Daily Health Policy Report

Tuesday, January 22, 2013

Last updated: Tue, Jan 22

KHN Original Reporting & Guest Opinion

Administration News

Women's Health

Health Reform


Public Health & Education

State Watch

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Insurers Prod Doctors, Hospitals To Stop Elective Early Deliveries

Kaiser Health News staff writer Phil Galewitz, working in collaboration with The Washington Post, reports: "While most babies delivered at 38 weeks do not end up in intensive care, research shows they are more likely to have feeding, breathing and developmental problems than those born at 39 or 40 weeks. Since 1979, the American College of Obstetricians and Gynecologists (ACOG) has recommended against deliveries or induced labor before 39 weeks unless there are medical reasons, such as the mother's high blood pressure or diabetes or signs that the fetus may be in distress. Still, an estimated 10 to 15 percent of U.S. babies every year are delivered early without medical cause, according to the Department of Health and Human Services" (Galewitz,1/21). Read the story.

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Insuring Your Health: Hospices, Wary Of Costs, May Be Discouraging Patients With High Expenses

Kaiser Health News consumer columnist Michelle Andrews writes: "Many people who are terminally ill delay entering hospice care until just a few days or weeks before they die, in part because they or their families don't want to admit that there's no hope for a cure. … A recent study published in the journal Health Affairs found that there may be another reason that patients don't take advantage of the comprehensive services that hospice provides: restrictive enrollment policies that may discourage patients from signing up" (Andrews, 1/21). Read the column.

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Capsules: AMA Offers $10 Million To Fund Med School Innovations

Now on Kaiser Health News' blog, Mary Agnes Carey reports: "Memo to medical schools: If you have new ideas on how to train doctors, the American Medical Association may have some cash for you. The AMA says it will provide $10 million over the next five years to fund eight to 12 'bold, innovative projects'" (Carey, 1/21). Check out what else is on the blog.

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Obama: 'Medicare and Medicaid ... Strengthen Us' (Video)

This Kaiser Health News video clip features excepts from  President Barack Obama's second inaugural adress in which he discussed the need to reduce health costs, but also defended the importance of Medicare and Medicaid (1/22). Watch the video.

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Political Cartoon: 'Sniffing Out The Problem?'

Kaiser Health News provides a fresh take on health policy developments with "Sniffing Out The Problem?" by Dave Coverly. 

Meanwhile, here is today's health policy haiku:

If Not Now, When?

For the first time, an 
Inauguration address
Includes Medicaid.

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

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Administration News

Obama's Vision Includes Safety Net Programs

Drawing on language from his re-election campaign, President Barack Obama used his inaugural address to set out a promise to preserve programs like Medicare and Medicaid.

The Wall Street Journal: Obama Vows Aggressive Agenda
With specifics not usually offered in inaugural addresses, Mr. Obama promised to preserve government health-care programs, expand rights for women and gay couples, and press for gun controls, overhauls of the tax code and immigration laws, as well as climate-change measures (Lee, 1/21).

The Associated Press: Obama Stands His Ground On Fiscal Debates
But it was the paragraph that followed in his inaugural address that foreshadowed what's to come — more hard bargaining and more last-minute deals driven by Obama's own conviction that he now wields an upper hand. "We must make the hard choices to reduce the cost of health care and the size of our deficit. But we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future," he said. "The commitments we make to each other — through Medicare, and Medicaid, and Social Security — these things do not sap our initiative; they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great." This was the language of his re-election campaign (Kuhnhenn, 1/22).

The New York Times: Obama Offers Liberal Vision: 'We Must Act'
On a day that echoed with refrains from the civil rights era and tributes to the Rev. Dr. Martin Luther King Jr., Mr. Obama dispensed with the post-partisan appeals of four years ago to lay out a forceful vision of advancing gay rights, showing more tolerance toward illegal immigrants, preserving the social welfare safety net and acting to stop climate change (Baker, 1/21).

Los Angeles Times: In Obama's Inaugural Speech, A Sweeping Liberal Vision
But Obama made clear he views government as essential to fix the nation's problems and to guarantee the security of its citizens, reaffirming Democratic ideology stretching from the days of Franklin D. Roosevelt's New Deal. "Medicare and Medicaid and Social Security, these things do not sap our initiative," he said. "They do not make us a nation of takers. They free us to take the risks that make this country great." The remarks were an allusion to one of the fiercest arguments of the presidential campaign — when Republican nominee Mitt Romney described 47% of Americans, Obama supporters, as overly reliant on government — as well as to attacks on entitlement programs during recent budget battles in Congress (West and Parsons, 1/21).

