Daily Health Policy Report

Thursday, January 24, 2013

Last updated: Thu, Jan 24

KHN Original Reporting & Guest Opinion

Capitol Hill Watch

Health Reform

Health Care Marketplace

Medicaid

State Watch

Weekend Reading

Editorials and Opinions

KHN Original Reporting & Guest Opinion

Fighting Painful Misconceptions About Sickle Cell Disease In The ER

Reporting for Kaiser Health News, Beryl Lieff Benderly writes: When sickle cell patients arrive at emergency rooms, they often have great difficulty getting the treatment they need. Paula Tanabe, an associate professor at the Duke University School of Nursing, is making it her mission to change that” (Lieff Benderly, 1/24). Read the story.

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Political Cartoon: 'Killing Me Softly?'

Kaiser Health News provides a fresh take on health policy developments with "Killing Me Softly?" by Harley Schwadron.

Meanwhile, here is today's health policy haiku:

TWO MORE MONTHS 

Debt deal just postpones
The inevitable: MORE
entitlement fights.
-Anonymous

Plus, here's a bonus haiku... just because:

DOUBLE COVERAGE

But can I put my
imaginary girlfriend
on my family plan?
-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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Capitol Hill Watch

House GOP Seeks Steep Spending Cuts, But Delays Day Of Reckoning

In the next budget battle chapter, House Republicans plan to demand spending cuts that would balance the budget in 10 years and require significant changes to Medicare and other safety-net programs.

The New York Times: House Votes Sidesteps An Ultimatum On Debt
Senator Harry Reid of Nevada, the majority leader … said he would take up and pass the House bill without changes as soon as next week. … He said he would then move quickly on a budget plan for the first time since 2009. "Democrats are eager to contrast our pro-growth, pro-middle-class budget priorities with the House Republicans' Ryan budget that would end Medicare as we know it … ," said Senator Patty Murray of Washington, the chairwoman of the Senate Budget Committee. House Republicans appeared eager for that fight. For two years, the House has passed detailed but nonbinding budget plans that would cut domestic programs …  enact changes to Medicare that would offer older people fixed subsidies to buy private health insurance, and mandate a much-simplified tax code. … Now, Republicans said, the debate will be over numbers (Weisman, 1/23).

Los Angeles Times: House GOP Seeks Steep Cuts While Raising Debt Ceiling
Stepping up their austerity campaign, House Republicans plan to demand far deeper spending cuts from President Obama to balance the federal budget in just 10 years, an extraordinary goal that would hit Medicare and other safety-net programs. House Speaker John A. Boehner (R-Ohio), confronted with a more conservative Republican majority, agreed to the dramatic initiative to coax reluctant rank-and-file lawmakers Wednesday to approve a temporary suspension of the $16.4-trillion debt limit without any cuts in spending (Mascaro, 1/23).

The Associated Press/Washington Post: A Revised Deficit Collision Course: Senate Dems Eye New Taxes, GOP Seeks Deeper Spending Cuts
The nation's sharp disagreements over taxes and spending are on a re-routed collision course, as Senate Democrats launch a plan that includes new taxes and House Republicans vow to speed up their plan to balance the federal budget with spending cuts alone. The Republicans' new approach would require even deeper cuts in social programs than they pushed last year. Liberals denounced those earlier plans as severe and unfair, and they say the new version would be worse (1/24).

The Wall Street Journal: Passing Debt Bill, GOP Pledges End To Deficits
The House defused one potential debt crisis Wednesday, while a top Republican set the stage for a far broader debate over whether it is possible to actually balance the U.S. budget in coming years (Hook, Boles and O'Connor, 1/23).

The Wall Street Journal's Washington Wire: Ryan Expects 'Big Down Payment' On Debt
The Wisconsin Republican, long a favorite of conservative activists, said the budget would rely on the new tax revenue Congress agreed to earlier this month. But he provided few other details for how he would plan to erase deficits that exceed $1 trillion beyond broad promises to cut additional money from popular entitlements and other safety nets for the poor and elderly, highlighting Medicaid, the health-care program for low-income Americans (O'Connor and Boles, 1/23).

