital investments (Kutscher, 1/1).

In the meantime, a fight over control of a large hospital in California brews --

Los Angeles Times: Battle To Control St. John's Hospital Seems Far From Over
Amid a nationwide wave of health care mergers, a deal was brewing this fall to sell St. John's Health Center, a storied Santa Monica hospital founded by Catholic nuns and befriended by Hollywood stars. Then, without notice, late last month the hospital's out-of-town owner ousted the top executives, fired most of the directors and thrust into public view a long-simmering debate about the hospital's future (Terhune, 12/25).

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Editorials and Opinions

Viewpoints: Republicans Reject Their Own Market-Based Ideas; Analyzing Entitlement Spending

The Washington Post: Republicans Rejecting Their Own Ideas
It's harder and harder for politicians on the right to think straight about health care. Conservatives once genuinely interested in finding market-based ways for the government to expand health insurance coverage have, since the rise of Obamacare, made choices that are dysfunctional, even from their own perspective. Start with the decision of the vast majority of Republican governors to refuse to set up the state insurance exchanges required under the law (E.J. Dionne Jr. 12/26). 

The New York Times: Another Fiscal Flop
Over the course of the 20th century, America built its welfare state. It was, by and large, a great achievement, expanding opportunity and security for millions. Unfortunately, as the population aged and health care costs surged, it became unaffordable. ... By 2025, entitlement spending and debt payments are projected to suck up all federal revenue. Obligations to the elderly are already squeezing programs for the young and the needy. Those obligations will lead to gigantic living standard declines for future generations (David Brooks, 12/31).

Bloomberg: Focus On Health-Care Costs Causes More Spending
In 1983, the Ronald Reagan administration enacted one of the most significant cost reforms in Medicare's history. The prospective payment system switched inpatient hospital reimbursement from open-ended fee-for-service to fixed fees paid per diagnosis. In theory, this would give hospitals the incentive to treat patients as quickly and economically as possible. The new rules did drive big changes. Since 1983, the total number of days spent by Medicare patients in hospitals has fallen 40 percent, even as the number of Medicare enrollees has risen 60 percent. The average inpatient stay is now just over five days, down from 10...The prospective payment system is only one obvious example of a long trend. Most of major developments in health care ... could be described as increasing health care's productivity. None of these achievements has lowered prices (David Goldhill, 1/1).

JAMA: The Era Of Delivery Reform Begins
Health care reform evolves in distinct phases. Insurance reform, the critical first step, gained a foothold through the 2010 Affordable Care Act. The nation now enters the midst of payment reform, a second chapter motivated by the need to slow health care spending. Payers across the country are increasingly putting health care on a budget, moving from fee-for-service to lump-sum payments for bundles of services or populations of patients. Hospitals, health care centers, and physicians in turn are consolidating into accountable care organizations (ACOs) to address these new payment contracts, which reward lower spending and higher quality (Zirui Song and Thomas Lee, 1/2).

The New York Times: The Gift Of After-Hours Medical Care
A new study shows that people who have after-hours access to their doctor use the emergency room less. Published online in the journal Health Affairs, the study found that one in five people who attempted after-hours contact with their primary care doctor reported it was "very difficult" or "somewhat difficult" to do so. But those who reported less difficulty contacting a doctor after hours, say on nights and weekends, had fewer emergency room visits than people who experienced more difficulty. I can relate at least one experience in which our pediatrician’s evening hours saved us an emergency room visit (Ann Carrns, 12/26). 

The Boston Globe: Making The Most Of Bedside Manner
One busy call night, while handling multiple admissions from our emergency room, I received a page notifying me that a new patient, Mr. T, had just arrived on the hospital floor. I looked up his medical record number, but no records were found in our computer system. I rushed to his room, expecting the worst. When I arrived, he appeared remarkably stable. The chart at his bedside provided a working diagnosis for Mr. T’s primary complaint, shortness of breath, but I wanted to hear directly from him about his condition. After reviewing his vital signs, I put down my notes, pulled a chair up, and began taking his history (Kiran Gupta, 12/31). 