Politico: President Obama's Second Term: Return Of The Liberal
President Barack Obama's second inaugural address was the most liberal speech he has delivered as president — a blunt summons to wage war on poverty, defend entitlements for the middle class, end "perpetual war" overseas and move past the calibrated progressive agenda of his first term. … In a challenge to the GOP, Obama mentioned the country's $16.4 trillion debt load once and then, only to announce his stalwart opposition to slashing Medicare, Medicaid and Social Security (Thrush, 1/21).

Modern Healthcare: Obama Sees 'Hard Choices' On Health Costs
President Barack Obama used his second inaugural address to underline his promise to reduce federal healthcare costs without cutting benefits. In an address light on healthcare references, he never mentioned his signature healthcare law, which launches its major provisions next year. Obama's speech echoed campaign trail comments that while changes are needed to keep Medicare and Medicaid solvent, they should not impact beneficiaries. … In the run-up to another round of discussions on changes to the federal entitlement programs, Obama framed the federal healthcare programs in the sharp terms of a divisive election that turned in part on Republicans' proposed changes to the federal entitlement programs (Daly, 1/21).

Politico: Obama Dodges 'Hard Choices' On Entitlements
President Barack Obama insisted four years ago that the nation must make "hard decisions" to preserve entitlement programs. But on Monday, the "hard choices" he spoke of on health care and the deficit came with a major caveat: He's not willing to give up much (Budoff Brown, 1/22).

Medpage Today: Obama Highlights Health Issues In Inauguration
Health care received a couple of direct mentions from President Obama in his inauguration speech Monday, but he stood up for entitlement programs amid ongoing calls for changes. ... Obama seemed to reference changes for the programs that some say would only shift costs or add burdens to beneficiaries. For example, Republicans in Congress have called for transforming Medicaid into a block grant program or raising the Medicare eligibility age to 67. Rep. Jim McDermott, MD (D-Wash.), told MedPage Today Monday the president was trying in his speech to inspire hope we can come together to accomplish the nation's goals- including providing healthcare for those who need it (Pittman, 1/21).

From the Republican perspective --

Lexington Herald: Sen. Mitch McConnell Says Medicare, Social Security Must Change To Fix U.S. Debt
The nation's debt is its biggest problem, and the only way to fix it is to make changes in entitlement programs such as Social Security and Medicare, U.S. Sen. Mitch McConnell said Friday. McConnell, speaking to several hundred people during Commerce Lexington's Public Policy Luncheon at the Hyatt Regency, said those changes should include raising eligibility ages over time. "Only one thing can save this country, and that's to get a handle on this deficit and debt issue," said McConnell, the Senate minority leader. "No action means the demise" of entitlement programs, he said. "We have to assure they will be there for future generations" (Brammer, 1/21).

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Administration Unveils New Set Of Medical Privacy Rules

The Obama administration released a new set of rules and protections designed to govern patient privacy under the Health Insurance Portability and Accountability Act of 1996.

Medpage Today: New HIPAA Rules Fortify Patient Privacy
Addressing 15 years of digital advances in health record information, the Department of Health and Human Services released stronger rules and protections governing patient privacy last week. The long-awaited rules enhance the Health Insurance Portability and Accountability Act of 1996 (HIPAA), which governs health records and patient information. HHS is expanding the government's scope over health care providers, health plans, and other entities that process health insurance claims to include their contractors and subcontractors -- "business associates" -- with whom they share protected health information. … The new rules increase penalties for noncompliance to a maximum of $1.5 million per violation. The changes also strengthen the Health Information Technology for Economic and Clinical Health (HITECH) breach notification requirements by making clear when breaches must be reported to HHS (Struck, 1/21).

The Associated Press: Medical Privacy Rules Get An Update
Those medical privacy rules you run into at hospitals, pharmacies and in your own doctor's office are getting an update. Regulations unveiled this week by the Obama administration create new information rights that should make life easier for consumers (Alonso-Zaldivar, 1/18).

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Women's Health

On Roe Anniversary, Poll Finds Wide Support For Abortion Access

A Wall Street Journal/NBC News poll finds that 70 percent of Americans think the landmark Supreme Court case should stand. But those against abortion continue their battle to overturn the decision with a new generation of leaders and state-by-state strategies to restrict the procedure.