Politico: Next Up: Sequester, Budget Resolution
The dueling House and Senate budget resolutions could force the two parties into a serious policy debate over cuts to Medicare, Social Security and Medicaid — as well as whether to raise new taxes through a reform of the Tax Code — something that was largely avoided in the previous Congress. How this is resolved will define Obama's second term in office and whether Capitol Hill can finally get a handle on its finances — or fall into yet another crisis (Raju and Bresnahan, 1/23).

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SGR Fix On House Subcommittee's To-Do List

The GOP leaders of the House Ways and Means Committee are "determined" to solve the "Sustainable Growth Rate problem" this year. Meanwhile, House Democrats are reviving a bill to prevent some workers from avoiding Medicare taxes.

PoliticoPro: Brady: Camp Determined To Get 'Doc Fix' This Year
Hopes of a permanent doc fix are already brewing again in the House. Powerful Ways and Means Committee Chairman Dave Camp is determined to solve the Sustainable Growth Rate problem once and for all, says Rep. Kevin Brady, the newly installed chairman of the panel's Health Subcommittee (Cunningham, 1/23).

The Hill: Dem Bill Named For Gingrich Targets Medicare Tax Loophole
House Democrats are bringing back a bill to prevent some workers from avoiding Medicare taxes. The Narrowing Exceptions for Withholding Taxes (NEWT) Act was first introduced by former Rep. Pete Stark (D-Calif.), who accused Newt Gingrich of exploiting the Medicare loophole to save $69,000 in 2010 (Viebeck, 1/23).

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Health Reform

Employer-Insurer Coalition Asks HHS To Pare Essential Benefits

Employers, insurers and health providers worry that requiring expansive coverage in the policies sold in health insurance markets could make insurance unaffordable.

Modern Healthcare: HHS Urged To Keep Essential Benefits Affordable For Small Business
A coalition of business groups, health plans and health care providers is urging HHS to follow private-sector approaches as the department develops a final rule on the essential health benefits that individual and small-group plans must cover as part of the 2010 health care reform law. The Essential Health Benefits Coalition, whose membership includes the National Retail Federation, the U.S. Chamber of Commerce, America's Health Insurance Plans, the American Osteopathic Association and the Pharmacy Care Management Association, submitted a list last month of six recommendations to HHS in response to the department's November proposed rule on essential health benefits (Zigmond, 1/23).

CQ Healthbeat: Employers, Insurers Press CMS To Prune Essential Benefits
The growing concern among insurance analysts that coverage will be unaffordable in the new health care exchanges might create a fresh opportunity for federal officials to be persuaded to trim requirements in the final essential health benefits rule, which is expected out in February or March. Employers and insurers certainly hope so. With a few weeks to go before the final version is expected, they held a news briefing Wednesday to highlight six recommendations for shaping the rule in a way that they say makes coverage less costly (Reichard, 1/23).

Premiums for smokers under the health law are also getting attention --

California Healthline: The Premium Conundrum: Do Smokers Get A Fair Break Under Obamacare?
The Affordable Care Act contains a number of provisions intended to incent "personal responsibility," or the notion that health care isn't just a right -- it's an obligation. None of these measures is more prominent than the law's individual mandate, designed to ensure that every American obtains health coverage or pays a fine for choosing to go uninsured. But one provision that's gotten much less attention -- until recently -- relates to smoking; specifically, the ACA allows payers to treat tobacco users very differently by opening the door to much higher premiums for this population. That measure has some health policy analysts cheering, suggesting that higher premiums are necessary to raise revenue for the law and (hopefully) deter smokers' bad habits. But other observers have warned that the ACA takes a heavy-handed stick to smokers who may be unhappily addicted to tobacco, rather than enticing them with a carrot to quit (Diamond, 1/23).