The New York Times: Approaching Illness As A Team
The Cleveland Clinic, long considered a premier medical system, is gaining new renown for innovation in improving the quality of care while holding down costs. In its most fundamental reform, the clinic in the past five years has created 18 "institutes" that use multidisciplinary teams to treat diseases or problems involving a particular organ system, say the heart or the brain, instead of having patients bounce from one specialist to another on their own. ... This team approach can improve the quality of care because all the experts are involved in deciding the best treatment option, which can save time and money (12/24). 

The New York Times: Republicans Must Support Public Financing For Contraception
Two weeks ago, Gov. Bobby Jindal of Louisiana, a potential Republican presidential candidate in 2016, proposed making oral contraceptives available "over the counter." This was a remarkable — and wholly positive — postelection development. It is just the sort of bold thinking the Republican Party needs to overcome its reputation for being unsympathetic to women’s concerns (Juleanna Glover, 12/27).

Los Angeles Times: Individual Mandate In Healthcare Was Year's Top Consumer Story
This was the year of the healthcare mandate. No other consumer story of 2012 comes close. In a split decision, with Chief Justice John G. Roberts Jr. casting the deciding vote, the U.S. Supreme Court upheld the cornerstone of President Obama's healthcare reform law, the most sweeping overhaul of our dysfunctional medical system in decades. The so-called individual mandate requires that most people have health insurance. It's the trade-off for the insurance industry's agreement to stop denying coverage to people with preexisting conditions and to stop charging higher rates if you get sick (David Lazarus, 12/30).

(St. Paul) Pioneer Press: How To Ensure Children's Mental Health
As a pediatric surgeon, I have spent my career giving children a chance to become healthy adults. When children are struck by serious medical conditions, their loved ones and doctors wrestle to understand what happened and how we can make it better. We use every advantage -- research, technology, our understanding of the human body -- to help children heal and secure a chance to live out their full potential (Kurt Newman, 1/2).

Kansas City Star: In Missouri, The Smoking Addiction Lingers On
Tobacco is still a big part of international efforts to keep people smoking. The same holds true in Missouri, nearly a Third World state compared with others. At 17 cents a pack, Missouri has the lowest cigarette tax in the nation. Instead of raising the tax to 90 cents to slow sales, reduce health care costs and increase longevity, Missourians in November voted it down. The low tax encourages smokers, and a lot of people seem proud of that. The Republican-dominated state legislature appears to not care much about health. Smoking is good for business (Lewis Diuguid, 12/30). 

Kansas City Star: Health Care Expansion A Midwest Mystery Train
Often, donor-state status is unavoidable, an accident of geography: We get more in farm supports because we have more farms. But sometimes states and cities choose to become tax donors. ... Which is important to keep in mind in 2013 as legislatures in Kansas and Missouri discuss expanding Medicaid, the health insurance program for the poor. Republican lawmakers in both states have said the expansion may be too expensive, or would help implement what they call Obamacare, which they detest. Both are defensible positions. But rejecting millions in Medicaid subsidies will unquestionably turn taxpayers in both states into health care donors — Kansas and Missouri tax money will be spent on health care for the poor in California and New York. And we would be donors by choice, not geography
(Dave Helling, 1/1). 

JAMA: How And Why US Health Care Differs From That In Other OECD Countries
United States health care, often hailed as "the best health care system in the world," is also faulted for being too costly, leaving many millions of individuals uninsured, and having avoidable lapses in quality. Criticism often draws on comparisons with other countries of the Organization for Economic Co-operation and Development (OECD). This Viewpoint also makes such comparisons, over a broad range of variables, and reaches one inescapable conclusion—US health care is very different from health care in other countries. Potential reasons for the differences are discussed, leading to the conclusion that future efforts to control cost, provide universal coverage, and improve health outcomes will have to consider the United States' particular history, values, and political system (Victor Fuchs, 1/2). 

Health Policy Solutions (a Colo. news service): Easier To Buy A Gun Than To Access Mental Health Care In Colorado
Preventing gun violence means requiring a comprehensive and universal background check of both the buyer and seller in every single gun purchase in America. Preventing mass killings also means addressing the prevalence of semi-automatic assault weapons. In Colorado it is easier to purchase an AR-15 assault rifle, the one used by the shooter in Newtown, than it is to access high-quality, affordable mental health and substance use disorder treatment in the community. … It is essential that we have the resources to get individuals appropriate and affordable mental health care when and where they need it. Colorado ranks near the bottom on per capita mental health funding (Moe Keller, 12/31).

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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.