The Wall Street Journal: Support Grows For Roe V. Wade
Seven in 10 Americans believe Roe v. Wade should stand, according to new data from a Wall Street Journal/NBC News poll, as the landmark Supreme Court abortion-rights ruling turns 40 on Tuesday. That is the highest level of support for the decision, which established a woman's right to an abortion, since polls began tracking it in 1989. The shift is mostly the result of more Democrats backing the decision—particularly Hispanics and African-Americans—and a slight uptick in support from Republicans (Radnofsky and Jones, 1/21).

Politico: Anti-Abortion Groups Take Page From NRA Playbook
Even before Roe v. Wade, there was the National Right to Life Committee. On this 40th anniversary of the landmark abortion decision, the NRLC remains the biggest anti-abortion group. But other groups have risen to claim the voice of the movement. Some, like Susan B. Anthony List, Americans United for Life and Concerned Women for America have brought on board a new generation of younger anti-abortion activists who are media-savvy, skilled at fundraising and able to extend the reach of the movement deep into statehouses and on ballots nationwide (Smith, 1/21).

Boston Globe: Advances in Reproductive Health Since Roe V. Wade
Tuesday will mark the 40th anniversary of the Supreme Court's ruling on Roe v. Wade that struck down many state and federal restrictions on abortions, and it's a perfect time to reflect on how much (and also how little) women’s reproductive health issues have changed since then. Abortion remains a highly charged political issue — leading Congress to continue to ban federal funding for abortion procedures. And women in most states are finding it harder lately to get one with the recent passage of more restrictions, like waiting periods (Kotz, 1/21).

CNN: Before And After Roe V. Wade
Tuesday marks the 40th anniversary of the Roe v. Wade Supreme Court decision. In a 7-2 ruling on January 22, 1973, the justices declared laws prohibiting abortion violated a woman's constitutional right to privacy. They also said states could regulate abortion procedures in the interest of a woman's health or in protecting a potential human life starting at the end of the pregnancy's first trimester. Abortion was legal under common law in the United States leading up to the 19th century, says Leslie Reagan, professor of history and law at the University of Illinois and author of "When Abortion was a Crime." Early laws only prohibited the use of toxic substances to cause miscarriages after "quickening," or when a woman feels her child move -- usually four or five months into the pregnancy (Wilson, 1/22).

NPR: 'Roe V. Wade' Turns 40, But Abortion Debate Is Even Older
Jan. 22, 2013, marks the 40th anniversary of Roe v. Wade, the landmark Supreme Court decision that legalized abortion nationwide. But the conventional wisdom that the court's 7-2 decision marked the beginning of a contentious battle that still rages today is not the case, according to those on both sides of the dispute (Rovner, 1/22).

National Journal: As Roe v. Wade Turns 40, Foes Focus On State Capitols
President Obama’s re-election bid emphasized abortion rights more than any other presidential campaign in history, warning women that their reproductive freedom was at stake on Nov. 6. But while Obama picked Supreme Court justices believed to support abortion rights and backed federal funding for Planned Parenthood, state legislatures quietly passed a record-setting number of restrictions over the past two years, according to the Guttmacher Institute (Reinhard, 1/22).

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Health Reform

Health Law's New Spending Offers Tempting Target In Search For Savings

The overhaul includes $1.7 trillion in new spending over the next decade -- which is being eyed by members of Congress for various reasons. Meanwhile, the Los Angeles Times reports on a mental health coverage gap in the health law's effort to expand access to health care, and The Washington Post reports on how employer challenges to the law are taking shape.

Politico: Affordable Care Act Still Provides Tempting Cost Savings
Republicans never got their chance to chop down President Barack Obama's health care law, but that doesn't mean it's safe from the clippers as Congress looks for solutions for tough fiscal times. The Affordable Care Act brings in a lot of new taxes and savings, but it also dishes out as much as $1.7 trillion in new spending over the next decade -- money that looks awfully tempting to lawmakers scrounging around for ways to fund other projects or pay down the deficit (Cunningham, 1/22).

Los Angeles Times: Obama Intends To Fix Holes In Mental Health Coverage
When President Obama pledged this week to strengthen the nation's mental health system to help reduce gun violence, he also implicitly acknowledged that a gap remains in his signature effort to guarantee Americans access to health care (Levey, 1/19).

The Washington Post: Employers Challenging Health Law Contraceptive Provision
The next legal challenge to the Affordable Care Act is moving quickly to the high court, and bringing potent questions about religious freedom, gender equality and corporate "personhood." The issue is the health care law's requirement that employers without a specific exemption must provide workers with insurance plans that cover a full range of birth-control measures and contraceptive drugs (Barnes, 1/20).