In the meantime, the GOP returns to efforts to repeal parts of the health law in a new Congress --

Modern Healthcare: New Session Of Congress Brings More Anti-Reform Legislation
New year, same resolution. Just weeks into the 113th Congress, GOP lawmakers are making attempts to dismantle the 2010 healthcare law, and one of those efforts has bipartisan support. That's the legislation introduced today by Rep. Phil Roe (R-Tenn.) to repeal the Patient Protection and Affordable Care Act's contentious -- and unpopular -- Independent Payment Advisory Board. Roe, a physician, introduced his bill in the last Congress and more than 230 co-sponsors signed onto it, including 20 Democrats (it later passed as part of other legislation). The bill Roe introduced today currently has 83 original co-sponsors from last year's legislation, and a spokeswoman for Roe said in an e-mail that his office expects the bill to gain support (Zigmond, 1/23).

National Journal: Critics Of Medicare Board Should Be Careful What They Wish For
Of the controversial elements of the president’s health reform law, the provision with perhaps the most bipartisan opposition is its Medicare cost-containment board. The Independent Payment Advisory Board, sometimes called a "rationing board" or "death panel" by its detractors, is designed to help control Medicare spending. Its 15 Senate-confirmed members have the authority to craft new Medicare payment policy with the force of law if costs grow faster than a specified rate. What many critics don’t realize is that if that 15-person board is not assembled, the law hands a lot of power to the secretary of Health and Human Services (Sanger-Katz).

And a former player in the health law's march through Congress sizes up his new role --

Politico: Nelson: From 60th Vote To ACA's Implementation
As CEO, earning nearly $1 million a year, [former Sen. Ben] Nelson will be a leading intermediary between the states and Washington. The states are trying to implement the wide-ranging law without sinking their health insurance markets -- or giving up too much of their traditional regulatory turf. And the U.S. Department of Health and Human Services is working like mad to get the law ready in time for 2014 -- including in states that aren't exactly bending over backward to help (Millman, 1/23).

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Votes, Plans Heat Up Medicaid Expansion Issue In States

Lawmakers and officials in Wyoming, Mississippi, Florida, Colorado and California hold hearings, take votes and consider their very different stances on whether to expand their Medicaid programs.

The Associated Press: Wyoming Lawmakers Vote Against Medicaid Expansion
Wyoming will reject federal money for an expansion of Medicaid intended to cover tens of thousands of low-income residents if the state Senate follows the advice of a legislative committee. The Senate Labor Health and Social Services Committee voted 4-to-1 Wednesday to recommend the full Senate kill a bill that would add nearly 18,000 people to the Medicaid rolls in the state (1/24).

The Associated Press: Some Miss. Hospitals Backing Medicaid Expansion
Some Mississippi hospital administrators say they worry about bad financial consequences if the state doesn't expand Medicaid under the federal health care overhaul. Specifically, they worry hospitals will have to continue providing care for uninsured people even if the federal government stops reimbursing part of the expense (Pettus, 1/23).

Health News Florida: Senators Tackle Medicaid Economies
State Senate committee hearings tend to be long on detail, short on excitement. But Tuesday saw an impassioned debate between two high-profile health economists with opposite views on the Patient Protection and Affordable Care Act (PPACA). The Select Senate Committee on PPACA heard dueling arguments from Massachusetts Institute of Technology professor Jonathan Gruber, who helped design a health plan in his state in 2006 that became the model for the 2010 federal law (Gentry, 1/24).

Health Policy Solutions (a Colo. news service): Better Care Grounds Medicaid Frequent Flyers
Then everything changed almost overnight last April when [one patient] became one of the first patients in an "accountable care" program that aims to revolutionize Medicaid in Colorado. The new initiative could be one of the keys to Gov. John Hickenlooper's plan to cut Medicaid costs while simultaneously adding about 160,000 new low-income patients. Earlier this month, Hickenlooper announced that Colorado plans to expand Medicaid. The governor projected that Medicaid expansion would cost $128 million over 10 years, but vowed to save as much as $280 million through cuts and more efficient care (Kerwin McCrimmon, 1/23).