The Hill: Obama Officials Ditch 'Exchanges' In Rebranding Of Health Care Reform Law
The Obama administration is re-branding the central component of its signature health care law. The Health and Human Services Department suddenly stopped referring to insurance "exchanges" this week, even as it heralded ongoing efforts to prod states into setting up their own. Instead, press materials and a website for the public referred to insurance "marketplaces" in each state (Baker, 1/20).

Meanwhile, on the state level --

The Associated Press: Democrats Plan Bill For State-Run Health Exchange
A potential clash looms between the Democratic-controlled Legislature and Republican Gov. Susana Martinez over the administration's plan to implement a state-run health insurance exchange. At issue is whether state law must be changed for the exchange, which is envisioned as an online shopping center for the uninsured to buy health coverage with benefits tailored to New Mexico (Massey, 1/21).

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Amgen Drug Gets Boost In Fiscal Cliff Legislation

The New York Times: Medicare Pricing Delay Is Political Win For Drug Maker
Just two weeks after pleading guilty in a major federal fraud case, Amgen, the world's largest biotechnology firm, scored a largely unnoticed coup on Capitol Hill: Lawmakers inserted a paragraph into the "fiscal cliff" bill that did not mention the company by name but strongly favored one of its drugs. The language buried in Section 632 of the law delays a set of Medicare price restraints on a class of drugs that includes Sensipar, a lucrative Amgen pill used by kidney dialysis patients (Lipton and Sack, 1/19).

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CMS Actuary To Retire Feb. 1

Medpage Today: Bottom Line: CMS Actuary Closes Books
Rick Foster is about a year away from becoming eligible for one of the public health programs he helped oversee for nearly 2 decades. Like many people at or near that age, Foster, 64, is going to retire on Feb. 1, leaving the post of chief actuary for the Centers for Medicare and Medicaid Services (CMS) -- a position he's held since February 1995. His office is responsible for the financial analysis -- retrospective and prospective -- of Medicare and Medicaid, programs that, combined, accounted for roughly 35 percent of all health care spending in 2011. He also works with policymakers in Washington to dissect proposed healthcare legislation and changes to the two federal programs. Along the way, Foster's fingerprints can be found on major aspects of Medicare policy (Pittman, 1/19).

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Public Health & Education

$30 For A Flu Shot: An Outrage Or A Bargain?

The Los Angeles Times looks at the economics of producing a successful flu vaccine each year. And Reuters explores what may be on the horizon to improve those immunizations.

Los Angeles Times: Why Does A Flu Shot Cost So Much?
Among the long list of reasons the fearful give for reasons they're not getting a flu shot … there's one that relates more closely to economics: cost. For while doctors urge everyone to get a flu shot, flu shots, like many other things in life, are not free. Stop by your local CVS or Walgreens and you'll shell out $30 or so for the pleasure of getting poked by a needle behind a suggestion of a curtain. So why aren't flu shots free, or nearly free? After all, they've been around for a while, and there's a lot of demand -- isn't it about time flu shots cost the same as, say generic Tylenol? If only, says Curtis Allen, a spokesman for the Centers for Disease Control and Prevention. The real question should probably be -- why does the flu shot cost so little? (Semuels, 1/21).

Reuters: Insight: U.S. Government Investment Gives Flu Vaccines A Shot In The Arm
Fighting the flu may soon get easier. As early as next year, more modern and more effective vaccines will hit the market, thanks to investments by the U.S. government and pharmaceutical companies. And even bigger scientific advances are expected in the next decade, including a "universal" flu vaccine given every five to 10 years that would fight many strains of a virus, making annual shots all but obsolete (Steenhuysen, 1/19).

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State Watch

State Abortion Restrictions Having Impact

In Kansas, Pennsylvania, North Carolina and Texas, new laws limiting abortion providers spur changes for clinics and patients.

The Associated Press/ABC News: A.C.L.U. Halts Challenge In Kansas On Abortion Coverage'
The American Civil Liberties Union ended its challenge to a Kansas law restricting private health insurance coverage for abortions. A court filing shows the parties have agreed to dismiss all remaining claims ... The agreement followed a federal judge’s Jan. 7 ruling that, as a matter of law, the A.C.L.U. failed to provide any evidence that the Kansas Legislature’s predominant motivation in passing the 2011 law was to make it more difficult to get abortions (Hegeman, 1/19).

News & Observer: More Abortion Legislation May Be Headed For General Assembly
Proposals to exclude abortion coverage from federal health insurance exchanges and to outlaw abortions based on gender preferences are two pieces of legislation likely to come before the General Assembly this session, a state lawmaker said Saturday. Although North Carolina has not yet established an insurance exchange program as required by the federal Affordable Care Act, lawmakers already are planning to remove abortion coverage as a potential option, Rep. Paul “Skip” Stam said (Elder, 1/21).

Philadelphia Inquirer: Most Pa. Clinics Complying With New Abortion Law
Six months after Pennsylvania began regulating abortion clinics as outpatient surgery centers under a controversial new law, most clinics are complying - and complaining. The state lists 17 abortion providers, down from 22 a year ago. But only 13 of the remaining providers have been approved to do surgical abortions, a loss of five surgical facilities. The four remaining clinics are restricted to providing nonsurgical terminations using abortion pills. ... it's too soon to tell if the measure will drive up prices and further reduce women's access to abortion, as critics have predicted (McCullough, 1/22).

Meanwhile --

The Texas Tribune: Interactive: Are There Enough Providers In The Texas Women’s Health Program?Since Texas replaced the Medicaid Women's Health Program with the Texas Women's Health Program — an effort to exclude providers affiliated with abortion clinics and, in particular, Planned Parenthood — Democratic legislators and family planning advocates have questioned whether the remaining providers enrolled in the program have the capacity to absorb the 40,800 patients that Planned Parenthood saw last year. In response, the Texas Health and Human Services Commission conducted a survey of women's health providers near those Planned Parenthood clinics to find out whether Texas WHP patients would have trouble accessing services (Aaronson, 1/21).


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State Roundup: Ariz. Gov. Proposing Hospital Tax For Medicaid Expansion As Nev. Ponders Options

Health policy news from Arizona, California, North Carolina, Nevada, Ohio, Colorado, Kansas and Georgia.

The New York Times: Medicaid Expansion Is Delicate Maneuver For Arizona's Republican Governor
[Ariz. Gov. Jan] Brewer, who has become something of a conservative icon for her aggressive opposition to Mr. Obama's policies, surprised many Legislature watchers at her State of the State address last week by saying she wanted to expand the state’s Medicaid program to include anyone who makes up to 133 percent of the federal poverty level, or $14,856 for an individual. The risk if Arizona does otherwise, she said, is losing the federal funds and the health care jobs that come with the changes. It could be simply a case of math trumping ideology (Santos, 1/19).

The Associated Press/USA Today: Arizona To Tax Hospitals To Pay For Medicaid
Brewer is believed to be the first governor to publicly come up with a way to fund the controversial Medicaid expansion. Not even California Gov. Jerry Brown, a Democrat in a state that largely supports the new federal health plan, has figured out how to pay for a boosted Medicaid plan. Her proposal to add about 300,000 low-income Arizonans to her state's Medicaid plan relies on funding from hospitals through a so-called provider tax (Christie, 1/20).

The Associated Press: Medicaid Cost Sharing Will Be Hot Debate In Nevada
Gov. Brian Sandoval's recommendation that Medicaid recipients share in the cost of care has been met with criticism from advocates for the poor, but the agency chief who oversees Nevada's complex social safety net programs says such requirements are not a new concept (Chereb, 1/19).

The Associated Press: Report: California Not Ready To Control Inmate Health Care
It's too soon for California to retake control of its prison mental health system, a federal court overseer said Friday in dealing a blow to a proposal made by Gov. Jerry Brown last week. Too many inmates are still committing suicide and going untreated for their mental illness in California prisons, special master Matthew Lopes said in a 609-page report filed Friday in federal court in Sacramento (Thompson, 1/19).

The Associated Press: Ohio Health Insurance Company Sues State, Feds Over Health Care Power Struggle
An Ohio health insurance company is suing state and federal officials over confusion in rules for a program for patients with pre-existing conditions. At issue is a high-risk insurance pool created by President Barack Obama's health care law targeting patients turned away by insurance companies because of such conditions as cancer or heart disease. The pool is meant to act as a temporary patch until 2014, when the federal law will require insurers to accept all applicants, regardless of medical history (Sanner, 1/18).

The Associated Press: Hospitals Join To Take Big Health Overhaul Step
The two big academic medical centers serving Vermont, often seen as rivals in the past, announced Friday they are joining forces with 13 other Vermont hospitals and health clinics to form a new "accountable care organization" -- OneCare Vermont -- to focus on efficiency and quality in health care. The federal Affordable Care Act of 2010 called for the creation of such ACOs, which are designed to change the way doctors and hospitals are paid (Gram, 1/18).