California Healthline: Health Care Stakeholders Await State Of State, Special Session
The State of the State speech today by Gov. Jerry Brown (D) could kick off a flurry of health care activity in California. The governor is expected to address the state's decision to join the Medicaid expansion (Medi-Cal in California) in today's speech. Two options proposed by Brown -- county- and state-based plans -- will be hashed out in the upcoming month or two, most likely during the Legislature's special session on health care. State health officials have said the special session will be called by Brown by the end of January (Gorn, 1/24).

If governors reject the expansion, it could leave some U.S. citizens in those states without coverage while some legal immigrants get it --

The Associated Press: Immigration Fallout From Saying No To 'Obamacare'
Governors who reject health insurance for the poor under the federal health care overhaul could wind up in a politically awkward position on immigration: A quirk in the law means some U.S. citizens would be forced to go without coverage, while legal immigrants residing in the same state could still get it (Alonso-Zaldivar, 1/23).

And a poll finds wide support among voters in key states for the Medicaid expansion --

The Hill: Poll Finds Broad Support For Medicaid Expansion
Registered voters in seven states want their governors to participate in the Medicaid expansion under President Obama's health care law, according to polling released Wednesday by the American Cancer Society Cancer Action Network (ACS CAN). The survey found majority support for the Medicaid expansion in each of the seven states surveyed, some of which are on the fence about the expansion (Baker, 1/23).

Medpage Today: ACS Poll Shows Support For Medicaid Expansion
Voters by large margins in seven key states supported expanding Medicaid programs as provided for under the Affordable Care Act (ACA), according to a poll conducted by the American Cancer Society (ACS) Cancer Action Network. Registered voters in Florida, Iowa, Kentucky, Michigan, New Jersey, and New Mexico -- states that are all still deciding whether to expand their Medicaid programs under the ACA -- supported expansion by margins ranging from 38 percent to 49 percent, the ACS said Wednesday. Voters in Texas -- a very conservative state with a governor already against expansion -- supported the move 58 percent to 30 percent (Pittman, 1/23).

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Health Care Marketplace

WellPoint Profits Up 38% As Insurer Girds For Big Changes In 2013

WellPoint's 4th quarter earnings surged even as the company offered a cautious outlook for 2013 as it prepares to sell policies in new online health insurance marketplaces and expands its Medicare Advantage business.

Los Angeles Times: WellPoint's 4th Quarter Profit Jumps
But the company said it remains cautious about the year ahead in light of federal budget battles over Medicare and Medicaid and upheaval in the health insurance markets from the federal Affordable Care Act. WellPoint estimated full-year earnings of $7.60 a share, below analysts' expectations of $7.94 a share compiled by FactSet. The Indianapolis company said the search is still underway for a new CEO to replace Angela Braly, who stepped down in August after major shareholders expressed dissatisfaction with the company's performance (Terhune, 1/23).

The Associated Press/Washington Post: WellPoint 4th Quarter Profit Jumps 38 Percent; Insurer Says Costs Could Weigh On 2013 Performance
WellPoint Inc.'s fourth-quarter earnings jumped 38 percent compared to the final quarter of 2011, when the nation’s second largest health insurer incurred a big hit from its Medicare Advantage business (1/23).

The Wall Street Journal: WellPoint Earnings Rise 38% Amid Light Commercial Costs
Health insurers are preparing for the planned opening of state-based exchanges for individuals and small businesses. People will be able to seek plans there for coverage starting in 2014, potentially putting millions of new members in play for health insurers. Meantime, the industry is also aiming to add business as states expand Medicaid coverage under the health law and create new plans to cover high-cost people on Medicaid and Medicare, known as dual eligibles. WellPoint recently closed on a $4.46 billion purchase of Medicaid insurer Amerigroup to help chase the emerging dual-eligible market while lessening its tilt toward individual and small-group markets, which are considered most exposed to the exchanges (Kamp, 1/23).