Health Policy Solutions (a Colo. news service): Health Disparities In Colorado Huge, Persistent, Complex
The gap in the infant mortality rate is just one measurement by which the state’s largest groups of ethnic and racial minorities trail whites, and it is an anomaly unto itself. Colorado's infant mortality rate is lower than the national average for whites and significantly higher than the national average for Latinos and blacks. And an I-News examination of more than a decade of health data found those disparities are widening (Vaughan, 1/21). 

California Healthline: California Behind National Curve In Care For Chronically Ill Children
California is behind the national curve in caring for chronically ill children, according to a study released last week by the Lucile Packard Foundation for Children's Health based in Palo Alto. In particular, the coordination of care and access to specialists for California's chronically ill children ranks among the worst six states in the nation, according to the study. ... The study estimated about 1 million children under age 18 have a chronic health care need, such as asthma or diabetes (Gorn, 1/22). 

The Associated Press: [N.C.] State Health Officials Waited Five Days Before Informing Public Of Meningitis Threat
Days after investigators linked a deadly cluster of rare fungal meningitis cases in Tennessee to tainted back pain medication, state officials received an urgent email from the federal Centers for Disease Control and Prevention. The federal health agency said North Carolina had a possible fungal meningitis case with links to the Tennessee outbreak. If true, the CDC said it would confirm a "broader contamination issue" (1/21).

Kansas Health Institute: Local Health Departments Fret Cutback In State HIV Testing
The state health department earlier this month stopped analyzing HIV tests for many of the state's medium and small counties and also stopped providing rapid or oral test kits, which is creating a new burden for cash-strapped health departments and creating some uncertainty whether they can continue testing for the disease in some rural locations around Kansas (Shields, 1/21).

Georgia Health News: Marvel Of Telemedicine Includes Stroke Care
Georgia's telemedicine network is a jewel in the state's health care infrastructure. It's delivering medical care in rural areas, using high-definition cameras to illuminate problem areas and transmit them to a doctor hours away with clear pictures. The examinations can range from skin problems to behavioral health issues (Miller, 1/18).

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Editorials and Opinions

Viewpoints: 'A President Set To Fight' And A Speech That Argues For 'A Collective Turn'

Editorial pages react to President Barack Obama's second inaugural speech.

The Wall Street Journal: Speech Signals A President Set To Fight Over New To-Do List
On Monday, there was a clear sense that a pent-up Obama agenda had begun to tumble out—along with a clear willingness to engage in more and new partisan battles with Republicans in pursuit of it. Yes, he said, there will be an attempt to reform the tax code—a bipartisan idea if ever there was one—but also a real attempt to address climate change; more efforts to control health costs without eroding the benefits enjoyed by the elderly or disabled; efforts to advance gay rights and gender equality; a push to overhaul the immigration system; and an attempt to curb gun violence (Gerald Seib, 1/21).

The New York Times: President Barack Obama
In every sphere of life — improving education, building roads, caring for the poor and elderly, training workers, recovering from natural disasters, providing for our defense — progress requires that Americans do these things together, Mr. Obama said. That applies, he said, to "the commitments we make to each other — through Medicare, and Medicaid, and Social Security — these things do not sap our initiative; they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great" (1/21).

The New York Times: The Collective Turn
The president then described some of the places where collective action is necessary: to address global warming, to fortify the middle class, to defend Medicare and Social Security, to guarantee equal pay for women and equal rights for gays and lesbians. During his first term, Obama was inhibited by his desire to be postpartisan, by the need to not offend the Republicans with whom he was negotiating. Now he is liberated. ... We have to engage his core narrative and his core arguments for a collective turn (David Brooks, 1/21).

The Wall Street Journal: We The Government
On that theme, the speech was especially striking for including a specific defense of the federal entitlement programs that everyone knows must be reformed. Mr. Obama cited "Medicare, and Medicaid, and Social Security" by name as "the commitments we make to each other." Typically, such programmatic specificity is reserved for State of the Union speeches. Mr. Obama almost seemed to be elevating them to Constitutional rights (1/21).

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Viewpoints: Looking Back At Landmark Roe v. Wade Decision

Opinion writers reflect on the 40th anniversary of the Supreme Court decision regarding abortion.

Politico: The Sad Legacy Of Roe v. Wade
Since I entered the working world as a nurse more than 40 years ago, women have broken through unthinkable barriers. Today, more women than men are graduating from college; a record number of women are serving in Congress; and the percentage of businesses owned by women is fast approaching 50 percent (Rep. Diane Black, 1/22).

Kansas City Star: Roe V. Wade Ruling Still Worth Honoring
Forty years ago today, a U.S. Supreme Court decision guaranteed women the qualified constitutional right to terminate a pregnancy. Over the decades, that right has been fiercely opposed and defended in courtrooms, on the streets and in state legislatures. Yet it survives, and must continue to do so. An America in which women are denied the right to make the most essential decision regarding reproduction is unthinkable. Thirteen years after the landmark Roe v. Wade ruling, a Missouri case revealed a turn on the Supreme Court. The 5-4 Webster v. Reproductive Health Services decision upheld a state ban on using public facilities and employees for performing abortions (1/21).

Philadelphia Inquirer: The Success Story Known As Roe Vs. Wade
Twenty years ago I appeared in the film Motherless: A Legacy of Loss from Illegal Abortion, talking about the history of abortion. The 28-minute documentary, embedded above, profiles three women and one man whose mothers died of complications from abortion before its legalization. The film also includes the testimony of a former chief physician at Philadelphia General Hospital recalling the 32-bed ward for women being treated for what he called “botched, criminal abortions.” Surprisingly, the film is still being used in classrooms, and its message -- that the legalization of abortion following the Supreme Court’s Roe v. Wade decision saved women’s lives -- is still relevant. Tuesday is the 40th anniversary of the Roe v. Wade decision that found a woman's right to an abortion fell within the right to privacy protected by the Fourteenth Amendment to the United States Constitution (Janet Golden, 1/22).

Oregonian: Roe V. Wade Anniversary: Keep Abortion Safe And Legal
It was 40 years ago today that the U.S. Supreme Court legalized abortion in the historic Roe v. Wade case. This landmark ruling affirmed that the constitutionally protected right to privacy includes every woman's ability to make her own personal medical decisions, without the interference of politicians. Four decades later, a majority of Americans still agree with the high court: Personal health care decisions should be left up to a woman. None of us can understand a woman's specific situation. We don't walk in her shoes. … Undoubtedly, voters made it clear in 2012 that they are opposed to policies that demean and dismiss women (Laura Patten, 1/22).

The New York Times: Better Reporting For Abortions
Forty years after Roe v. Wade, Americans seem to be traveling in opposite directions on abortion. The Democratic Party’s latest platform opposes "any and all efforts to weaken or undermine" legal abortion. On the other hand, the last two years saw the adoption by state legislatures of the highest number of laws regulating or restricting abortion in decades (Charles A. Donovan, 1/21).

The New York Times: Leeches, Lye And Spanish Fly
What is most striking about this history of probes and poisons is that throughout all recorded time, there have been women so desperate to end a pregnancy that they were willing to endure excruciating pain and considerable risk, including infection, sterility, permanent injury, puncture and hemorrhage, to say nothing of shame and ostracism. Where abortion was illegal, they risked prosecution and imprisonment. And death, of course (Kate Manning, 1/21). 

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Viewpoints: A 'Fail Safe' And A 'Time Bomb' In Health Law; Reason For 'Optimism' About Health Costs?

Los Angeles Times: Healthcare Reform's Fail-Safe
Although Republicans are eager to repeal the entire 2010 healthcare reform law, they started the new session of Congress last week by taking aim at one provision in particular: the Independent Payment Advisory Board, a yet-to-be-named group of 15 presidential appointees from various healthcare disciplines that could play a key role in limiting the growth of Medicare spending. Critics argue that it's a bad idea and even un-American to put so much power in the hands of unelected bureaucrats. But with lawmakers seemingly unable to resist the pressure from the healthcare industry to spend freely on Medicare, enlisting the help of independent experts may be the only way to hold down costs (1/20).

The Washington Post: The Time Bomb In Obamacare?
A willow, not an oak. So said conservatives of Chief Justice John Roberts when he rescued the Affordable Care Act (ACA) — a.k.a. Obamacare — from being found unconstitutional. But the manner in which he did this may have made the ACA unworkable, thereby putting it on a path to ultimate extinction (George F. Will, 1/18).