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Medicaid

Survey: States Progress On Medicaid Upgrades, But Much Remains To Be Done

According to the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families, states are hustling to prepare for coverage changes whether or not they participate in the health law's expansion. 

Politico: States Hustle To Modernize Medicaid
Whether states accept or reject the Medicaid expansion under the health law, they've got plenty of work to do to get ready for big changes in coverage next year. And as of Jan. 1, 47 states had grabbed or requested bonus federal dollars to upgrade their aging Medicaid enrollment systems, according to a state survey released Wednesday from the Kaiser Commission on Medicaid and the Uninsured and the Georgetown University Center for Children and Families (Millman and Smith, 1/23).

Modern Healthcare: Much Work Remains On Medicaid Upgrades, Survey Finds
States have made progress in implementing Medicaid upgrades required by the 2010 federal health care overhaul but much work remains to be done, according to an annual survey of all 50 programs. Only about 20 states have indicated that they expect to expand their Medicaid programs' eligibility to all residents with incomes of up to 138 percent of the federal poverty level, as authorized by the Patient Protection and Affordable Care Act, said Diane Rowland, executive director of the Kaiser Commission on Medicaid and the Uninsured. The Supreme Court's 2012 decision upholding the law eliminated financial penalties for states that do not undertake the expansion. All states are required to implement upgrades to their systems by next year, but relatively few have completed these, according to her group's 12th annual survey of the states (Daly, 1/23).

Earliler, KHN coverage: Report: States Making It Easier To Apply For Medicaid (Galewitz, 1/23).

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State Watch

States Roundup: Jindal Reverses Medicaid Hospice Cut

A roundup of health policy news from Massachusetts, Louisiana, Georgia, Minnesota, Virginia, California and Kansas.

The Associated Press/Miami Herald: Massachusetts' Law Set Stage For National Health Overhaul, Becomes A Template For Other States
When Massachusetts adopted its landmark health care law in 2006, the goals were ambitious and the potential solutions complex. ... What are they getting in return? ... more people visiting doctors, more employees getting coverage through their jobs and an increase of insured residents to 98 percent, far above the national average, ... Other states would also do well to note the difficulties resulting from the law: a shortage of primary care doctors, which is expected to be an unintended consequence of the federal law, and an increase in the number of procedures that insurers were required to pay for, which raised costs (LeBlanc, 1/24).

Politico: Ex-Medicare Chief Moves Toward Run For Governor
Former Medicare chief Don Berwick stepped closer to a run for Massachusetts governor this week, organizing a fundraising committee that will test the traction of a potential candidacy. "This does not represent a change. In other states, this would be called an exploratory committee," Berwick, a Democrat, told POLITICO on Wednesday. "I've not set a deadline for a final decision" (Cheney, 1/24).

The Associated Press: Louisiana Shelves Cut To Medicaid Hospice Program
Louisiana Gov. Bobby Jindal's administration scrapped plans Wednesday to shutter the state’s Medicaid hospice program in February, meaning the state will continue to provide end-of-life care to people on their death beds who can't afford private insurance. Jindal's health secretary Bruce Greenstein made the announcement as hospice program supporters were gathering for a candlelight vigil on the state capitol steps to protest the cut (Deslatte, 1/24).

Georgia Health News: Project Shows Progress On Hospital Readmissions
Fourteen communities in a national care improvement project — including an area in suburban Atlanta — saw a significant decrease in Medicare patients who were rehospitalized within 30 days of a discharge, a new study shows. ... This area — designated a community for purposes of the project — is east of the city of Atlanta. Overall Medicare hospitalizations in that area also fell by 7.37 percent. The group of 14 communities nationally reduced readmissions by 5.7 percent over a two-year period, vs. a 2 percent drop in a control group. (Miller, 1/23).

The Associated Press/ABC News: After Shootings, States Rethink Mental Health Cuts
Dozens of states have slashed spending on mental health care over the last four years, driven by the recession's toll on revenue and, in some cases, a new zeal to shrink government. But that trend may be heading for a U-turn in 2013 after last year’s shooting rampages by two mentally disturbed gunmen. The reversal is especially jarring in statehouses dominated by conservative Republicans, who aggressively cut welfare programs but now find themselves caught in a crosscurrent of pressures involving gun control, public safety and health care for millions of disadvantaged Americans (Beaumont, 1/23).

Kansas Health Institute: Mental Health Initiative To Target People Headed For Jail Or Mental Hospitals
A new mental health initiative proposed earlier this month by Gov. Sam Brownback would target services to mentally ill people considered most at risk of being jailed or sent to a state hospital. Additional details of the plan, which is still on the drawing board, were described today at a meeting of the Mental Health Coalition of Kansas (Ranney, 1/23).

MPR: Bill Would Fund Spine, Brain Injury Research
Two DFL lawmakers are proposing to create a state grant program that would dedicate $4 million each year to spinal cord and traumatic brain injury research. Senate author Jeff Hayden of Minneapolis said his legislation would funnel the state funds to a public research entity. Hayden said the state should be a partner in finding a cure for spinal and brain injuries because the state often pays for the long-term care associated with the conditions (Benson, 1/23).

HealthyCal: Urban Babies More Likely To Be Hospitalized
Babies living in California’s rural counties were less likely to be hospitalized in the first year of life than their urban counterparts, according to a recent study published in the journal Pediatrics. Researchers analyzed records for more than 6.4 million babies born in California between 1993 and 2005, calculating the rate of non-birth hospital utilization before the babies’ first birthdays (Bartos, 1/24).

The Associated Press: Va. Agency Pulls Public Access To Hospital Reports
The Virginia Department of Health will no longer provide public access to its hospital complaint investigations after an Associated Press story found inconsistencies in the probe of a woman's care at Inova Fairfax Hospital. The change in policy was ordered by the federal agency that oversees Medicare and Medicaid, ... Inova has denied wrongdoing and said its care was appropriate. No action has been taken against the hospital (Barakat, 1/23).

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Weekend Reading

Longer Looks: Mississippi's Last Abortion Clinic; Rural Docs

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

Boston Globe: End-Of-Life Care Rarely Discussed
Precious final days for many Massachusetts residents are still not spent the way they would have chosen — at home with loved ones — but in a hospital. And health-care providers do not routinely discuss end-of-life care preferences with patients, said Dr. Lachlan Forrow, director of ethics and palliative care programs at Beth Israel Deaconess Medical Center, and chair of the expert panel [two years ago]. ... [The panel]suggested Massachusetts launch a high-visibility public education campaign about the need for advance end-of-life care planning. It recommended training for caregivers, who often receive little guidance about discussing the sensitive issue with patients. ... The panel also suggested Medicaid be revamped to ensure that all low-income patients have insurance coverage for hospice care, and state websites post information about end-of-life services available at each hospital. Budget cuts have stalled progress on many of the panel’s recommendations (Kay Lazar, 1/21).

American Medical News: Death Certificates Present Final Medical Complication
Death certificates are vital documents that serve as the primary source of information for families, insurance companies and authorities about a patient's cause of death. The information also helps policymakers set public health goals and research funding priorities. But signing a death certificate is not always a straightforward process. Physicians often face uncertainties about an individual's cause of death or how to answer the portions of certificates they are responsible for. Although the basic format has changed little in the last few decades, doctors face difficulties as some states attempt to convert from paper to electronic certificates (Carolyne Krupa, 1/21).

National Review: Treat The 1 Percent: Our Mental-Health System Is Failing Those Most At Risk
Erika Menendez, the 31-year-old woman who is alleged to have pushed a man to his death beneath a subway train in New York City, represents everything that is wrong with America's system of treating the mentally ill. ... State mental-health officials declined to confirm that Menendez had been diagnosed with a psychiatric condition, invoking patient privacy. ... In truth, these invocations of patient privacy have little to do with the privacy of the patient — federal law allows the release of information for issues of “serious threat to health and safety" and "public interest and benefit activities" — and much to do with covering up the incompetence of the mental-health institutions (E. Fuller Torrey, 1/28).