The Washington Post: N. Virginia Campaign Volunteers Urge Obama To Be Bold In 2nd Term
Volunteer campaign workers who played a crucial role in reelecting President Obama have some advice for him on the eve of his Monday inauguration: Be bolder than in your first term, Mr. President. Worry less about offending conservatives. ... Lock in the benefits of Obamacare before Republicans can find new ways to undermine it. Compromise in a big way with the GOP only to reach a deal to curb the federal budget deficit. Do so even if it requires some cuts to entitlement programs like Medicare — providing the Republicans accept more tax increases and shrinkage at the Pentagon (Robert McCartney, 1/19).

The Washington Post: The Case For Deficit Optimism
You might have heard about a recent spat in which House Speaker John Boehner told the Wall Street Journal that President Obama told him, "we don't have a spending problem." Cue the shock and horror from right! In fact, what Obama said is that we have "a health-care problem," not a spending problem. This is, in general, a fairly uncontroversial point on the right, at least when it's not being made by Obama. Turns out, it’s also true. ... So here’s the good news: The growth of health-care costs has slowed in recent years. Big time. From 2009 to 2011, which is the most recent data available, health-care costs have grown by less than four percentage points. That’s compared to typical growth of six or seven percentage points through most of the Aughts. And Medicare is following suit: Spending in 2012 grew by only 3.2 percent (Ezra Klein, 1/20).

Baltimore Sun: End The 'Doc Fix' Charade, Once And For All
Doctors are breathing a collective sigh of relief because we again escaped a cut in Medicare payments. But this whole recurrent charade underscores, once again, the unresolved issue of how to pay doctors. ... It may be that we physicians are paid enough, or at least nearly so. But there is no objective way to calculate reasonable compensation for physicians. After all, what doctors do — preserving health and saving lives — is, in a sense, priceless (James Burdick, 1/22).

Bloomberg: How Whole Foods Market Innovates In Employee Health Care
Companies can make a big difference for their employees — providing good health insurance and promoting good health — all while keeping costs down. I call companies who operate this way "conscious businesses" because they understand that health care should not be only about containing costs — it should be about helping people lead healthy, vibrant, fulfilling lives. I have tried to build my own company on these principles. For example, Whole Foods Market is combating rising health-care costs through a range of innovative health-care and wellness plans (John Mackey, 1/21).

The New York Times' Opinionator: You Are Going To Die
I hadn't realized, until I was forcibly divested of it, that I'd been harboring the idea that someday, when this whole crazy adventure was over, I would at some point be nine again, sitting around the dinner table with Mom and Dad and my sister. And beneath it all, even at age 45, there is the irrational, little-kid fear: Who's going to take care of me? I remember my mother telling me that when her own mother died, when Mom was in her 40s, her first thought was: I'm an orphan (Tim Kreider, 1/20)

The New York Times: When The Patient Knows Best
In oncology, my field, any serious diagnosis almost inevitably leads to the recommendation to treat, treat, treat. As clinicians, this satisfies our need to help, to do something about this hard disease. The financial incentives in modern medicine also encourage aggressive treatment. And then there's the fact that no one wants to die. All those forces keep doctors much quieter on the subject of risks than benefits. But what a disservice that silence does to our patients, each of whom, like Amy, is an individual and wants to receive care on her own terms (Theresa Brown, 1/19). 

The Wall Street Journal: Healthier Births And Babies—With Midwives
Something has gone wrong with the way that we handle birth in this county. After nearly a century of progress, deliveries are now getting more dangerous rather than less so. The number of women who go into shock during childbirth has more than doubled in the past decade, and those who suffer kidney failure rose 97%. Globally, we are tied with Belarus in maternal mortality. As we look for solutions, we'd be well served to examine a remarkable 1920s success story that has almost been forgotten. The key was taking a more personal approach, with a focus on prenatal care, in the style of British midwives (Nathanael Johnson, 1/18).

Boston Globe: Antibullying Idea Clicks
A couple of weeks ago, Amanda Palmer, the musician who became famous as one-half of the Dresden Dolls, logged on to her computer and did something we all do but are loath to admit: She typed her name into the search engine. She calls it ego surfing. The first listing was a link to a blog item that bitterly criticized her. The critic called her a fake communist. Whatever that is. Intrigued, Palmer then typed in “Hate A...” but before she could type Amanda Palmer the auto-fill completed the name: Amanda Todd. Palmer had never heard of her, and assumed it was some sort of celebrity who would typically draw the ire of Internet trolls. But she Googled the name and found out that Amanda Todd was a 15-year-old girl from British Columbia who killed herself last fall after being relentlessly bullied (Kevin Cullen, 1/22).

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Stephanie Stapleton

Andrew Villegas

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.