Mother Jones: Inside Mississippi's Last Abortion Clinic
Jackson Women's Health Organization holds the dubious distinction of being Mississippi's only remaining abortion clinic. In 1981, there were 14, but thanks in part to increasingly repressive legislation, the others have closed. Last April, Republican Gov. Phil Bryant signed a new law requiring any doctor performing abortions in the state to have permission to admit patients at a local hospital. That's a problem for Jackson Women's Health, since neither of its two doctors—both of whom fly into Mississippi to provide abortions—has admitting privileges. ... The state requires abortion clinics to abide by many of the same building codes as hospitals, even though other medical offices don't have to follow these rules. ...The Center for Reproductive Rights has challenged the new law, and the state department of health has given the clinic until January to comply. If it fails, Michelle Movahed, an attorney at the center, worries that the closure could set off a domino effect, with more and more legislatures using red tape to close clinics—in effect nullifying Roe v. Wade one state at a time (Kate Sheppard and Matt Eich, 1/22).

Los Angeles Times: Central Valley Physicians Dispense More Than Medical Care
Thirty years ago, Oscar (Sablan) and his wife, Marcia, made a plan: work in a rural area for three years and walk away without any medical school debt. So they moved from tropical Hawaii to dusty Firebaugh and started a practice in a trailer on the corner of O and 9th streets. They didn't intend to stay. They are still here, the only full-time doctors in town, treating many of the same families as when they arrived. ... But now Oscar is 61 and Maria is 65, and they realize they can't do this forever. ... But they're worried about what will happen to their patients. ... Much of inland California is made up of towns just like Firebaugh, where large swaths of the population are uninsured, where traveling to a hospital means a long drive, and where doctors and pharmacists are in short supply (Anna Gorman, 1/22). 

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Editorials and Opinions

Viewpoints: GOP's Hope To End Deficits In 10 Years Will Mean 'Dramatic Cuts' In Entitlements; Mass. Health Overhaul Brings Need For More Taxes

Los Angeles Times: Paul Ryan's Next Budget: More Of The Same – A Lot More
Ryan has a daunting new assignment that may make that message even more difficult to sell. He's been charged by House Speaker John A. Boehner with drawing up a new budget that will erase the federal deficit within 10 years (the first Ryan budget, written in 2011, needed 30 years) solely through spending cuts -- no new tax revenues allowed. That means Ryan's next budget will require even more dramatic cuts in "entitlements" -- Medicare, Medicaid and Social Security -- than the last one (Doyle McManus, 1/23).

The New York Times: A Debt Crisis Averted, For Now
If the House actually wants to put forth a balanced budget over the next 10 years, as Mr. Boehner vowed to do on Wednesday, let the public see what that really means: unimaginable cuts and changes to Medicare and Medicaid, and the elimination of scores of popular and vital programs that benefit both the poor and the middle class. Up to now, Republicans have been understandably wary of specifying how that would be done without raising taxes (1/23). 

The New York Times’ Opinionator: When Paying It Forward Pays Us Back
Many of the most effective (social programs) are not a mere expense to be trimmed off a budget; they often can and do save considerable money for society. ... One such example is the Transitional Care Model (TCM), which provides planning and home follow-up by trained nurses for chronically ill Medicare patients during and after hospitalization. The TCM illustrates a key point. Often, to save money you need to change systems, or add new functions, not just cut things (David Bornstein, 1/23). 

The Wall Street Journal: The RomneyCare Bill Comes Due
The health reform that Mitt Romney passed in 2006 in Massachusetts presaged President Obama's, and its results are showing what we can expect nationwide. The latest warning comes in a huge new tax increase proposed by Governor Deval Patrick. Last week the second-term Democrat followed his party's recent habit and proposed an increase in the state's single-rate income tax ... The lesson for voters is that universal health care is going to have universally large costs. The middle class will pay the bill, as they are starting to do in Massachusetts (1/23).

The Washington Post: Obama's Mainstream Pitch
Obama’s address was firmly in the mainstream ... The speech sounded so robustly liberal not because the president or his party has changed but because the Republican Party has, moving far outside the norms of American political thought. ... But in a world in which Republicans have endorsed a budget that would eviscerate Medicaid and turn it into a block grant and that would change Medicare into a voucher program whose value would quickly be overtaken by inflation, protecting the integrity of these programs suddenly sounds bold. Note that Obama did not say these programs were immune from reform (Kenneth S. Baer, 1/23). 

JAMA: Embracing (or Not) The Medicaid Expansion 
[I]t’s important to keep things in perspective. Many are worried that if the law is not implemented immediately and fully, then it will fail. This certainly wasn’t the case with the original passage of Medicaid in 1965. Only 26 signed up in the first year after Medicaid began; it wasn’t until about 18 years later, in 1982, that the last state, Arizona, agreed to participate. That didn’t prevent Medicaid from becoming as American as apple pie (Dr. Aaron E. Carroll, 1/23).

The New York Times' Opinionator: Misconceptions 
Last year alone, 19 state legislatures enacted a total of 43 new restrictions on access to abortion (six states accounted for more than half the new restrictions, with the ever-reliable Arizona leading the pack with seven).  ... At the time I graduated from high school, a year before the Supreme Court decided Griswold v. Connecticut, not only was abortion still illegal in my home state, but so was birth control, even for married couples. Every time I drove by the building, and especially this week, I think to myself that despite all the worries and perturbations of the last 40 years, there’s progress (Linda Greenhouse, 1/23).

Medpage Today: WANTED: 'EMR 3.0' For Dummies
Like most of my colleagues, I can tick off at least five or six large "pioneer" corporations – companies like Epic, Cerner, Allscripts, Siemens – in the forefront of the technology explosion that yielded important tools for advancing the field of electronic medical records (EMRs). Although research into their impact on quality of care and patient safety remains modest and is often controversial, these tools have eliminated considerable issues related to poor physician handwriting and have greatly improved internal and external provider communications and reporting (Dr. David Nash, 1/23).

Palm Beach Post: Let State Deny Greed-Based Health Insurance Increases
Though medical costs have slowed as fewer Americans seek health care because of the economy, insurance premiums in some states are rising as high as 25 percent. Critics blame the Affordable Care Act, even though key provisions don’t take effect until next year. In fact, Obamacare is only partly responsible. Insurers get most blame as they seek maximum profits before the health care landscape drastically changes (Rhonda Swan, 1/23).

The New England Journal of Medicine: The Underside of the Silver Tsunami — Older Adults and Mental Health Care
Approximately 5.6 million to 8 million Americans 65 years of age or older have mental health or substance-use disorders, and the Institute of Medicine (IOM) estimates that their numbers will reach 10.1 million to 14.4 million by 2030. ... Older adults with mental health disorders have greater disability than those with physical illness alone, as well as poorer health outcomes and higher rates of hospitalization and emergency department visits, resulting in per-person costs that are 47% to more than 200% higher. Yet mental health services account for only 1% of Medicare expenditures (Dr. Stephen J. Bartels and John A. Naslund, 1/23).

The New England Journal of Medicine: A Different Model — Medical Care in Cuba
Any visitor can see that Cuba remains far from a developed country in basic infrastructure such as roads, housing, plumbing, and sanitation. Nonetheless, Cubans are beginning to face the same health problems the developed world faces, with increasing rates of coronary disease and obesity and an aging population (11.7% of Cubans are now 65 years of age or older). Their unusual health care system addresses those problems in ways that grew out of Cuba's peculiar political and economic history, but the system they have created — with a physician for everyone, an early focus on prevention, and clear attention to community health — may inform progress in other countries as well (Dr. Edward W. Campion and Stephen Morrissey, 1/23).

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EDITOR:
Stephanie Stapleton

ASSOCIATE EDITOR:
Andrew Villegas

WRITERS:
Marissa Evans
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.